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IOTAIRx
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med1-instruct

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Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 32, 'gender': 'F', 'symptoms': 'Unsteadiness', 'medical_history': ['1. Prostate cancer - diagnosed ___ years ago, no treatment\nincluding radiation. Currently taking Saw ___.', '2. s/p appendectomy', '3. hx of L hip fracture from a fall - s/p replacement in ___ \nandwalks with cane since.', '4. ?hx of HTN - unclear when and why he stopped taking\nanti-hypertensive but currently not on any medication.'], 'family_history': 'Noncontributory', 'present_illness': 'Patient is a ___ yo RHM with hx of prostate cancer diagnosed\n___ years ago but not undergoing any therapy here after an episode\nof unsteadiness this morning.\n\nPatient reports that he awoke to urinate in the bottle (usual\nhabit) at 3:30 in the morning then went back to bed. He awoke\nabout 90 minutes later around 5 and when he stood up to go to \nthe\nbathroom but could not ambulate. He reports that he "couldn\'t\nmaneuver" - he denies any weakness, lightheadedness, vertigo or\nheadache. He says that because he just couldn\'t maneuver, he \nsat\nback down on the bed and he tried to get up again but once \nagain,\ncould not walk. He reports that he can\'t really describe it\nother than "not being able to maneuver." After 2~3x, he was\nfinally able to stay standing up but felt uncomfortable going to\nthe bathroom to freshen up including shaving hence he just used\nhis bottle again to urinate then walked to the living room to \nsit\ndown in his chair and wait for his daughter to come down. He\nreports that he was less steady when walking to the chair as if\nhe was tipsy but did not sway in any particular direction or\nfall.\n\nHe denies ever experiencing any similar symptoms. He denies any\ndysarthria, dysphagia, vertigo, tinnitus or falls. He walks \nwith\na cane at baseline since L hip fracture followed by replacement \n___\nyears ago. He takes care of his own ADLs and drives but reports\nthat he will stop driving as of today. \n\nHis daughter came down later and found him to seem slower with\nless speech than usual hence took him to ___ for\nevaluation. She did not see any facial asymmetry or weakness \nandspeech was not dysarthric but she was concerned that he seemed\nunsteady. At ___, he received ASA 325 mg and IVF. After head\nCT which shows no acute pathology, patient was transferred here\nfor further evaluation and work-up.\n\nFamily reports that he appears baseline right now. He does not\ntake any prescription meds at home and he does not take ASA\neither. He does take some vitamins and saw ___ for the\nprostate.\n\nROS negative including fever or sick contact. He does report\nthat he does not have AC in his house hence he has been sleeping\nwith the windows open. He also reports that he may not have \nbeen\ndrinking much water - he says he does not like water and he\ndrinks tea but may have been drinking less tea than usual.\n\nAlso, he had an episode of falling while in the grocery store 6\nmonths ago. He reports that he was feeling extremely tired and\nwhile at the cash register, he supposedly plopped over onto the\nconveyor. He was assisted to his car and because he felt well \nby\nthen and since his daughter lives nearby, he just drove home\nwithout an incident.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'ValACYclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.7', 'valuenum': 47.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.28', 'valuenum': 3.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.0', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '513', 'valuenum': 513.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 15.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58.6', 'valuenum': 58.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T 98.7 BP 63 HR 147/57 RR18 O2Sat\nGen: Lying on the ED stretcher, NAD\nHEENT: NC/AT, moist oral mucosa - wears dentures. \nNeck: No carotid or vertebral bruit\nCV: RRR, faint heart sounds - no M/R/G appreciated.\nLung: Clear \nAbd: +BS, soft, nontender \nExt: 1+ edema bilaterally upto malleoli, symm. dorsalis pedis\npalpable.\n\nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal \naffect. Oriented to person, place, and date. Mildly\ninattentive. Speech is fluent with normal comprehension and\nrepetition; dysnomia with low frequency words. No dysarthria. No\nright left confusion. ?Astereognosis - unable to tell the \nnumberswritten in either hands but able to tell apart quarter. \n \nCranial Nerves: \nII: Pupils equally round and reactive to light, 2 to 1.5 mm\nbilaterally. Visual fields are full to confrontation. \nIII, IV & VI: Extraocular movements intact bilaterally -~5 beat\nend-gaze nystagmus bilaterally with limited vertical gaze but\nlikely physiologic given his age. \nV: Sensation intact to LT and PP. \nVII: Facial movement symmetric. \nVIII: Hearing intact to finger rub bilaterally - mildly hard of\nhearing. \nX: Palate elevation symmetrical. \nXI: Sternocleidomastoid and trapezius normal bilaterally. \nXII: Tongue midline, movements intact\n \nMotor: \nNormal bulk and tone bilaterally. No observed myoclonus or\ntremor. No asterixis or pronator drift\n Del Tri Bi WE FE FF IP H Q DF PF \nR ___ ___ ___ 5 5 \nL ___ ___ ___ 5 5 \n \nSensation: Intact to light touch, pinprick, and cold but no JPS\nin big toes and mildly decreased vibratory sensation in both\ntoes.\n \nReflexes: \nTrace and symm reflexes but Achilles unable to be elicited. \nToes downgoing bilaterally \n \nCoordination: FTN and FTF normal but RAM slow and clumsy\nbilaterally. No truncal ataxia.\n \nGait: +Romberg - wide based and not steady with some\nretropulsion.', 'diagnoses': [{'icd_code': '0478', 'desc': 'Other specified viral meningitis'}, {'icd_code': '0521', 'desc': 'Varicella (hemorrhagic) pneumonitis'}, {'icd_code': '0527', 'desc': 'Chickenpox with other specified complications'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': "___ 06:12PM URINE COLOR-Yellow APPEAR-Cloudy SP ___\n___ 06:12PM URINE BLOOD-MOD NITRITE-NEG PROTEIN-100 \nGLUCOSE-NEG KETONE-40 BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 LEUK-LG\n___ 06:12PM URINE RBC-55* WBC->1000* BACTERIA-FEW \nYEAST-NONE EPI-0\n___ 06:12PM URINE WBCCLUMP-MANY MUCOUS-OCC\n___ 12:40PM GLUCOSE-100 UREA N-16 CREAT-1.0 SODIUM-137 \nPOTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-26 ANION GAP-12\n___ 12:40PM cTropnT-<0.01\n___ 12:40PM CK(CPK)-47\n___ 12:40PM WBC-9.6 RBC-4.48* HGB-13.7* HCT-41.4 MCV-92 \nMCH-30.5 MCHC-33.0 RDW-13.7\n___ 12:40PM NEUTS-85.8* LYMPHS-8.9* MONOS-4.7 EOS-0.3 \nBASOS-0.3\n___ 12:40PM PLT COUNT-191\n___ 12:40PM ___ PTT-27.1 ___\n\nNoncontrast CT head;\nThere is no intracranial hemorrhage, mass effect, shift of \nnormally \nmidline structures or edema. The gray-white matter \ndifferentiation is \nnormally preserved. The ventricles and cerebral sulci are \nprominent, \ncompatible with age-related involutional change. There are mild \nperiventricular hypodensities consistent with chronic \nmicrovascular ischemic \nchange. The cavernous portions of the internal carotid arteries \nand the \nvertebral arteries demonstrate vascular calcifications. The \nvisualized \nparanasal sinuses and mastoid air cells are well aerated. \n\nMRI/MRA head/neck;\n1. No acute intracranial abnormality; specifically, there is no \nabnormality \nof diffusion to specifically suggest an acute ischemic event. \nFurthermore, \nthere is no evidence of previous territorial or lacunar \ninfarction. \n2. Moderate global atrophy, concordant with the patient's age. \n3. Overall, unremarkable cranial and cervical MRA, notable only \nfor a \nrelatively hypoplastic A1 segment of the right ACA, which \ndemonstrates \nsignificant mural irregularity and possible flow-limiting \nstenosis in its most \ndistal portion, at its junction with the A2 segment/ACOM \ncomplex. No other \nstenosis is seen.\nMr. ___ is a ___ RHM with untreated prostate cancer diagnosed \n___ years ago and ?hx of HTN here after an episode of unsteadiness \nwhen he stood up to go to the bathroom this morning. He reports \nfeeling discombubulated and feeling as if he was\nunable to maneuver his legs but denies weakness, numbness, \nvertigo, lightheadedness or headache. This may have lasted <10 \nminutes then he was able to ambulate to another room although he \nreports that he was not as steady as usual. He was initially \ntaken to ___ where he received IVF and ASA plus head \nCT then transferred here. He was mildly hypertensive but \notherwise stable vitals. On exam, patient is mildly inattentive \nwith possible ideomotor dyspraxia but no\nneglect. Patient has fatigable end-gaze nystagmus but no \nvertical nystagmus. There is no dysmetria but his RAM is slow \nand mildly clumsy bilaterally. He has full strength but poor \nJPS hence positive Romberg and has wide based gait that is \nreportedly baseline. Patient's exam is reassuring but given \nthe hx of what sounds to be incoordination/dyspraxia or \nconfusion and acuity, he was admitted for possible vascular \nevent of posterior circulation and was started on aspirin 81 mg \ndaily. The patient underwent MRI/A head and neck which did not \nshow any evidence of acute stroke. His LDL was 68 and HbA1c was \n5.7. He was found to have a urinary tract infection with > 1000 \nWBC in his UA and UCx revealed e. coli and enterococcus. He was \nstarted on bactrim for his UTI and will complete as an \noutpatient. The morning after admission he and his family were \nvery eager to be discharged home after learning that he did not \nsuffer an acute stroke. The medical team was still somewhat \nconcerned in regards to his safety at home due to his persistent \nmildly unsteady gait. He was seen by physical therapy and it \nwas decided that he could be discharged home with a home safety \nevaluation as well as 24-hour supervision by his family for the \nnext several days until he is at his baseline strength and \nstability. He will follow up with his PCP as well as Dr. ___."}}
{'final_diagnoses': ['Unsteadiness of gait in the setting of a urinary tract infection'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ RHM with untreated prostate cancer diagnosed \n___ years ago and ?hx of HTN here after an episode of unsteadiness \nwhen he stood up to go to the bathroom this morning. He reports \nfeeling discombubulated and feeling as if he was\nunable to maneuver his legs but denies weakness, numbness, \nvertigo, lightheadedness or headache. This may have lasted <10 \nminutes then he was able to ambulate to another room although he \nreports that he was not as steady as usual. He was initially \ntaken to ___ where he received IVF and ASA plus head \nCT then transferred here. He was mildly hypertensive but \notherwise stable vitals. On exam, patient is mildly inattentive \nwith possible ideomotor dyspraxia but no\nneglect. Patient has fatigable end-gaze nystagmus but no \nvertical nystagmus. There is no dysmetria but his RAM is slow \nand mildly clumsy bilaterally. He has full strength but poor \nJPS hence positive Romberg and has wide based gait that is \nreportedly baseline. Patient's exam is reassuring but given \nthe hx of what sounds to be incoordination/dyspraxia or \nconfusion and acuity, he was admitted for possible vascular \nevent of posterior circulation and was started on aspirin 81 mg \ndaily. The patient underwent MRI/A head and neck which did not \nshow any evidence of acute stroke. His LDL was 68 and HbA1c was \n5.7. He was found to have a urinary tract infection with > 1000 \nWBC in his UA and UCx revealed e. coli and enterococcus. He was \nstarted on bactrim for his UTI and will complete as an \noutpatient. The morning after admission he and his family were \nvery eager to be discharged home after learning that he did not \nsuffer an acute stroke. The medical team was still somewhat \nconcerned in regards to his safety at home due to his persistent \nmildly unsteady gait. He was seen by physical therapy and it \nwas decided that he could be discharged home with a home safety \nevaluation as well as 24-hour supervision by his family for the \nnext several days until he is at his baseline strength and \nstability. He will follow up with his PCP as well as Dr. ___.", 'medications_prescribed': ['Aspirin 81 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', 'Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) \nTablet PO BID (2 times a day) for 3 days.\nDisp:*6 Tablet(s)* Refills:*0*', 'Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Ascorbic Acid ___ mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'Rigors', 'medical_history': ['Stage IIB NSCLC diagnosed ___', ' - s/p LUL lobectomy c/b PA tear, which was repaired', ' - found to have LN involvement, tx with concurrent\nchemoradiation (cisplatin/etoposide) ___', ' - now with recurrence in mediastinum, imaging suggesting \nbone/liver mets, started on gemcitabine', '?Esophageal CA (pt unsure if separate primary vs related to \n___)', 'Anxiety and panic attacks', 'Paroxysmal Atrial fibrillation, not on coumadin', 'Hyperlipidemia ', 's/p cataract surgery', 'h/o Skin cancer removed from nose, pt thinks it was basal cell', 'Osteoporosis', 'Mitral valve prolapse', 'Hearing loss, R ear'], 'family_history': 'Father was a ___ and had silicosis and Lung CA\nSister with ___ Cancer\nOther Aunts with breast cancer and lung cancer', 'present_illness': 'This is a ___ yo female with a history of metastatic lung CA who \npresents from clinic with rigors. Over the past few days, she \nhas been feeling unwell with mild HA, cough, temp up to ~99.8. \nShe had a negative CXR performed yesterday. She was started on \nlevofloxacin 500 mg daily for a 7 day course. She also notes \nusing ibuprofen and ASA in the last several days.\n\nShe was seen in clinic yesterday for gemcitabine infusion, but \nthis was held for pancytopenia (WBC 0.7, hct 25.8, plt 30). She \nwas given filgrastim for ANC 300, plus 1 liter IV fluid. She \nreturned today for 2 units pRBCs. ANC was up to 1500, although \ngiven another dose of filgrastim due to T 100.0 at home. She was \ngiven 2 units pRBCs and 1 bag of platelets, but after the \nplatelet transfusion developed rigors. No fevers, sweats, \ndyspnea, rash, pruritus. VS at that time: T 98.2, HR 85, O2 \n100%. She received acetaminophen 650mg. Given concern for \ntransfusion reaction vs infection, she was directly admitted for \nfurther evaluation. Blood and urine cultures were sent in \nclinic.\n\nShe currently feels well with no complaints. Also denies blurry \nvision, CP, n/v/d, abd pain, bloody stools, dysuria, frequency, \nurgency, hematuria, sore throat, odynophagia.', 'medications': [{'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lithium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (EXTended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '5X/DAY', 'doses_per_24_hrs': 5.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'rOPINIRole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '34', 'valuenum': 34.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.3', 'valuenum': 53.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '45', 'valuenum': 45.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TR*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LG*.'}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'pH >= 8.5 may cause falsely elevated urine protein.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hazy*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam: \nVitals: T: 97.1 BP: 110/60 P: 77 R: 18 O2: 97RA\nGeneral: Well appearing female in NAD\nHEENT: MMM, OP clear, no scleral icterus\nNeck: No cervical LAD, supple\nLungs: CTAB\nCV: RRR, ___ systolic murmur at LUSB\nAbdomen: +BS. S/NT/ND.\nExt: WWP without edema\nSkin: No rash appreciated', 'diagnoses': [{'icd_code': 'S82842A', 'desc': 'Displaced bimalleolar fracture of left lower leg, initial encounter for closed fracture'}, {'icd_code': 'W050XXA', 'desc': 'Fall from non-moving wheelchair, initial encounter'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'F319', 'desc': 'Bipolar disorder, unspecified'}], 'summary': 'ADMISSION LABS:\n.\n___ 11:50AM BLOOD WBC-0.7*# RBC-2.66* Hgb-9.1* Hct-25.8* \nMCV-97 MCH-34.1* MCHC-35.2* RDW-11.6 Plt Ct-30*#\n___ 10:40AM BLOOD WBC-2.0*# RBC-2.70* Hgb-9.3* Hct-25.5* \nMCV-95 MCH-34.5* MCHC-36.4* RDW-11.5 Plt Ct-23*\n___ 10:40AM BLOOD Neuts-71.9* ___ Monos-1.7* \nEos-0.6 Baso-1.1\n___ 11:50AM BLOOD ___ ___\n___ 10:40AM BLOOD ___ ___\n.\nDISCHARGE LABS:\n.\nCXR PA/lat ___: No acute cardiopulmonary abnormality.\n___ 06:10AM BLOOD WBC-0.9* RBC-3.27* Hgb-10.6* Hct-29.6* \nMCV-91 MCH-32.4* MCHC-35.8* RDW-14.0 Plt Ct-16*\n___ 06:10AM BLOOD ___ ___\n___ 06:10AM BLOOD Glucose-93 UreaN-13 Creat-0.8 Na-140 \nK-4.0 Cl-106 HCO3-25 AnGap-13\n.\nCXR ___: No acute process\n.\nCXR ___: Stable postoperative and post-radiation therapy \nchanges in the left hemithorax. No findings to suggest acute \npneumonia. \nThis is a ___ yo female with a history of breast CA who presents \nfrom clinic with rigors.\n\n# Rigors: Given recent low grade temperatures and neutropenia, \ninfection was concerning. However, her symptoms were temporally \nassociated with platelet and RBC transfusion, so this seemed \nmore likely. She remained afebrile throughout her admission and \nwell appearing. She did note a cough which she had developed \nearlier in the week prior to admisison, but 2 chest x-rays were \nobtained throughout admission and were both without concern for \npneumonia. She was started emperically on cefepime for her \nfever, but this was stopped on the day of discharge, and she was \nswitched back to her prior levoquin course started as an \noutpatient. \n.\n# Pancytopenia: Most likely related to gemcitabine. Given 2 \nunits RBC and 1 bag plts on admission. Her Hct was improve to \n29.6 on discharge. Her platelets were still low at 16, but she \ndid not have any signs of bleeding or petichiae. She was \nadvised to stop her aspirin and ibupfrofen at home until further \ninstructed by her oncologist. Her ANC also dropped to 376 at \ndischarge, but given that she was afebrile and clinically well, \nwe felt she could be discharged on her prior levoquin course. \nShe was instructed to take her temperature daily at home and \ncome to the ER or call her oncologist if she develops fevers. \nShe has follow up for ___ with her oncologist\n.\n# Lung CA: On discharge, pt was C1D19 of Gemcitabine. Further \ntreatment will be planned per her primary oncologist\n.\n# Paroxysmal afib: We continued her home atenolol, and held her \naspirin as above.\n.\n# Hyperlipidemia: Continued statin\n.\n# Code: confirmed full\n.\n# Follow-up/Transitional:\n-Pt with oncology follow up on ___. CBC and ANC should be \nchecked at this point.\n-Aspirin and ibuprofen should be held given her thrombocytopenia'}}
{'final_diagnoses': ['Primary:', '-Fevers', '-Thrombocytopenia', '-Anemia', 'Secondary:', '-Non-small cell lung cancer'], 'procedures': ['None'], 'visit_summary': 'This is a ___ yo female with a history of breast CA who presents \nfrom clinic with rigors.\n\n# Rigors: Given recent low grade temperatures and neutropenia, \ninfection was concerning. However, her symptoms were temporally \nassociated with platelet and RBC transfusion, so this seemed \nmore likely. She remained afebrile throughout her admission and \nwell appearing. She did note a cough which she had developed \nearlier in the week prior to admisison, but 2 chest x-rays were \nobtained throughout admission and were both without concern for \npneumonia. She was started emperically on cefepime for her \nfever, but this was stopped on the day of discharge, and she was \nswitched back to her prior levoquin course started as an \noutpatient. \n.\n# Pancytopenia: Most likely related to gemcitabine. Given 2 \nunits RBC and 1 bag plts on admission. Her Hct was improve to \n29.6 on discharge. Her platelets were still low at 16, but she \ndid not have any signs of bleeding or petichiae. She was \nadvised to stop her aspirin and ibupfrofen at home until further \ninstructed by her oncologist. Her ANC also dropped to 376 at \ndischarge, but given that she was afebrile and clinically well, \nwe felt she could be discharged on her prior levoquin course. \nShe was instructed to take her temperature daily at home and \ncome to the ER or call her oncologist if she develops fevers. \nShe has follow up for ___ with her oncologist\n.\n# Lung CA: On discharge, pt was C1D19 of Gemcitabine. Further \ntreatment will be planned per her primary oncologist\n.\n# Paroxysmal afib: We continued her home atenolol, and held her \naspirin as above.\n.\n# Hyperlipidemia: Continued statin\n.\n# Code: confirmed full\n.\n# Follow-up/Transitional:\n-Pt with oncology follow up on ___. CBC and ANC should be \nchecked at this point.\n-Aspirin and ibuprofen should be held given her thrombocytopenia', 'medications_prescribed': ['1. atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '2. chlordiazepoxide HCl 25 mg Capsule Sig: One (1) Capsule PO \ntwice a day as needed for anxiety. ', '3. diazepam 2 mg Tablet Sig: One (1) Tablet PO every four (4) \nhours as needed for panic . ', '4. levofloxacin 500 mg Tablet Sig: One (1) Tablet PO once a day: \ncontinue until further directed by your oncologist. ', '5. prochlorperazine maleate 5 mg Tablet Sig: One (1) Tablet PO \nevery six (6) hours as needed for nausea. ', '6. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '7. multivitamin-minerals-lutein Tablet Sig: One (1) Tablet \nPO once a day. ', '8. guaifenesin 50 mg/5 mL Liquid Sig: Ten (10) mL PO every ___ \nhours as needed for cough.\nDisp:*qs mL* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 84, 'gender': 'F', 'symptoms': 'dyspnea', 'medical_history': ['- Hypertension', '- Asthma', '- Migraines vs tension headache', '- Psoriasis', '- Psoriatic arthritis on methotrexate, occasional remicade \ntreatments (last ___', '- Sleep apnea', '- ___ to sulfa', '- hx +PPD with TB treated ___ with ___ year of INH', '- hx of blood transfusion in ___ with her placenta previa'], 'family_history': 'Father with colon cancer at ___, still alive. Mom with MI @ ___. \nSister with congenital heart disease.', 'present_illness': "___ year old female hx HTN, asthma, OSA presenting with c/o \ncough/dyspnea. \nPatient reports 5d ago onset of dry cough and feeling of chest \n'tightness'/congestion. This progressed to include headache, \nsore throat, sinus congestion as well as dyspnea. Describes \ncough as dry, non productive, worse at night, keeping her up at \nnight. Denies fevers or chills, no sick contacts or recent \ntravel. No headaches, muscle aches or joint aches, no \nn/v/diarrhea. She has not used her albuterol inhaler for 'years' \nand did not try it at home. \nShe presented to ___ office today with these complaints. \nAmbulatory 02 sat was 96% with HR 114, was noted to be diffusely \nwheezy on exam. She was referred to the ED for nebs/obs. \nIn the ED initial vitals were: 98.4 102 150/86 22 98%. Labs were \nnotable for WBC 11.1, chem-7 unremarkable, normal lactate, u/a \nnegative. CXR showed no acute process. Patient was given duonebs \nhowever ambulatory 02 sat was 90% and patient was \nsymptomatically dizzy so was admitted for further observation, \npeak flow noted to be 220. Patent was given duonebs, prednisone \n60mg, toradol x1, as well as levofloxacin for suspicion of \npneumonia. \n\nOn the floor patient still c/o chest tightness/congestion and \nmild dyspnea, endorses reduced PO intake. Otherwise no \ncomplaints. \n\nReview of Systems: \n(+) as above \n(-) fever, chills, night sweats, headache, vision changes, chest \npain, abdominal pain, nausea, vomiting, diarrhea, constipation, \nBRBPR, melena, hematochezia, dysuria, hematuria.", 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'PrimiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '381', 'valuenum': 381.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.7', 'valuenum': 49.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 75.5, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '368', 'valuenum': 368.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.8', 'valuenum': 50.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '379', 'valuenum': 379.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.9', 'valuenum': 51.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.5', 'valuenum': 21.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.7, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.32', 'valuenum': 1.32, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70.2', 'valuenum': 70.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '311', 'valuenum': 311.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.15', 'valuenum': 0.15, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.56', 'valuenum': 0.56, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.16', 'valuenum': 5.16, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.5', 'valuenum': 53.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\nVitals- 97.8 175/94 hr 109 22 98% RA \nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- diffuse expiratory wheezing posteriorly with intermittent \nrhonchi, no crackles appreciated \nCV- tachycardic, ___ systolic murmur LUSB \nAbdomen- soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro- CNs2-12 intact, motor function grossly normal \n\nDISCHARGE EXAM\nVitals- 98.7 125/71 hr 85 20 98% RA\nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- intermittent rhonchi posteriorly, no wheezing or crackles \n\nCV- tachycardic, ___ systolic murmur LUSB \nAbdomen- soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro- CNs2-12 intact, motor function grossly normal', 'diagnoses': [{'icd_code': 'T814XXD', 'desc': 'Infection following a procedure, subsequent encounter'}, {'icd_code': 'L03116', 'desc': 'Cellulitis of left lower limb'}, {'icd_code': 'I5032', 'desc': 'Chronic diastolic (congestive) heart failure'}, {'icd_code': 'E8770', 'desc': 'Fluid overload, unspecified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'T8131XD', 'desc': 'Disruption of external operation (surgical) wound, not elsewhere classified, subsequent encounter'}, {'icd_code': 'Y838', 'desc': 'Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}], 'summary': '___ 05:14PM URINE HOURS-RANDOM\n___:14PM URINE UHOLD-HOLD\n___ 05:14PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 05:14PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n___ 05:14PM URINE RBC-1 WBC-1 BACTERIA-FEW YEAST-NONE \nEPI-2\n___ 03:25PM LACTATE-1.9\n___ 03:05PM GLUCOSE-90 UREA N-11 CREAT-0.5 SODIUM-138 \nPOTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-25 ANION GAP-14\n___ 03:05PM WBC-11.1*# RBC-4.35 HGB-13.4 HCT-41.1 MCV-94 \nMCH-30.8 MCHC-32.6 RDW-13.2\n___ 03:05PM NEUTS-71.0* ___ MONOS-5.6 EOS-1.1 \nBASOS-0.7\n___ 03:05PM PLT COUNT-328\n\nDISCHARGE LABS\n\n___ 07:10AM BLOOD WBC-8.8 RBC-4.03* Hgb-12.4 Hct-37.7 \nMCV-94 MCH-30.7 MCHC-32.8 RDW-12.9 Plt ___\n___ 07:10AM BLOOD Glucose-139* UreaN-10 Creat-0.4 Na-138 \nK-3.6 Cl-105 HCO3-21* AnGap-16\n___ 07:10AM BLOOD Mg-2.1\n\nMICRO\n___ URINE URINE CULTURE-PENDING EMERGENCY WARD \n___ BLOOD CULTURE Blood Culture, Routine-PENDING \n___ BLOOD CULTURE Blood Culture, Routine-PENDING \n\n\nREPORTS\n\n___ Imaging CHEST (PA & LAT) \nIMPRESSION: \n \nNo acute cardiopulmonary process.\n___ year old female hx HTN, asthma, OSA presenting with c/o \ncough/dyspnea concerning for asthma exacerbation. \n\n# Asthma exacerbation: patient p/w with congestion, dyspnea and \nwheezing on exam concerning for asthma flare, likely triggered \nby viral URI. Peak flow was <250 in ED, failed stacked nebs. \nPatient was treated with standing duonebs, predniosone 60mg then \n40mg daily. Her breathing was much improved by hospital day 1 \nand she felt ready to go home. Peak flow on discharge was 300. \nShe was encouraged to remain compliant with her asthma inhalers \nand to follow up with her pulmonologist as she has not seen this \ndoctor in quite some time. She was discharged on a 6d \nprednisone taper. Advised her to monitor her peak flows at home \nand notify her providers if worsening.\n\nCHRONIC ISSUES\n# HTN: continued losartan \n# Hx migraines: continued verapamil, amitriptyline \n# Psoriatic arthritis: follows with rheum, on weekly MTX and \nsometimes remicade around flares. continued indomethacin, held \nMTX \n# Insomnia: continued trazadone:PRN \n\nTRANSITIONAL ISSUES\n- patient should have follow up with pulmonology to continue to \naddress asthma management\n- will complete 6d steroid taper\n- remained full code'}}
{'final_diagnoses': ['asthma exacerbation'], 'procedures': ['None'], 'visit_summary': '___ year old female hx HTN, asthma, OSA presenting with c/o \ncough/dyspnea concerning for asthma exacerbation. \n\n# Asthma exacerbation: patient p/w with congestion, dyspnea and \nwheezing on exam concerning for asthma flare, likely triggered \nby viral URI. Peak flow was <250 in ED, failed stacked nebs. \nPatient was treated with standing duonebs, predniosone 60mg then \n40mg daily. Her breathing was much improved by hospital day 1 \nand she felt ready to go home. Peak flow on discharge was 300. \nShe was encouraged to remain compliant with her asthma inhalers \nand to follow up with her pulmonologist as she has not seen this \ndoctor in quite some time. She was discharged on a 6d \nprednisone taper. Advised her to monitor her peak flows at home \nand notify her providers if worsening.\n\nCHRONIC ISSUES\n# HTN: continued losartan \n# Hx migraines: continued verapamil, amitriptyline \n# Psoriatic arthritis: follows with rheum, on weekly MTX and \nsometimes remicade around flares. continued indomethacin, held \nMTX \n# Insomnia: continued trazadone:PRN \n\nTRANSITIONAL ISSUES\n- patient should have follow up with pulmonology to continue to \naddress asthma management\n- will complete 6d steroid taper\n- remained full code', 'medications_prescribed': ['1. Amitriptyline 50 mg PO HS', '2. Duloxetine 60 mg PO BID', '3. FoLIC Acid 1 mg PO DAILY', '4. Indomethacin 50 mg PO BID', '5. Losartan Potassium 50 mg PO DAILY', '6. TraZODone 100 mg PO HS:PRN sleep', '7. Verapamil SR 240 mg PO Q24H', '8. Albuterol Inhaler 2 PUFF IH Q6H:PRN SOB \nRX *albuterol 2 puffs INH Q4H:PRN Disp #*1 Inhaler Refills:*0', '9. Methotrexate 22.5 mg PO 1X/WEEK (___)', '10. PredniSONE 40 mg PO DAILY Duration: 2 Days \nStart: Today - ___, First Dose: Next Routine Administration \nTime \nRX *prednisone 20 mg 2 tablet(s) by mouth daily Disp #*4 Tablet \nRefills:*0', '11. PredniSONE 20 mg PO DAILY Duration: 2 Days \nStart: After 40 mg tapered dose \nRX *prednisone 20 mg 1 tablet(s) by mouth daily Disp #*2 Tablet \nRefills:*0', '12. PredniSONE 10 mg PO DAILY Duration: 2 Days \nStart: After 20 mg tapered dose \nRX *prednisone 10 mg 1 tablet(s) by mouth daily Disp #*2 Tablet \nRefills:*0', '13. Guaifenesin ___ mL PO Q6H:PRN cough \nRX *guaifenesin 100 mg/5 mL 10 mL by mouth Q6H:PRN Disp #*1 \nBottle Refills:*0', '14. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 89, 'gender': 'F', 'symptoms': 'headache, peripheral vision loss, enlargement of left blind spot', 'medical_history': ["___'s thyroiditis/hypothyroidism", 'Breast cancer DX in ___ with recurrence 6 months later, s/p\ndouble mastectomy, radiation and chemotherapy', 'Type II DM with Diabetic proliferative OD and non proliferative\nretinopathy OS and neuropathy', 'HTN', 'HLD ', 'cervical spinal stenosis s/p C5-C7 fusion in ___', 'Neck botox injections q3 months', 'carpal tunnel syndrome'], 'family_history': 'Daughter: migraines\nSister: migraines\nHeart disease, HTN, DM run in the family\nPaternal grandmother and aunt had a stroke in their ___\nNo history of blood clots', 'present_illness': 'Ms. ___ is a ___ year-old right-handed woman with breast\ncancer in ___ s/p b/l masectomy/chemo/XRT, insulin dependent\ndiabetes c/b retinopathy who was recently evaluated for b/l\npapilledema with negative initial work up who is now referred\nfrom neuro urgent care for admission given new peripheral vision\nloss. \n\nOn ___, patient was referred from ___ when she was found to\nhave bilateral papilledema on exam. At that time, she reported\nseeing brown spots and thin lines in the periphery of her right\neye 1 weeks prior. Simultaneously, she had a ___ headache in\nthe bitemporal and retro-orbital region associated with nausea. \nThe quality of the headache was throbbing. The headache at that\ntime was exacerbated with standing. She was seen in ___ and\n___ to have hemorrhagic proliferative retinopathy in the right\neye and had laser. On ___, she had vision changes in the left\neye and was found to have b/l papilledema in ___. Of\nnote, she had a headache for 5 days at that point. So, she was\nreferred to the ED for evaluation of given concern for elevated\nICP. Her neuroloogical exam was normal except for papilledema. \nA NCHCT was performed and unremarkable. A lumbar puncture was\nobtained with opening pressure of 23. Patient was discharged\nhome. After the lumbar puncture, the headache improved for\nseveral days.\n\n4 to 5 days after discharge from the ED, the headache returned\nand was severe for ~10 days (___. It was retro-orbital,\nbitemporal, bioccipital and throbbing. Pt was having nausea as\nwell as some vomiting. One week after ED presentation, she had a\nlaser on the left eye in ___ 1 week after that. The optic\nnerves were still edematous per pt. She was not sure if her\nheadache was related to the eye surgery. The headache was so\nsevere that pt could not function. When going from lying to\nstanding, her vision darkened/became dim and she saw sparkles in\nboth eyes. There was more shadow on the right periphery. So,\nshe scheduled another ophtho appt which was yesterday. When she\ncovered her right eye, the vision in the ___ her left eye\nwas gone, like a donut. If she covered the left eye, it seemed\nas though the vision in her right eye was moving. Since\nyesterday, she has noted decreased R peripheral vision. The\nheadache persists and is a ___ in severity. She has mild \nnausea,\nlast vomited 1 week ago. Headache is more severe upon waking up\nin the morning. Once she gets up and moves around, it improves \na\nbit. If she strains to go to the bathroom, has more pulsating\nnature to the headache. The headache has woken her up in the\nmiddle of the night. She has numbness on the right face below \nthe\neye and at the temple. Per husband, she has made some \nparaphasic\nerrors which she usually notices and corrects. She has also \nnoted\na right sided peripheral visual field loss. Patient was seen in\n___ clinic on ___ and at that time visual fields were\nunchanged from prior.\n\nMs. ___ also notes that when walking, she is drifting a\nlittle bit to the right with severe HAs, but this has not\nhappened lately. Patient volunteers in the NICU holding babies.\nOn ___, one of the nurses noted she was drifting to the right\nwhen walking down the hallway. \n\nShe denies any history of blood clots or miscarriages.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '5X/WEEK', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '2X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 68 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '239', 'valuenum': 239.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.97', 'valuenum': 2.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.63', 'valuenum': 2.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T 98.2 HR 84 BP 140/62 RR 18 O2 98% 0 \nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT\nNeck: Supple. No nuchal rigidity\nPulmonary: CTABL\nCardiac: RRR, no murmurs\nAbdomen: soft, nontender, nondistended\nExtremities: no edema, pulses palpated; stocking on RUE ___ hx \nof\nlymphedema\nSkin: no rashes or lesions noted.\n\nNeurologic:\n-Mental Status: Alert, oriented to self, place, date. Able to\nrelate history without difficulty. Attentive, able to name ___\nbackward without difficulty. Language is fluent with intact\nrepetition and comprehension. Normal prosody. There were no\nparaphasic errors. Pt. was able to name both high and low\nfrequency objects. Able to read without difficulty. Speech was\nnot dysarthric. Able to follow both midline and appendicular\ncommands. There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. Mild L esotropia. Horizontal\ndiplopia elicited on R and L lateral gaze. R superior\nquadrantanopsia. Enlarged blind spot on L>>R. Funduscopic exam\nrevealed no papilledema on the right, unable to visualize disc \non\nleft.\nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch except small patch on\nleft V3 distribution.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally.\nNo adventitious movements, such as tremor, noted. \n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 5 5 5\nR 5 ___ ___ 5 5 5 5 5 5 5\n-Sensory: No deficits to light touch. Decreased pinprickin\ndistal lower extremities to mid shin b/l. Mildly decreased\nproprioception to small position change at halluxes. No\nextinction to DSS.\n-DTRs:\n Bi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 2 2 2 2 1\nPlantar response was flexor bilaterally.\n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF or HKS bilaterally, though subjectively some\ndifficulty with HKS on left. Mild dysmetria on finger tapping \nand\nfoot tapping on the left.\n-Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Able to walk in tandem but with difficulty. Romberg with\nmild sway.', 'diagnoses': [{'icd_code': '71596', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, lower leg'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '99678', 'desc': 'Other complications due to other internal orthopedic device, implant, and graft'}, {'icd_code': '7295', 'desc': 'Pain in limb'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '2410', 'desc': 'Nontoxic uninodular goiter'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}], 'summary': '___ 05:00PM URINE HOURS-RANDOM\n___ 05:00PM URINE HOURS-RANDOM\n___ 05:00PM URINE GR HOLD-HOLD\n___ 05:00PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 05:00PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 05:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-300 KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-TR\n___ 05:00PM URINE RBC-0 WBC-11* BACTERIA-FEW YEAST-NONE \nEPI-1 TRANS EPI-<1\n___ 05:00PM URINE MUCOUS-RARE\n___ 02:30PM GLUCOSE-242* UREA N-12 CREAT-0.8 SODIUM-137 \nPOTASSIUM-4.8 CHLORIDE-100 TOTAL CO2-24 ANION GAP-18\n___ 02:30PM estGFR-Using this\n___ 02:30PM CALCIUM-9.1 PHOSPHATE-3.7 MAGNESIUM-1.9\n___ 02:30PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 02:30PM WBC-7.0 RBC-4.34 HGB-13.3 HCT-37.7 MCV-87 \nMCH-30.5 MCHC-35.2* RDW-13.4\n___ 02:30PM NEUTS-60.1 ___ MONOS-7.2 EOS-2.5 \nBASOS-0.6\n___ 02:30PM PLT COUNT-182\nMs ___ was admitted due to a headache associated with \npapilledema. She was admitted to the neurology service primarily \nfor concern for pseudotumor. MRI and MRV did not show blood \nclots. A small 7mm signal abnormality in the C1 lateral \nvertebral body was seen on MRI and was evaluated with CT with \ncontrast which showed that it was clearly consistent with a \nmetastatic lesion and did not show contrast enhancement. A large \nvolume spinal tap was performed during this admission with a \nnormal opening pressure of 15 (inconsistent with pseudotumor). \nMRI orbits did not show edema or enhancement of the optic \nnerves. Ultimately, Ms. ___ vision loss was felt to be \nmost consistent with rapid progression of her diabetic \nproliferative retinopathy. Ophthalmology evaluation during her \nadmission suggested evaluation for possible infectious \n(syphillis, cat scratch, lyme, tb) and inflammatory etiologies \n(neurosarcoid, vasculitis). ESR/CRP was normal, ___ - , ANCA - , \nlysozyme pending, ACE pending, bartonella pending, lyme pending. \nRPR, FTA-abs, and quantiferon gold were not drawn during the \nadmission but will be done as an outpatient. Phone messages were \nleft regarding this outpatient labs for Ms. ___ and also \nfor her husband. \n\nHer right sided throbbing headaches with right face and neck \ndecreased sensation were likely due to a migraine that may be \nprecipitated by your vision difficulty. Taking daily \nopiate/narcotic medications daily (she was taking 2 percocets \ndaily) may have also been leading to rebound headaches. To help \nabort her migraine, we gave her a prescription for Compazine 10 \nmg to be taken at bedtime for two nights in a row. She was told \nto premedicate with 25 mg of Benadryl approximately 30 minutes \nbefore Compazine given her history of akathisia with Compazine. \nAs both Compazine and Benadryl cause drowsiness, she was advised \nto take fall precautions. She was also advised to take fall \nprecautions given her vision loss.'}}
{'final_diagnoses': ['macular degeneration, bilateral ', 'pseudopapilledema', 'insulin dependent diabetes'], 'procedures': ['lumbar puncture'], 'visit_summary': 'Ms ___ was admitted due to a headache associated with \npapilledema. She was admitted to the neurology service primarily \nfor concern for pseudotumor. MRI and MRV did not show blood \nclots. A small 7mm signal abnormality in the C1 lateral \nvertebral body was seen on MRI and was evaluated with CT with \ncontrast which showed that it was clearly consistent with a \nmetastatic lesion and did not show contrast enhancement. A large \nvolume spinal tap was performed during this admission with a \nnormal opening pressure of 15 (inconsistent with pseudotumor). \nMRI orbits did not show edema or enhancement of the optic \nnerves. Ultimately, Ms. ___ vision loss was felt to be \nmost consistent with rapid progression of her diabetic \nproliferative retinopathy. Ophthalmology evaluation during her \nadmission suggested evaluation for possible infectious \n(syphillis, cat scratch, lyme, tb) and inflammatory etiologies \n(neurosarcoid, vasculitis). ESR/CRP was normal, ___ - , ANCA - , \nlysozyme pending, ACE pending, bartonella pending, lyme pending. \nRPR, FTA-abs, and quantiferon gold were not drawn during the \nadmission but will be done as an outpatient. Phone messages were \nleft regarding this outpatient labs for Ms. ___ and also \nfor her husband. \n\nHer right sided throbbing headaches with right face and neck \ndecreased sensation were likely due to a migraine that may be \nprecipitated by your vision difficulty. Taking daily \nopiate/narcotic medications daily (she was taking 2 percocets \ndaily) may have also been leading to rebound headaches. To help \nabort her migraine, we gave her a prescription for Compazine 10 \nmg to be taken at bedtime for two nights in a row. She was told \nto premedicate with 25 mg of Benadryl approximately 30 minutes \nbefore Compazine given her history of akathisia with Compazine. \nAs both Compazine and Benadryl cause drowsiness, she was advised \nto take fall precautions. She was also advised to take fall \nprecautions given her vision loss.', 'medications_prescribed': ['Atenolol 25 mg PO DAILY ', 'Baclofen 10 mg PO QHS ', 'Byetta (exenatide) 10 mcg/dose(250 mcg/mL) 2.4 mL \nsubcutaneous qAM and pre-dinner ', 'Duloxetine 20 mg PO BID ', 'Xalatan (latanoprost) 0.005 % ophthalmic QHS ', 'Levothyroxine Sodium 75 mcg PO DAILY ', 'Lisinopril 5 mg PO DAILY ', 'meloxicam 7.5 mg ORAL DAILY ', 'Oxycodone-Acetaminophen (5mg-325mg) 0.25 TAB PO TID ', 'Pantoprazole 40 mg PO Q24H ', 'Rosuvastatin Calcium 20 mg PO DAILY ', 'Tizanidine 1 mg PO BID ', 'Zolpidem Tartrate 10 mg PO HS ', 'GenTeal Mild to Moderate (artificial tears(hypromellose)) \n0.3 % ophthalmic qAM ', 'GenTeal Gel (carboxymethylcell-hypromellose) 0.25-0.3 % \nophthalmic at bedtime ', 'Timolol Maleate 0.5% 1 DROP BOTH EYES DAILY ', 'NPH 65 Units Breakfast', 'NPH 65 Units Bedtime', 'Regular 20 Units Breakfast', 'Regular 16 Units Bedtime', 'Insulin SC Sliding Scale using HUM Insulin', 'Prochlorperazine 10 mg PO HS Duration: 2 Doses \nplease take 25 mg of Benadryl 30 minutes prior to taking \nCompazine. \nRX *prochlorperazine maleate [Compazine] 10 mg 1 tablet(s) by \nmouth at bedtime Disp #*2 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Fatigue, Shortness of Breath', 'medical_history': ['- Systolic/diastolic HF', '- Atrial fibrillation', '- Hypertension', '- Insulin-dependent DM type II', '- CKI', '- Hypothyroidism', '- Basal cell carcinoma', '- Peripheral neuropathy', '- Chronic venous stasis dermatitis', '- Hyperlipidemia', '- PUD-associated GI bleed', '- Psoriatic arthritis', '- BPH', '- S/p anterior/posterior L5/S1 fusion', '- Biliary sepsis', '- Cholecystitis s/p cholecystectomy', '- Right proximal humerus fracture in ___'], 'family_history': 'Father died of MI at age ___. Sister died of MS.', 'present_illness': '___ with h/o IDDM, HTN, COPD, systolic and diastolic heart \nfailure (EF 50%), CKD, afib on warfarin who initially presented \n___ with 3 weeks of SOB, dry cough, and 10 lb weight loss and \ngeneral pruritis over the same period with findings of \nleukocytosis with lymphocytosis on labs. Bone marrow biopsy was \nconsistent with splenic marginal zone lymphoma v. hairy cell \nvariant. Patient now back at ___ after being in MICU for \nattempted VATS on ___. \n\nOn ___, decompensated during VATS, had poor ventilation, \netiology likely due to rituxan-induced lung injury. There is low \nsuspicion of fungal infection.\n\nOf note, patient was administered rituxan on ___ and was noted \nto have chest pain and shortness of breath during transfusion - \nit was restarted at slower infusion rate over 4 days. He was due \nfor week 3 of rituximab on ___ but this was not \nadministered in the setting of worsening renal dysfunction. \n\n___ hospital course has been complicated by progressive \nhypoxic respiratory failure. Etiology is presumed to be \nrituxan-induced lung injury, although still on the differenital \nare lymphoma, and less likely aspergillus or bacterial \npneumonia. Aspergillus from BAL was positive 2.92 on ___, but \nhas since cleared in the serum. Patient reportedly traveled in \n___ states recently and visited some caves. He was started \non voriconazole and switched to ambisome after worsening \nrespiratory failure. He was subsequently switched to \nposaconazole in the setting of ___. ___, patient was noted to \nhave worsened respiratory status with fever for which FICU \nevaluated and CXR was noted to have worsened progression of b/l \ninfiltrates - Vanc/zosyn was started for presumed HCAP, though \nvanc d/c 2 days later. CT chest following day was concerning for \nrapid progression of diffuse lung disease with ?wide spread \ninfection drug toxicity, possibly ARDs. Pulmonary process has \nnot improved despite aggressive diuresis (lost 30 lbs since \nadmission) in the setting of CHF. Pulmonology was reconsulted on \n___ and recommended discussion with ID re: utility of repeat \nbronch for BAL galactomannan, continuing treatment of invasive \naspergillosis and presumed HCAP in addition to transition back \nto home po lasix. \nPatient was administered increased dose of 60mg \nmethylprednisolone on ___ for concern of ?COP - he had \npreviously been on a prednisone taper for malignancy 40mg on \n___, 50mg prednisone ___ weaned to 30mg on ___ for 4 days, \n15mg on ___. \n\nHospital course complicated by acute on chronic renal failure \n(baseline creat 1.9-2) thought to be cardiorenal vs \nambisome/voriconazole-induced renal dysfunction as abx were \ngiven ___ and kidney function acutely worsened after ___. \nNephrology was consulted - His urine sediment does not show \nobvious ATN and showed presence of hyaline casts, which can be \nseen in patients with heart failure. \n\nPatient has also been on insulin drip in the setting of steroids \ngiven with chemotherapy. He was switched back to SC insulin on \n___, but had to resume insulin gtt due to persistent \nhyperglycemia. \n\nHe has had persistent RUQ abd pain though with normal LFTs \nthought to be secondary to lymphomatous infiltration vs primary \nliver disease though RUQ u/s and liver MRI unrevealing.', 'medications': [{'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Fluticasone-Salmeterol Diskus (100/50)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Fluticasone-Salmeterol Diskus (100/50)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Rosuvastatin Calcium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 614.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 171.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 165.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '177', 'valuenum': 177.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM: \n=================\nVITALS - 97.7 110/62 99 RR20 98%RA\nGeneral: NAD, appears well\nHEENT: no scleral icterus/pallor, no oropharyngeal lesions, \nLymph: no supraclavicular, cervical or axillary LAD\nCV: irregularly irregular, no m/r/g, ns1s2\nLungs: CTAB, bibasilar crackles, minimal wheezes\nAbdomen: Soft, tender to palpation RUQ, no rebound or guarding. \nCholecystectomy scar noted, seperate surgery scar noted below \numbilicus\nGU: No suprapubic tenderness\nExt: Warm, well perfused. numerous excorations on skin, \nmottled skin vesicular blister on right knee\nNeuro: II-XII grossly intact, ___ strength in right hand from \nprevious injury\n\nDISCHARGE EXAM: \n=================\nVitals: 98.3 77 112/64 20 99% RA\nGeneral: obese man sitting in bed, NAD \nHEENT: no scleral icterus/pallor, no oropharyngeal lesions, \nLYMPH: No supraclavicular, cervical, parotid, or axillary LAD.\nCV: irregularly irregular, S1 S2, no m/r/g \nLUNGS: CTABL \nABDOMEN: obese, mild tenderness to palpation diffusely, no \nrebound or guarding. Cholecystectomy scar noted, back surgery \nscar noted below umbilicus and over sacrum. 1+ pitting edema at \nhips b/l. \nEXT: Warm, well perfused. numerous excorations on skin, mottled \nskin. Venous stasis changes on ___ bilaterally. thigh edema ___ \nto TEDS.', 'diagnoses': [{'icd_code': '80706', 'desc': 'Closed fracture of six ribs'}, {'icd_code': '2930', 'desc': 'Delirium due to conditions classified elsewhere'}, {'icd_code': '8072', 'desc': 'Closed fracture of sternum'}, {'icd_code': '81342', 'desc': 'Other closed fractures of distal end of radius (alone)'}, {'icd_code': '8260', 'desc': 'Closed fracture of one or more phalanges of foot'}, {'icd_code': '8242', 'desc': 'Fracture of lateral malleolus, closed'}, {'icd_code': '33811', 'desc': 'Acute pain due to trauma'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '7213', 'desc': 'Lumbosacral spondylosis without myelopathy'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'V113'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V454'}, {'icd_code': 'E8160', 'desc': 'Motor vehicle traffic accident due to loss of control, without collision on the highway, injuring driver of motor vehicle other than motorcycle'}], 'summary': "ADMISSION LAB\n==============\n___ 01:45PM UREA N-65* CREAT-2.8* SODIUM-135 \nPOTASSIUM-5.2* CHLORIDE-97 TOTAL CO2-27 ANION GAP-16\n___ 01:45PM LD(LDH)-412* AMYLASE-84\n___ 01:45PM LIPASE-32\n___ 01:45PM proBNP-1215*\n___ 01:45PM CALCIUM-10.0 URIC ACID-9.0*\n___ 01:45PM HBsAg-NEGATIVE HBs Ab-NEGATIVE HBc \nAb-NEGATIVE\n___ 01:45PM CRP-45.1*\n___ 01:45PM b2micro-16.3*\n___ 01:45PM HCV Ab-NEGATIVE\n___ 01:45PM WBC-28.0* RBC-3.75* HGB-11.8* HCT-36.7* \nMCV-98 MCH-31.5 MCHC-32.2 RDW-15.7* RDWSD-55.9*\n___ 01:45PM NEUTS-37 BANDS-0 ___ MONOS-18* EOS-0 \nBASOS-1 ___ MYELOS-0 AbsNeut-10.36* AbsLymp-12.32* \nAbsMono-5.04* AbsEos-0.00* AbsBaso-0.28*\n___ 01:45PM ___\n___ 01:45PM QUAN G6PD-11.2\n___ 01:45PM RET AUT-3.2* ABS RET-0.12*\n\nPERTINENT FINDINGS\n====================\n___ 01:45PM BLOOD proBNP-1215*\n___ 04:00PM BLOOD proBNP-5166*\n___ 12:00AM BLOOD FreeKap-25.2* ___ Fr K/L-1.57 \nb2micro-7.9*\n\n___ 15:49 \nASPERGILLUS GALACTOMANNAN ANTIGEN \n Test Result Reference \nRange/Units\nINDEX VALUE 2.92 H <0.50\nASPERGILLUS AG, EIA, BAL Detected A Not Detected\n \n\n___ 10:26 am SPUTUM Source: Endotracheal. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n <10 PMNs and <10 epithelial cells/100X field. \n 1+ (<1 per 1000X FIELD): GRAM POSITIVE COCCI IN \nPAIRS. \n 1+ (<1 per 1000X FIELD): GRAM POSITIVE ROD(S). \n QUALITY OF SPECIMEN CANNOT BE ASSESSED. \n\n RESPIRATORY CULTURE (Final ___: \n SPARSE GROWTH Commensal Respiratory Flora. \n STAPH AUREUS COAG +. SPARSE GROWTH. \n This isolate is presumed to be resistant to clindamycin \nbased on\n the detection of inducible resistance . \n Oxacillin RESISTANT Staphylococci MUST be reported as \nalso\n RESISTANT to other penicillins, cephalosporins, \ncarbacephems,\n carbapenems, and beta-lactamase inhibitor combinations. \n\n Rifampin should not be used alone for therapy. \n GRAM NEGATIVE ROD(S). RARE GROWTH. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n | \nCLINDAMYCIN----------- R\nERYTHROMYCIN---------- R\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN---------- =>8 R\nOXACILLIN------------- =>4 R\nRIFAMPIN-------------- <=0.5 S\nTETRACYCLINE---------- <=1 S\nTRIMETHOPRIM/SULFA---- <=0.5 S\nVANCOMYCIN------------ 1 S\n\nIMAGING\n========\nBone Marrow ___\nHYPERCELLULAR BONE MARROW WITH MATURING TRILINEAGE \nH EMATOPOIESIS, INFILTRATED WITH B CELL LYMPHOMA/LEUKEMIA.\n\nCT ABD Pelvis w/o contrast ___\n1. Splenomegaly. \n2. Chronic bladder diverticulum which contains a stone. \n3. No pathologically enlarged lymph nodes identified. \n\nCYTOGENETICS (___): 80% of the metaphase peripheral blood cells \nexamined had an abnormal karyotype with a derivative chromosome \nresulting in loss of the short arms of chromosomes 8 and 17 and \na dicentric chromosome from an unbalanced translocation \ninvolving chromosome 1 and 19. FISH has confirmed that the loss \nof 17p has resulted in loss of the TP53 gene (see below). Two \nrelated neoplastic clones were detected. One clone also had an \nunbalanced translocation involving chromosomes 3 and 12. There \nwas no evidence by ___ of deletion 13q14, trisomy 12, or \nrearrangement of the IGH or MYC genes. These clonal findings are \ncompatible with a lymphoprolierative disorder, but are not \ncharacteristic of any particular neoplasm. The simpler of the \ntwo clones was observed in the bone marrow sample collected on \n___, but more extensive clonal evolution is present there. \nLoss of TP53 gene suggests an unfavorable prognosis.\n\nTTE (___): left atrium is moderately dilated. The right atrium \nis moderately dilated. There is mild symmetric left ventricular \nhypertrophy. The left ventricular cavity is moderately dilated. \nDue to suboptimal technical quality, a focal wall motion \nabnormality cannot be fully excluded. Overall left ventricular \nsystolic function is moderately depressed (LVEF = 35 %). Tissue \nDoppler imaging suggests a normal left ventricular filling \npressure (PCWP<12mmHg). Right ventricular chamber size and free \nwall motion are normal. The ascending aorta is mildly dilated. \nThe aortic valve leaflets (3) are mildly thickened but aortic \nstenosis is not present. No aortic regurgitation is seen. The \nmitral valve appears structurally normal with trivial mitral \nregurgitation. The estimated pulmonary artery systolic pressure \nis normal. There is a trivial/physiologic pericardial effusion. \nThere are no echocardiographic signs of tamponade. \nCompared with the prior study (images reviewed) of ___, \nthe left ventricular ejection fraction is reduced. This may be a \nfunction of ventricular rate, which was significantly higher \nduring the present study. \n\nMRI LIVER (___): \n1. Normal signal in the liver parenchyma. No evidence of a \nfocal mass, \nthough note, the exam is limited by the lack of IV contrast. \n2. Moderate splenomegaly. An incompletely characterized 19 mm \nsplenic is statistically likely a hemangioma. \n3. Periportal adenopathy and prominent retroperitoneal lymph \nnodes. \n4. Small duodenal diverticulum. \n\nParotid U/S (___): Two hypoechoic/isoechoic structures in the \nleft parotid region corresponding to the area of \nswelling/tenderness as \nindicated by the patient. These may represent enlarged lymph \nnodes \n\nCT CHEST (___): Widespread ground-glass and nodular opacities \nhave significantly progressed when compared prior examinations. \nBilateral pleural effusions have increased. Extensive \nmediastinal and hilar adenopathy has remain stable when compared \nto the most recent exam, however has increased since ___. \nGiven the rapid progression of diffuse lung disease the main \nconsideration is acute pathology including widespread infection, \ndrug toxicity or noncardiogenic edema (ARDS). Although the \nlymph nodes have increased since mid ___, they could be \nreactive to the pulmonary condition rather than indicate active \nlymphoproliferative disorder. \n\nDISCHARGE\n==========\n___ 12:00AM BLOOD WBC-6.5 RBC-2.57* Hgb-7.6* Hct-24.9* \nMCV-97 MCH-29.6 MCHC-30.5* RDW-18.2* RDWSD-64.0* Plt ___\n___ 12:00AM BLOOD Neuts-72* Bands-0 ___ Monos-9 Eos-0 \nBaso-0 ___ Myelos-0 AbsNeut-4.68 AbsLymp-1.24 \nAbsMono-0.59 AbsEos-0.00* AbsBaso-0.00*\n___ 12:00AM BLOOD ___ PTT-35.1 ___\n___ 12:00AM BLOOD Glucose-260* UreaN-23* Creat-1.1 Na-134 \nK-4.1 Cl-94* HCO3-30 AnGap-14\n___ 12:00AM BLOOD ALT-34 AST-14 LD(LDH)-295* AlkPhos-104 \nTotBili-0.3\n___ 12:00AM BLOOD Calcium-8.1* Phos-2.5* Mg-1.9 UricAcd-7.\n___ with h/o systolic and diastolic heart failure (now:EF \n35%)IDDM, HTN, COPD, CKD (Baseline Cr 1.8-2.0), afib on warfarin \nwho initially presented ___ with 3 weeks of SOB, dry cough, 10 \nlb weight loss and general pruritis along with findings of \nleukocytosis with lymphocytosis on labs, found to have B Cell \nLymphoma NOS, course c/b hypoxemic respiratory failure ___ to \nRituxan pneumonitis, as well as Asperillus PNA and MRSA PNA \nrequiring intubation and pressors in the ICU. Steroid taper for \npneumonitis, finished 10d course of Vanc for MRSA PNA, on \nVoriconazole for a total of ___ weeks for Aspergillus. Developed \ntemporary ___ on CKD and ___ over hospital course, \npossibly ___ to shock. Restabilized, transferred to ___, \nclinically improved, and was started on Ibrutinib on ___ for \nhis Lymphoma, which he has been tolerating. Was retaining urine \nat discharge, requiring foley placement. \n\nACTIVE ISSUES:\n==============\n\n# B Cell Lymphoma NOS: \nSplenic marginal zone vs. hairy cell variant. The patient \npresented with lymphocytosis, fatigue, submandibular swelling \nand 10 lb unintentional weight loss over 3 weeks. Tissue \ncytology on ___ & ___: findings consistent with involvement by \nkappa restricted B lymphoproliferative disorder without CD5, \nCD10 or CD23 expression - further studies do not support a \ndiagnosis of classic hairy cell leukemia. B-cells had an \natypical immunophenotype with subset loss of CD22, and \nexpression of CD11c, subset CD103 with absent CD25.\nBM biopsy on ___ showed hypercellular BM with maturing \ntrilineage hematopoesis, infiltrated with B cell \nlymphoma/leukemia.\nTreatment to date with 2 doses Rituxan, first dose on ___, \ninfusions were complicated by possible pneumonitis reaction. The \npt was noted to have chest pain and shortness of breath during \ntransfusion - it was restarted at a slower infusion rate over 4 \ndays. Pt was due for week 3 of rituximab on ___ but this \nwas not administered in the setting of worsening renal \ndysfunction. Pt had a hematologic response to the Rituxan, but \nboth for greater efficacy and to avoid further Rituxan exposure, \nit was preferred to switch chemotherapies, first thought to use \nSC Campath (alemtuzumab) in the future, though then it was \ndecided to use Ibrutinib. A port was placed on ___, and pt \nstarted Ibrutinib that day. He tolerated this well and was \ndischarged with heme/onc follow-up.\n\n# Aspergillus PNA / MRSA PNA / Hypersensitivty Pneumonitis ___ \nrituximab: \nPatient with hypoxemic respiratory failure secondary to numerous \npossible etiologies given history of CHF, COPD, OSA and \ninfection. Of note, patient did recently take a tour of the \n___ states at which time he visited some caves. A CT Chest \non ___ showed multifocal ground glass opacities, CXR ___ \nshowed minimally increased atelectasis, BAL ___ was neg for \nvirus/fungi and mixed bacterial flora. Crypto/B glucan \nHisto/Strongyloides/Mycoplasma/Blasto/ Cocci neg ; Aspergillus \npositive on BAL on ___. CMV/EBV/Adeno/RSV neg. Pt was started \non voriconazole and switched to ambisome after worsening \nrespiratory failure. He was subsequently switched to \nposaconazole in the setting of ___. On ___, patient was noted to \nhave worsened respiratory status with fever for which ICU \nevaluated and CXR was noted to have worsened progression of b/l \ninfiltrates - Vanc/zosyn was started for presumed HCAP, though \nvanc d/c'd 2 days later. CT chest the following day was \nconcerning for rapid progression of diffuse lung disease, \npossibly ARDS. Pulmonary process did not improved despite \naggressive diuresis (lost 30 lbs since admission) in the setting \nof CHF. Pulm was reconsulted on ___ and recommended discussion \nwith ID about utility of repeat bronch for BAL galactomannan, \ncontinued treatment of invasive aspergillosis and presumed HCAP \nin addition to transition back to home po lasix. Patient was \nadministered increased dose of 60mg methylprednisolone on ___ \nfor concern of COPD - he had previously been on a prednisone \ntaper for malignancy 40mg on ___, 50mg prednisone ___ weaned \nto 30mg on ___ for 4 days, 15mg on ___. On ___, the pt \ndecompensated during VATS, had poor ventilation, etiology likely \ndue to rituxan-induced lung injury. An attempt was made to have \na VATs done but he became very hypoxic and unstable when his ETT \nwas changed and the VATs was not done. He continued to worsen \nclinically requiring 3 pressors and paralytics. He then started \nto improve and was extubated on ___. BAL Cx subsequently grew \nout MRSA; he completed a 10 day course for this. After transfer \nto ___ service, pt's respiratory status improved, and was \neventually weaned off of O2, prednisone was tapered down, and \nBNPs decreased. He will remain on Voriconazole for at least a \ntotal of ___ week course, ID recs an eventual repeat CT-chest to \nevaluate need for longer treatment. \n\n# ___: \nPt presented with mildly increased LFTs which resolved over \nadmission, then again developed increased ALT/AST on ___, which \nmay have been secondary to shock. HBV/HCV were neg, as were RUQ \nU/S and MRI liver. Pt's LFTs have been stable and wnl.\n\n# Anemia: \nThere was no evidence of hemolysis, responded well to \ntransfusion. Needed 2x transfusions over his admission. There \nwas never any obvious source of bleeding, H&H stable. \n\n# CHF: Chronic with new EF change: \nacute CHF exacerbation vs tachycardia induced cardiomyopathy. \nEF change from 45% to 35% on ECHO ___ without evidence of \nPHT. Metoprolol increased to 37.5 QID from 25mg on ___ to \ncontrol HR then again to 50mg QID on ___ then again to 75mg Q6H \non ___. ECHO ___ showed EF 45-50% with moderate pulmonary HTN. \nCardiology was consulted and recommended diuresis. BNP elevated \nbut downtrending. Once pt was stabilized, he was restarted on \nhis home dose Lasix 60mg qd.\n\n# ___ on CKD: \nPt's baseline Cr was 1.9-2.1, Cr was 2.8 on admission. DDX \nincluded prerenal source ___ CHF or dehydration, or intrarenal \n___ infection or medication. Pt had no post renal symptoms. Pt's \nhome Lasix was originally held, renal was consulted. FeUrea 34.4 \nc/w possible prerenal cause. It was thought to be cardiorenal vs \nambisome/voriconazole-induced renal dysfunction as abx were \ngiven ___ and kidney function acutely worsened after ___. \nNephrology was consulted - his urine sediment didn't show \nobvious ATN and showed presence of hyaline casts, which can be \nseen in patients with heart failure. All potentially nephrotoxic \ndrugs were DC'd on ___. Pt's Cr normalizing, was 1.0-1.2 for \nmost of his course once he returned from the ICU, likely due to \nsarcopenia from a prolonged hospital stay. \n\n# A-fib: \nHad been a chronic issue. Low EF from TTE on ___. Pt's HR was \ndifficult to control, needing increasing amounts of Metoprolol. \nPt was found to have had persistent afib with RVR requiring \noccassional 1x metop 5 IV and waws uptitrated on metoprolol \ntartrate from 12.5 Q6 (___) to 25 Q6 (___) to 50mg Q6 (___). \nPt was transitioned to 200mg Metoprolol succinate before \ndischarge. Pt was previously on Warfarin, though got Lovenox Tx \ndose ___. Pt was transitioned again to Lovenox originally on \n___, though developed brief episode of hematuria, most likely \n___ to trauma from foley and foley malplacement, so was only \nstarted on ___. Pt was transitioned to Apixaban on ___ before \ndischarge, will DC to rehab on 5mg BID, but when transitions \nhome, will lower dose to 2.5mg BID ___ to decreased likelihood \nof DVTs when walking at home and potential increased bleeding \npropensity with Ibrutinib.\n\n# IDDM: \nPt had elevated glucoses >500 at last admission. FSGs have been \nbetter controlled on this admission, though they remained \ndifficult to control. ___ was consulted for assistance in \nadjusting ISS on this admission. He was discharged on \nsignificantly less insulin than his home dose; he will need \ncareful titration of insulin going forward.\n\nCHRONIC ISSUES:\n===============\n\n# Hyperuricemia / GOUT: \nPt's home Febuxostat was increased from 60 to 80mg daily as uric \nacid was increasing steadily on ___. Phos, K and Ca were \nloooking more like TLS on ___. Was found to be G6PD negative, \nconsidered rabicurase if uric acid >10. Febuxostat was changed \nto allopurinol ___ on ___ secondary to reduced GFR. Uric acid \nlevel remained elevated, though eventually decreased and \nallopurinol DC'd on ___. \n\n# NSVT: Occurred on ___ and ___. Pt's Metoprolol was \nincreased as above \n\n# COPD / OSA: Did not have previous home O2 requirement. We \ncontinued home albuterol inhaler PRN, tiotroprium, \nbudesonide-formoterol, montelukast. Nebulizers were used PRN. \nHad a CPAP at night w/O2. \n \n# CODE: DNR/DNI\n\n# EMERGENCY CONTACT: ___, wife ___ \n\n****TRANSITIONAL ISSUES****\n\n-Pt's Warfarin for AFib was discontinued ___ to potential drug \ninteractions with chemotherapy and temporary hematuria. Was \nrestarted on Lovenox, which he has been tolerating. Recommending \n5mg Apixaban BID while pt is in rehab, to be reduced to fixed \ndose of 2.5mg Apixaban BID when patient is ready for discharge \nhome, as pt's Ibrutinib can also induce bleeding tendency\n-Pt started on Ibrutinib (novel targeted chemotherapy), to be \ntaken by pt ongoing every morning. Rituximab was not tolerated \nby pt, caused possible pneumonitis. Will f/u in ___ clinic. \nPlease carefully monitor for bleeding while on ibrutinib, as \nvoriconazole may increase drug levels. \n-Pt will be taking Voriconazole for Aspergillus Pneumonia, ___ \nweek course, to be finished ___. Will reassess on \noutpatient follow up with ID, possibly requiring CT-Chest. \n-Pt was on prednisone taper after ICU stay, currently on 5mg x3 \ndays, to stop steroids completely on ___. \n-Atovaquone PCP PPx was stopped, given low suspicion for \nimmunocompromise requiring PCP ___. \n-Losartan was stopped, as pt's BPs have been well controlled on \nadmission. Metoprolol was increased from 75mg to 200mg qd, which \nmay explain lack of need for losartan. If BPs increase, would \nrecommend starting at 25mg Losartan.\n- Patient's renal function improved to a new baseline Cr of \n1.0-1.2 at the time of discharge\n- Patient discharged with foley; attempted voiding trial but \npatient was significantly retaining urine. Tamsulosin being \nheld while patient on Voriconazole due to significant drug-drug \ninteraction. He needs a voiding trial repeated in the next ___ \ndays; if he is still retaining urine he will need outpatient \nurology follow-up.\n- Patient with very difficult to control blood sugars during \nthis admission; will need frequent careful titrating of insulin \ngoing forward. \n- Patient will need 3x weekly CBC, electrolytes, and LFTs drawn \nand faxed to ___ clinic at ___. After the first \nweek of monitoring, 2x weekly for 1 week and then weekly \nthereafter will be sufficient."}}
{'final_diagnoses': ['B cell Lymphoma NOS', 'Hypoxemic Respiratory Failure', 'Aspergillus Pneumonia', '___ on CKD'], 'procedures': ['PICC line', 'Bronchoscopy', 'Intubation', 'Port Placement'], 'visit_summary': "___ with h/o systolic and diastolic heart failure (now:EF \n35%)IDDM, HTN, COPD, CKD (Baseline Cr 1.8-2.0), afib on warfarin \nwho initially presented ___ with 3 weeks of SOB, dry cough, 10 \nlb weight loss and general pruritis along with findings of \nleukocytosis with lymphocytosis on labs, found to have B Cell \nLymphoma NOS, course c/b hypoxemic respiratory failure ___ to \nRituxan pneumonitis, as well as Asperillus PNA and MRSA PNA \nrequiring intubation and pressors in the ICU. Steroid taper for \npneumonitis, finished 10d course of Vanc for MRSA PNA, on \nVoriconazole for a total of ___ weeks for Aspergillus. Developed \ntemporary ___ on CKD and ___ over hospital course, \npossibly ___ to shock. Restabilized, transferred to ___, \nclinically improved, and was started on Ibrutinib on ___ for \nhis Lymphoma, which he has been tolerating. Was retaining urine \nat discharge, requiring foley placement. \n\nACTIVE ISSUES:\n==============\n\n# B Cell Lymphoma NOS: \nSplenic marginal zone vs. hairy cell variant. The patient \npresented with lymphocytosis, fatigue, submandibular swelling \nand 10 lb unintentional weight loss over 3 weeks. Tissue \ncytology on ___ & ___: findings consistent with involvement by \nkappa restricted B lymphoproliferative disorder without CD5, \nCD10 or CD23 expression - further studies do not support a \ndiagnosis of classic hairy cell leukemia. B-cells had an \natypical immunophenotype with subset loss of CD22, and \nexpression of CD11c, subset CD103 with absent CD25.\nBM biopsy on ___ showed hypercellular BM with maturing \ntrilineage hematopoesis, infiltrated with B cell \nlymphoma/leukemia.\nTreatment to date with 2 doses Rituxan, first dose on ___, \ninfusions were complicated by possible pneumonitis reaction. The \npt was noted to have chest pain and shortness of breath during \ntransfusion - it was restarted at a slower infusion rate over 4 \ndays. Pt was due for week 3 of rituximab on ___ but this \nwas not administered in the setting of worsening renal \ndysfunction. Pt had a hematologic response to the Rituxan, but \nboth for greater efficacy and to avoid further Rituxan exposure, \nit was preferred to switch chemotherapies, first thought to use \nSC Campath (alemtuzumab) in the future, though then it was \ndecided to use Ibrutinib. A port was placed on ___, and pt \nstarted Ibrutinib that day. He tolerated this well and was \ndischarged with heme/onc follow-up.\n\n# Aspergillus PNA / MRSA PNA / Hypersensitivty Pneumonitis ___ \nrituximab: \nPatient with hypoxemic respiratory failure secondary to numerous \npossible etiologies given history of CHF, COPD, OSA and \ninfection. Of note, patient did recently take a tour of the \n___ states at which time he visited some caves. A CT Chest \non ___ showed multifocal ground glass opacities, CXR ___ \nshowed minimally increased atelectasis, BAL ___ was neg for \nvirus/fungi and mixed bacterial flora. Crypto/B glucan \nHisto/Strongyloides/Mycoplasma/Blasto/ Cocci neg ; Aspergillus \npositive on BAL on ___. CMV/EBV/Adeno/RSV neg. Pt was started \non voriconazole and switched to ambisome after worsening \nrespiratory failure. He was subsequently switched to \nposaconazole in the setting of ___. On ___, patient was noted to \nhave worsened respiratory status with fever for which ICU \nevaluated and CXR was noted to have worsened progression of b/l \ninfiltrates - Vanc/zosyn was started for presumed HCAP, though \nvanc d/c'd 2 days later. CT chest the following day was \nconcerning for rapid progression of diffuse lung disease, \npossibly ARDS. Pulmonary process did not improved despite \naggressive diuresis (lost 30 lbs since admission) in the setting \nof CHF. Pulm was reconsulted on ___ and recommended discussion \nwith ID about utility of repeat bronch for BAL galactomannan, \ncontinued treatment of invasive aspergillosis and presumed HCAP \nin addition to transition back to home po lasix. Patient was \nadministered increased dose of 60mg methylprednisolone on ___ \nfor concern of COPD - he had previously been on a prednisone \ntaper for malignancy 40mg on ___, 50mg prednisone ___ weaned \nto 30mg on ___ for 4 days, 15mg on ___. On ___, the pt \ndecompensated during VATS, had poor ventilation, etiology likely \ndue to rituxan-induced lung injury. An attempt was made to have \na VATs done but he became very hypoxic and unstable when his ETT \nwas changed and the VATs was not done. He continued to worsen \nclinically requiring 3 pressors and paralytics. He then started \nto improve and was extubated on ___. BAL Cx subsequently grew \nout MRSA; he completed a 10 day course for this. After transfer \nto ___ service, pt's respiratory status improved, and was \neventually weaned off of O2, prednisone was tapered down, and \nBNPs decreased. He will remain on Voriconazole for at least a \ntotal of ___ week course, ID recs an eventual repeat CT-chest to \nevaluate need for longer treatment. \n\n# ___: \nPt presented with mildly increased LFTs which resolved over \nadmission, then again developed increased ALT/AST on ___, which \nmay have been secondary to shock. HBV/HCV were neg, as were RUQ \nU/S and MRI liver. Pt's LFTs have been stable and wnl.\n\n# Anemia: \nThere was no evidence of hemolysis, responded well to \ntransfusion. Needed 2x transfusions over his admission. There \nwas never any obvious source of bleeding, H&H stable. \n\n# CHF: Chronic with new EF change: \nacute CHF exacerbation vs tachycardia induced cardiomyopathy. \nEF change from 45% to 35% on ECHO ___ without evidence of \nPHT. Metoprolol increased to 37.5 QID from 25mg on ___ to \ncontrol HR then again to 50mg QID on ___ then again to 75mg Q6H \non ___. ECHO ___ showed EF 45-50% with moderate pulmonary HTN. \nCardiology was consulted and recommended diuresis. BNP elevated \nbut downtrending. Once pt was stabilized, he was restarted on \nhis home dose Lasix 60mg qd.\n\n# ___ on CKD: \nPt's baseline Cr was 1.9-2.1, Cr was 2.8 on admission. DDX \nincluded prerenal source ___ CHF or dehydration, or intrarenal \n___ infection or medication. Pt had no post renal symptoms. Pt's \nhome Lasix was originally held, renal was consulted. FeUrea 34.4 \nc/w possible prerenal cause. It was thought to be cardiorenal vs \nambisome/voriconazole-induced renal dysfunction as abx were \ngiven ___ and kidney function acutely worsened after ___. \nNephrology was consulted - his urine sediment didn't show \nobvious ATN and showed presence of hyaline casts, which can be \nseen in patients with heart failure. All potentially nephrotoxic \ndrugs were DC'd on ___. Pt's Cr normalizing, was 1.0-1.2 for \nmost of his course once he returned from the ICU, likely due to \nsarcopenia from a prolonged hospital stay. \n\n# A-fib: \nHad been a chronic issue. Low EF from TTE on ___. Pt's HR was \ndifficult to control, needing increasing amounts of Metoprolol. \nPt was found to have had persistent afib with RVR requiring \noccassional 1x metop 5 IV and waws uptitrated on metoprolol \ntartrate from 12.5 Q6 (___) to 25 Q6 (___) to 50mg Q6 (___). \nPt was transitioned to 200mg Metoprolol succinate before \ndischarge. Pt was previously on Warfarin, though got Lovenox Tx \ndose ___. Pt was transitioned again to Lovenox originally on \n___, though developed brief episode of hematuria, most likely \n___ to trauma from foley and foley malplacement, so was only \nstarted on ___. Pt was transitioned to Apixaban on ___ before \ndischarge, will DC to rehab on 5mg BID, but when transitions \nhome, will lower dose to 2.5mg BID ___ to decreased likelihood \nof DVTs when walking at home and potential increased bleeding \npropensity with Ibrutinib.\n\n# IDDM: \nPt had elevated glucoses >500 at last admission. FSGs have been \nbetter controlled on this admission, though they remained \ndifficult to control. ___ was consulted for assistance in \nadjusting ISS on this admission. He was discharged on \nsignificantly less insulin than his home dose; he will need \ncareful titration of insulin going forward.\n\nCHRONIC ISSUES:\n===============\n\n# Hyperuricemia / GOUT: \nPt's home Febuxostat was increased from 60 to 80mg daily as uric \nacid was increasing steadily on ___. Phos, K and Ca were \nloooking more like TLS on ___. Was found to be G6PD negative, \nconsidered rabicurase if uric acid >10. Febuxostat was changed \nto allopurinol ___ on ___ secondary to reduced GFR. Uric acid \nlevel remained elevated, though eventually decreased and \nallopurinol DC'd on ___. \n\n# NSVT: Occurred on ___ and ___. Pt's Metoprolol was \nincreased as above \n\n# COPD / OSA: Did not have previous home O2 requirement. We \ncontinued home albuterol inhaler PRN, tiotroprium, \nbudesonide-formoterol, montelukast. Nebulizers were used PRN. \nHad a CPAP at night w/O2. \n \n# CODE: DNR/DNI\n\n# EMERGENCY CONTACT: ___, wife ___ \n\n****TRANSITIONAL ISSUES****\n\n-Pt's Warfarin for AFib was discontinued ___ to potential drug \ninteractions with chemotherapy and temporary hematuria. Was \nrestarted on Lovenox, which he has been tolerating. Recommending \n5mg Apixaban BID while pt is in rehab, to be reduced to fixed \ndose of 2.5mg Apixaban BID when patient is ready for discharge \nhome, as pt's Ibrutinib can also induce bleeding tendency\n-Pt started on Ibrutinib (novel targeted chemotherapy), to be \ntaken by pt ongoing every morning. Rituximab was not tolerated \nby pt, caused possible pneumonitis. Will f/u in ___ clinic. \nPlease carefully monitor for bleeding while on ibrutinib, as \nvoriconazole may increase drug levels. \n-Pt will be taking Voriconazole for Aspergillus Pneumonia, ___ \nweek course, to be finished ___. Will reassess on \noutpatient follow up with ID, possibly requiring CT-Chest. \n-Pt was on prednisone taper after ICU stay, currently on 5mg x3 \ndays, to stop steroids completely on ___. \n-Atovaquone PCP PPx was stopped, given low suspicion for \nimmunocompromise requiring PCP ___. \n-Losartan was stopped, as pt's BPs have been well controlled on \nadmission. Metoprolol was increased from 75mg to 200mg qd, which \nmay explain lack of need for losartan. If BPs increase, would \nrecommend starting at 25mg Losartan.\n- Patient's renal function improved to a new baseline Cr of \n1.0-1.2 at the time of discharge\n- Patient discharged with foley; attempted voiding trial but \npatient was significantly retaining urine. Tamsulosin being \nheld while patient on Voriconazole due to significant drug-drug \ninteraction. He needs a voiding trial repeated in the next ___ \ndays; if he is still retaining urine he will need outpatient \nurology follow-up.\n- Patient with very difficult to control blood sugars during \nthis admission; will need frequent careful titrating of insulin \ngoing forward. \n- Patient will need 3x weekly CBC, electrolytes, and LFTs drawn \nand faxed to ___ clinic at ___. After the first \nweek of monitoring, 2x weekly for 1 week and then weekly \nthereafter will be sufficient.", 'medications_prescribed': ['1. Finasteride 5 mg PO DAILY', '2. Furosemide 60 mg PO DAILY', '3. Levothyroxine Sodium 150 mcg PO DAILY', '4. Metoprolol Succinate XL 200 mg PO DAILY', '5. SulfaSALAzine_ 1500 mg PO BID', '6. Tiotropium Bromide 1 CAP IH DAILY', '7. Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath', '8. budesonide-formoterol 160-4.5 mcg/actuation inhalation daily', '9. Acyclovir 400 mg PO Q8H', '10. Imbruvica (ibrutinib) 420 mg PO DAILY', '11. Apixaban 5 mg PO BID', '12. PredniSONE 5 mg PO DAILY Duration: 3 Days \nStop on ___', '13. TraZODone 50 mg PO QHS:PRN insomnia', '14. Voriconazole 200 mg PO Q12H \nKeep taking until instructed to stop', '15. Ranitidine 150 mg PO QHS \ninteracts with ibrutinib/voriconazole, please give at night', '16. Fish Oil (Omega 3) 1000 mg PO BID', '17. Omeprazole 20 mg PO DAILY', '18. Simvastatin 20 mg PO DAILY', '19. Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID:PRN itch', '20. I-Caps (antiox#10-om3-dha-epa-lut-zeax) ___ mg Oral BID', '21. Febuxostat 60 mg PO DAILY', '22. fenofibrate nanocrystallized 48 mg oral daily', '23. Fluocinolone Acetonide 0.01% Solution 1 Appl TP DAILY', '24. Niacin 500 mg PO BID', '25. Miconazole Powder 2% 1 Appl TP QID:PRN discomfort', '26. Sarna Lotion 1 Appl TP QID:PRN pruritus', '27. Hydrocortisone Cream 2.5% 1 Appl TP TID:PRN pruritis', '28. Glargine 20 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'R hand pain', 'medical_history': ['Substance abuse', 'Asthma', 'History of endocarditis about ___ years ago with residual murmur \nper pt', 'Chronic low back pain on disability', 'RLE skin graft from foreign body injury', 'R hand metacarpal fracture CRPP', 'R hand I & D ___'], 'family_history': 'father - CAD, MI, DM', 'present_illness': '___ with a history of polysubstance abuse and IVDA presents with \nswelling, erythema, and drainage from right hand. He was \nrecently admitted to ___ on ___ with a right hand \nabscess as a complication of IV drug use. He initially received \nvanc/zosyn. His wound was debrided in the OR on ___. Cultures \ngrew pan sensitive Strep Anginosus, and he was discharged on \ncourse of Augmentin. He states that over the past 3 days he has \nhad increasing pain and redness of the hand, especially over the \n___ dorsal MCP joint. He also notes some drainage from the wound \nas well as fevers at home.\n\nIn the ED, initial vitals: 99.4 76 112/63 18 97% RA. Labs were \nsignificant for a leukocytosis of 11.4\n \nVitals prior to transfer: 98.3 75 102/59 18 98% RA \n\nVitals on arrival: 98.4 87 99/56 94% RA\n\nCurrently, he states that he continues to have R hand. He denies \nany CP, SOB, abd pain, n/v, diarrhea.', 'medications': [{'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '246', 'valuenum': 246.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 5.0, 'ref_range_upper': 36.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '244', 'valuenum': 244.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '238', 'valuenum': 238.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ON ADMISSION:\n===========\nVitals- 98.4 87 99/56 94% RA\nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, dry MM, oropharynx clear \nNeck- supple \nLungs- CTAB no wheezes, rales, rhonchi \nCV- RRR, ? ___ holosystolic murmur heard at L lower sternal \nborder \nAbdomen- soft, NT/ND bowel sounds present, no rebound tenderness \nor guarding\nGU- no foley \nExt- warm, well perfused, no ___ - R arm in clean dressing\nSkin- multiple tattoos \nNeuro- CNs2-12 intact, motor function grossly normal \n\nON DISCHARGE\n==========\nVitals- 98.2, 121/69, 81, 18, 100% on RA\nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, MMM, oropharynx clear \nNeck- supple \nLungs- CTAB no wheezes, rales, rhonchi \nCV- RRR, no MRG \nAbdomen- soft, NT/ND bowel sounds present, no rebound tenderness \nor guarding\nGU- no foley \nExt- warm, well perfused, no ___ - R hand in clean dressing, moving fingers well, capillary \nrefill intact\nSkin- multiple tattoos \nNeuro- CNs2-12 intact, motor function grossly normal', 'diagnoses': [{'icd_code': 'T405X1A', 'desc': 'Poisoning by cocaine, accidental (unintentional), initial encounter'}, {'icd_code': 'I63512', 'desc': 'Cerebral infarction due to unspecified occlusion or stenosis of left middle cerebral artery'}, {'icd_code': 'G8191', 'desc': 'Hemiplegia, unspecified affecting right dominant side'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'I67848', 'desc': 'Other cerebrovascular vasospasm and vasoconstriction'}, {'icd_code': 'Q211', 'desc': 'Atrial septal defect'}, {'icd_code': 'F1410', 'desc': 'Cocaine abuse, uncomplicated'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'E7800', 'desc': 'Pure hypercholesterolemia, unspecified'}, {'icd_code': 'N858', 'desc': 'Other specified noninflammatory disorders of uterus'}], 'summary': "ON ADMISSION:\n==========\n\n___ 04:45AM BLOOD WBC-11.4* RBC-4.26* Hgb-12.4* Hct-38.9* \nMCV-91 MCH-29.2 MCHC-32.0 RDW-13.1 Plt ___\n___ 04:45AM BLOOD Neuts-52.0 ___ Monos-5.2 Eos-1.3 \nBaso-0.8\n___ 04:45AM BLOOD ___ PTT-30.9 ___\n___ 04:45AM BLOOD Glucose-98 UreaN-9 Creat-1.2 Na-137 K-4.2 \nCl-99 HCO3-27 AnGap-15\n___ 08:00AM BLOOD Calcium-9.0 Phos-3.0 Mg-1.9\n\nMICRO:\n======\n___: blood cx-pnd\n___: blood cx-pnd\n___: wound cx\nGRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n WOUND CULTURE (Preliminary): \n MIXED BACTERIAL FLORA. \n\nIMAGING: \n=======\nCXR ___:\nThe cardiomediastinal hilar contours are within normal limits. \nThere is no focal consolidation, pleural effusion or \npneumothorax. \n\nHand XR\nThere is no acute fracture dislocation. Again noted, is a \ndeformity of the fifth metacarpal, likely from prior boxers \nfracture. There is no bony erosion or destruction. There are no \nradiopaque foreign bodies or soft tissue calcifications. Mild \ndegenerative changes are noted at the triscaphe joint. \n \nIMPRESSION: No acute fracture or dislocation. \n\nON DISCHARGE:\n===========\n\n___ 09:05AM BLOOD WBC-9.0 RBC-4.31* Hgb-12.5* Hct-39.6* \nMCV-92 MCH-29.0 MCHC-31.5 RDW-12.9 Plt ___\n___ 09:05AM BLOOD Glucose-155* UreaN-13 Creat-1.1 Na-137 \nK-4.2 Cl-100 HCO3-27 AnGap-14\n___ 09:05AM BLOOD ALT-36 AST-30 AlkPhos-91 TotBili-0.3\n___ 09:05AM BLOOD Calcium-9.1 Phos-3.8 Mg-1.___ with a history of polysubstance abuse and IVDA presents with \nswelling, erythema, and drainage from right hand.\n# R hand abscess: Pt presented with worsening erythema, edema \nand drainage of R hand wound. Pt recently admitted from \n___ for R hand abscess which was drained in OR and grew \nStrep Anginosus . Pt was discharged home with 10 day augmentin \nhowever noticed worsening pain, edema and fevers for past \nseveral days. He admitted later to questionable compliance with \nmedication but did deny further IV drug use. Plastic surgery saw \nin ED and incised and drained lesion. He was started on IV vanc \non ___. Gram stain grew multiple flora. Infectious Disease was \nconsulted. Given the pt's history of IV drug use, a PO \nantibiotic regimen was chosen. ID recommended cefpodoxime, which \nwas started on ___. Plan is for ___ week course, to be decided \nin ___ clinic. Pt was strongly encouraged to keep all \nappointments. His pain was managed with PO dilaudid.\n\n# Fevers in IVDU: Pt with history of endocarditis ___ years ago \nin setting of recent drug use who presented with reported fevers \nat home. On initial exam there was questionable holosystolic \nmurmur at L lower sternal border however this was later unable \nto be appreciated. There was no stigma of endocarditis on exam; \nno splinters, no ___ lesions or osslers nodes and CXR was \nunremarkable. He remained afebrile while inpatient and blood \ncultures were no growth. He was treated with antibiotics as \nabove. Suspicion for endocarditis was so low that echo was \ndeferred.\n\nCHRONIC MEDICAL ISSUES:\n#asthma: Pt continued on albuterol inhaler as needed.\n\n# chronic back pain: Pt continued on home gabapentin, pregabalin\n\n# tobacco abuse: Pt continued on nicotine patch while inpatient \n\nTRANSITIONAL ISSUES:\n[] Pt to follow up in hand clinic on ___\n[] Pt to start course of cefpodoxime. He will follow up with ID \nin clinic for decision of the duration of antibiotics needed \n(preliminary recommendations ___ weeks)\n[] Blood cultures pending at discharge"}}
{'final_diagnoses': ['R hand abscess', 'IV Drug use'], 'procedures': ['___: R hand I&D'], 'visit_summary': "# R hand abscess: Pt presented with worsening erythema, edema \nand drainage of R hand wound. Pt recently admitted from \n___ for R hand abscess which was drained in OR and grew \nStrep Anginosus . Pt was discharged home with 10 day augmentin \nhowever noticed worsening pain, edema and fevers for past \nseveral days. He admitted later to questionable compliance with \nmedication but did deny further IV drug use. Plastic surgery saw \nin ED and incised and drained lesion. He was started on IV vanc \non ___. Gram stain grew multiple flora. Infectious Disease was \nconsulted. Given the pt's history of IV drug use, a PO \nantibiotic regimen was chosen. ID recommended cefpodoxime, which \nwas started on ___. Plan is for ___ week course, to be decided \nin ___ clinic. Pt was strongly encouraged to keep all \nappointments. His pain was managed with PO dilaudid.\n\n# Fevers in IVDU: Pt with history of endocarditis ___ years ago \nin setting of recent drug use who presented with reported fevers \nat home. On initial exam there was questionable holosystolic \nmurmur at L lower sternal border however this was later unable \nto be appreciated. There was no stigma of endocarditis on exam; \nno splinters, no ___ lesions or osslers nodes and CXR was \nunremarkable. He remained afebrile while inpatient and blood \ncultures were no growth. He was treated with antibiotics as \nabove. Suspicion for endocarditis was so low that echo was \ndeferred.\n\nCHRONIC MEDICAL ISSUES:\n#asthma: Pt continued on albuterol inhaler as needed.\n\n# chronic back pain: Pt continued on home gabapentin, pregabalin\n\n# tobacco abuse: Pt continued on nicotine patch while inpatient \n\nTRANSITIONAL ISSUES:\n[] Pt to follow up in hand clinic on ___\n[] Pt to start course of cefpodoxime. He will follow up with ID \nin clinic for decision of the duration of antibiotics needed \n(preliminary recommendations ___ weeks)\n[] Blood cultures pending at discharge", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB, wheezing', 'BuPROPion (Sustained Release) 300 mg PO DAILY', 'Diazepam 5 mg PO QPM:PRN muscle spasm', 'Docusate Sodium 100 mg PO BID', 'Gabapentin 800 mg PO TID', 'HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain \nRX *hydromorphone 4 mg ___ tablet(s) by mouth every 3 hours as \nneeded Disp #*35 Tablet Refills:*0', 'Nicotine Patch 21 mg TD DAILY', 'Pregabalin 300 mg PO BID', 'Cefpodoxime Proxetil 200 mg PO Q12H \nRX *cefpodoxime 200 mg 1 tablet(s) by mouth every 12 hours Disp \n#*60 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'Tremulous', 'medical_history': ['1. Miliary tuberculosis. ', '2. Peritoneal tuberculosis, post treatment with four medications \n \nfor one year between ___ to ___. ', '3. Hypertension. ', '4. Hemorrhoids. ', '5. Duodenal ulcer. ', '6. H. pylori antibody equivocal positive, post treatment for two \n \nweeks. ', '7. Workup for elevated LFTs - ___ is weakly positive and her IgG \nand IgA are elevated. Awaiting MRCP, followed by ___', '1. Tubal ligation. ', '2. Laparotomy for small bowel obstruction with partial bowel \nresection when she was pregnant in ___. ', '3. EGD showed duodenal ulcer in ___. ', '4. Colonoscopy in ___ for guaiac-positive stool showed a single \n \nlarge angioectasia in proximal ascending colon, a 3-mm \nnonbleeding polyp in mid transverse colon. Pathology showed \nhyperplastic polyp, grade I internal hemorrhoids.'], 'family_history': 'Mom died at ___ years old of accident. Dad died at ___. One \nsister, one brother, four children without any medical problems. \nNo one has colon cancer, IBD, esophageal cancer, or gastric \ncancer.', 'present_illness': "___ yo F with a past medical history of TB, HTN, and PUD p/w 1 \nday of tremulousness. Patient awoke this morning feeling fine \nand then developed acute onset of chills and total body tremors \nthis morning at 11 am. She denies fevers, nausea, vomitting, \ndiarrhea, cough, chest pain, neck pain, headache and back pain. \nNo sick contacts, no recent travel and no pets. She did not take \nher temperature with this episode. She reports good po intake \nprior to 11 am but has not eaten since then. She reports similar \nsymptoms in the past that were workued up by Neurology with a \nclear cause, however these symptoms usually only last 2 hours \nand then abate spontaneously. Patient was seen at ___'s office \ntoday and SBP was noted to be 178mmHg. She was sent to the ED \nfor further evaluation. \n. \nIn the ED, she was found to be tremulous on exam, and tremors \nwere worse with ambulation. Initial labs were noteable for an \nAGMA that closed with 1 L IVF. She was also treated with 1 L NS, \nTylenol 1 gm po x1, and ativan 1 mg po x1. CXR was negative. No \ncultures were sent. TSH was pending at the time of transfer. On \ntransfer, VS were afebrile 102, 112/59, 25, 100 RA. \n. \nOf note, patient has been seen twice by Neurology for this \ncondition. \nTheir impression is that the patient's tremulousness is \nsecondary to her perspiration and does not reflect a \nneurological condiation. Neurology was more concerned for an \nendocrinopathy. \n. \nROS was otherwise essentially negative. The pt denied recent \nunintended weight loss, fevers, night sweats, headaches, \ndizziness or vertigo, changes in hearing or vision, including \namaurosis fugax, neck stiffness, lymphadenopathy, hematemesis, \ncoffee-ground emesis, dysphagia, odynophagia, heartburn, nausea, \nvomiting, diarrhea, constipation, steatorrhea, melena, \nhematochezia, cough, hemoptysis, wheezing, shortness of breath, \nchest pain, palpitations, dyspnea on exertion, increasing lower \nextremity swelling, orthpnea, paroxysmal nocturnal dyspnea, leg \npain while walking, joint pain.", 'medications': [{'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Timolol Maleate 0.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 36.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Effective ___, values will be reported from the ___ Vitamin D. Total assay. This assay accurately detects 25-hydroxyvitamin D3 but. does not accurately detect 25-hydroxyvitamin D2 and values may not be. accurate in patients taking vitamin D2 (ergocalciferol)..'}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '851', 'valuenum': 851.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T: 98 BP: 115/81 P: 102 R: 18 SaO2: 94 RA \nGeneral: Awake, alert, NAD, pleasant, appropriate, cooperative. \n\nHEENT: NCAT, PERRL, EOMI, no scleral icterus, MMM, no lesions \nnoted in OP \nNeck: supple, no significant JVD or carotid bruits appreciated \nPulmonary: Lungs CTA bilaterally, no wheezes, ronchi or rales \nCardiac: RR, nl S1 S2, no murmurs, rubs or gallops appreciated \nAbdomen: soft, NT, ND, normoactive bowel sounds, no masses or \norganomegaly noted \nExtremities: No edema, 2+ radial, DP pulses b/l \nLymphatics: No cervical, supraclavicular, axillary or inguinal \nlymphadenopathy noted \nSkin: no rashes or lesions noted. \nNeurologic: Alert, oriented x 3. Able to relate history without \ndifficulty. Cranial nerves II-XII intact. Normal bulk, strength \nand tone throughout. Tremors worse with action in UEs and LEs. \nMild tongue tremor. Negative babinski bilaterally.', 'diagnoses': [{'icd_code': 'F323', 'desc': 'Major depressive disorder, single episode, severe with psychotic features'}, {'icd_code': 'I671', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': 'F459', 'desc': 'Somatoform disorder, unspecified'}, {'icd_code': 'M5481', 'desc': 'Occipital neuralgia'}, {'icd_code': 'Z970', 'desc': 'Presence of artificial eye'}, {'icd_code': 'F4322', 'desc': 'Adjustment disorder with anxiety'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'Q150', 'desc': 'Congenital glaucoma'}, {'icd_code': 'M5011', 'desc': 'Cervical disc disorder with radiculopathy, high cervical region'}, {'icd_code': 'L650', 'desc': 'Telogen effluvium'}, {'icd_code': 'Z811', 'desc': 'Family history of alcohol abuse and dependence'}], 'summary': '___ 03:59PM WBC-7.4 RBC-3.85* HGB-10.8* HCT-32.5* MCV-84# \nMCH-28.0 MCHC-33.3 RDW-17.9*\n___ 03:59PM NEUTS-75.7* ___ MONOS-4.8 EOS-0.2 \nBASOS-0.3\n___ 03:59PM GLUCOSE-165* UREA N-4* CREAT-0.8 SODIUM-139 \nPOTASSIUM-3.7 CHLORIDE-101 TOTAL CO2-19* ANION GAP-23*\n___ 03:59PM CALCIUM-9.3 PHOSPHATE-2.9 MAGNESIUM-1.3*\n___ 03:59PM TSH-0.95\n___ 03:59PM T4-7.2\n\nEKG: Sinus tachycardia. Otherwise, probably normal tracing but \nbaseline artifact makes assessment difficult. Since the previous \ntracing of ___ there is probably no significant change.\nCTAP: 1. Heterogeneous post-contrast enhancement of the liver \nwith hypoenhancing lesion, which is too small to characterize \nbut statistically likely represents a cyst. This is stable. 2. \nCholelithiasis. 3. Slight interval decrease in size of the \nsimple fluid collection identified \nanterior to the stomach. This fluid does not have an enhancing \nrim and is \nlocated either within the omentum or between the omentum and \nstomach. it is of uncertain clinical significance. \nCXR: No pneumonia.\n___ yo F with a past medical history of TB, HTN, and PUD p/w 1 \nday of tremulousness.\n\n# Tremulousness: This is of unclear etiology. The patient has \nhad many of these episodes over the past ___ years and has been \nseen by neurology as an outpatient. They suggested an \nendocrinology work up. The episodes occur with flushing and \nhot-flashes. Differential includes pheochromocytoma, carcinoid \nand menopause. TSH and free T4 were relatively normal. AM \ncortisol was low but corticotropin stim test was normal. She was \nafebrile and without leukocytosis on exam. Had small anion gap \ninitially which resolved with 1L NS. Endocrinology and neurology \nwere consulted. She will follow up with endocrinology and \nneurology as an outpatient. Her symptoms resolved and she was \ndischarged with no tremors.\n\n# Tachycardia: Sinus tachycardia up to 130. This resolved with \nfluids and she was in NSR throughout her stay. She was \ndischarged in NSR.\n \n# Transaminitis: Currently being worked up by Dr. ___. Will \nfollow in ___ clinic as an outpatient.\n\n# Hypertension: Elevated upon admission. Resolved spontaneously. \nContinued on ACE-inhibitor per home regimen.\n\n# Peptic ulcer disease: anemia is at baseline. Continued PPI.\n\n# Anemia: At baseline. Should be followed up by primary care \nphysician.'}}
{'final_diagnoses': ['Tremors', 'Hypertension'], 'procedures': ['None'], 'visit_summary': '___ yo F with a past medical history of TB, HTN, and PUD p/w 1 \nday of tremulousness.\n\n# Tremulousness: This is of unclear etiology. The patient has \nhad many of these episodes over the past ___ years and has been \nseen by neurology as an outpatient. They suggested an \nendocrinology work up. The episodes occur with flushing and \nhot-flashes. Differential includes pheochromocytoma, carcinoid \nand menopause. TSH and free T4 were relatively normal. AM \ncortisol was low but corticotropin stim test was normal. She was \nafebrile and without leukocytosis on exam. Had small anion gap \ninitially which resolved with 1L NS. Endocrinology and neurology \nwere consulted. She will follow up with endocrinology and \nneurology as an outpatient. Her symptoms resolved and she was \ndischarged with no tremors.\n\n# Tachycardia: Sinus tachycardia up to 130. This resolved with \nfluids and she was in NSR throughout her stay. She was \ndischarged in NSR.\n \n# Transaminitis: Currently being worked up by Dr. ___. Will \nfollow in ___ clinic as an outpatient.\n\n# Hypertension: Elevated upon admission. Resolved spontaneously. \nContinued on ACE-inhibitor per home regimen.\n\n# Peptic ulcer disease: anemia is at baseline. Continued PPI.\n\n# Anemia: At baseline. Should be followed up by primary care \nphysician.', 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).', 'Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 54, 'gender': 'M', 'symptoms': 'abdominal pain, diarrhea', 'medical_history': ["-Indeterminate colitis, followed by Dr. ___ \ndiagnosed with Crohn's given patchy pattern of involvement on \nfirst colonoscopy); has never needed immunosuppressive therapy. \nPt now thought to have ulcerative colilitis.", '-hemorrhoids s/p bandings ', '-Transgender (female to male, surgical and hormonal) ', '-s/p mastectomy and TAH-BSO in ___ ', '-s/p L shoulder arthroscopy, ___ ', '-h/o Giardia infection at age ___ '], 'family_history': 'Sister with ulcerative colitis. Father with ___ \ncolitis', 'present_illness': 'Pt is a ___ y.o male with h.o UC dx in ___ who presents with 1 \nweek of abdominal cramping, worse after eating, diarrhea that is \nvariable with some formed stools, some diarrhea, and \nintermittent BRBPR (blood pellets in stool). Reports ___ daily \nuntil yesterday 20xdaily. Pt also reports significant nausea and \n1 day of night sweats. In addition, he reports weight loss of \n~10 lbs in 1 week due to decreased PO intake. Otherwise, denies \nfever, headache, ST, URI, CP, SOB, palpitations, other abdominal \npain, constipation, melena, dysuria, hematuria, joint pain, skin \nrash, paresthesias, weakness. Pt denies new foods, sick \ncontacts, recent antibiotics, travel. Of note, he was recently \ntapered off steroids 3weeks ago. Reports UC flare typically is \nbloody stool and dull LLQ pain. This is different and feels like \n"Food poisoning" per pt.', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.60', 'valuenum': 2.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 68.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '242', 'valuenum': 242.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.45', 'valuenum': 3.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'GEN: thin, NAD\nvitals: T 98.3, BP 101/67, HR 77, RR 16, sat 99% on RA\nHEENT: ncat eomi anicteric MMM no apparent OP lesions\nneck: no LAD, no JVD, supple\nchest: b/l ae no w/c/r\nheart: s1s2 rr no m/r/g\nabd:+bs, soft, mild TTP suprapubic area, no guarding or rebound \ntenderness\nback: non-tender, no CVA tenderness\next: no c/c/e 2+pulses\neuro: AAOx3, CN2-12 intact, non focal, no tremor\npsych: calm, cooperative\nskin: no apparent rash', 'diagnoses': [{'icd_code': '1518', 'desc': 'Malignant neoplasm of other specified sites of stomach'}, {'icd_code': '53140', 'desc': 'Chronic or unspecified gastric ulcer with hemorrhage, without mention of obstruction'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '1977', 'desc': 'Malignant neoplasm of liver, secondary'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': 'Admission Labs: ___ 05:09AM \nLACTATE-1.4\nGLUCOSE-92 UREA N-6 CREAT-1.2 SODIUM-139 POTASSIUM-4.7 CL-100 \nCO2-26\nWBC-8.3 RBC-4.60 HGB-12.7* HCT-38.6* MCV-84 PLT COUNT-275\n\nEKG-NSR @73, Na/ND, similar to prior \nSinus rhythm. Cannot exclude prior septal myocardial infarction \nbut may be \nnormal variant. Compared to the previous tracing of ___ \nthere is no \ndiagnostic change. \n\nMicrobiology: Stool cultures, C.difficile, Ova and Parasites all \nnegative\n\nDischarge Labs:\n___ 06:30AM WBC-8.0 RBC-3.78* Hgb-10.9* Hct-32.5* MCV-86 \nPlt ___\n___ 06:15AM Glucose-105* UreaN-12 Creat-0.8 Na-138 K-4.4 \nCl-103 HCO3-28 \n___ is a ___ y.o male with a history of ulcerative cholitis who \npresented with 1 week of abdominal cramping, nausea, and \ndiarrhea. \n \n#Abdominal cramping, nausea, diarrhea- This was initially \nbelieved to be infectious. As such, he was started on \nciprofloxacin and flagyl. His diarrhea actually became worse on \nthis therapy and he started having bloody stools. He was then \ntreated for an ulcerative colitis flare with IV Solumderol; \nCipro and Flagyl were continued. He was slowly weaned off of the \nSolumedrol to Prednisone and his diet was advanced to soft \nsolids. During this hospitalization the patient refused a \nflexible sigmoidoscopy; LFTs were normal, and CMV viral load and \nstool cultures were negative. He is being discharged on a slow \nsteroid taper; he completed his 7 day course of Cipro and Flagyl \non the day of discharge.'}}
{'final_diagnoses': ['Ulcerative colitis', 'Malnutriton', 'Anemia'], 'procedures': ['None'], 'visit_summary': '___ is a ___ y.o male with a history of ulcerative cholitis who \npresented with 1 week of abdominal cramping, nausea, and \ndiarrhea. \n \n#Abdominal cramping, nausea, diarrhea- This was initially \nbelieved to be infectious. As such, he was started on \nciprofloxacin and flagyl. His diarrhea actually became worse on \nthis therapy and he started having bloody stools. He was then \ntreated for an ulcerative colitis flare with IV Solumderol; \nCipro and Flagyl were continued. He was slowly weaned off of the \nSolumedrol to Prednisone and his diet was advanced to soft \nsolids. During this hospitalization the patient refused a \nflexible sigmoidoscopy; LFTs were normal, and CMV viral load and \nstool cultures were negative. He is being discharged on a slow \nsteroid taper; he completed his 7 day course of Cipro and Flagyl \non the day of discharge.', 'medications_prescribed': ['1. zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). ', '2. mesalamine 1,000 mg Suppository Sig: One (1) Suppository \nRectal DAILY (Daily). ', '3. lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) \nas needed for insomnia. ', '4. prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily) for 9 days: Please take 30mg (3 tablets) for 3 days, \nthen 20mg (2 tablets) for 3 days, then 10mg (1 tablet) for 3 \ndays.\nDisp:*18 Tablet(s)* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'Nausea, vomiting, abdominal pain', 'medical_history': ['Stage IIIc primary peritoneal serous \ncancer', 'DCIS of L breast', 'BRCA1', 'Stage 1A SCC of lung', 'Asthma', 'Hypertension'], 'family_history': 'Mother- ovarian cancer', 'present_illness': 'Ms. ___ is a ___ year old gravida 3, para ___ female with Stage \nIIIC optimally debulked primary peritoneal serous cancer with \nfurther disease progression since, presenting with left upper \nquadrant abdominal pain that started the night prior to \nadmission. The pain is consant and accompanied by nausea. \nMultiple episodes of small-volume emesis today. Last bowel \nmovement yesterday. No flatus or bowel movement since. She was \nseen for her regularly scheduled medical oncology appointment \ntoday by Dr. ___ ___ a stat CT abdomen/pelvis was \nordered showing a bowel obstruction with transition point in \nLUQ. Given zofran, ativan, and morphine in clinic with little \nrelief of symptoms. \nOf note, Ms. ___ underwent a exploratory laparotomy/lysis of \nadhesions/ radical hysterectomy/rectosigmoid resection with \nreanastamosis/ cystotomy repair/ Low anterior resection/ \nomentectomy in ___ and was considered optimally \ndebulked at that point. She initially underwent 6 cycles of \ncarboplatin and taxol followed by repeated chemotherapy \ntreatments including carboplatin/doxil, avastin, and gemcitabine \nuntil ___. She was found to have disease progression \nby CT and CA-125 in ___ of this year. She is currently \nenrolled in a clinical trial for ciplatin vs. olaparib in \nadvanced solid tumors.', 'medications': [{'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Terazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2, . Estimated GFR = 58 if non African-American (mL/min/1.73 m2) . Estimated GFR = 70 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam:\nT: 99 HR: 85 RR: 18 BP: 110/86 O2sat: 95%RA\nGeneral: No acute distress, alert, awake, oriented x 3\nHEENT: Healing oral mucosa lesion \nChest: Clear to auscultation bilaterally\nHeart: Regular rate and rhythm\nAbdomen: soft, mildly distended, tenderness to palpation in \nupper quadrants and periumbilically, hypoactive bowel sounds. No \nrebound/ guarding. \n\nDischarge Physical Exam: \nVital signs stable\nGeneral: No acute distress, alert, awake, oriented x 3 \nChest: Fine crackles at right base, otherwise clear to \nauscultation \nHeart: Regular rate and rhythm\nAbdomen: soft, non distended, no tenderness to palpation, + \nbowel sounds. No rebound/ guarding. \nExtremities: non tender, non edematous', 'diagnoses': [{'icd_code': 'C342', 'desc': 'Malignant neoplasm of middle lobe, bronchus or lung'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z85048', 'desc': 'Personal history of other malignant neoplasm of rectum, rectosigmoid junction, and anus'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z803', 'desc': 'Family history of malignant neoplasm of breast'}], 'summary': "IMAGING:\n\nCT Abdomen/pelvis with contrast (___):\nFINDINGS: \nCHEST: The base of the heart is unremarkable without pericardial \neffusion. \nThe lung bases have minimal bilateral atelectasis. There are no \npleural \neffusions, focal consolidation, or nodules. \nABDOMEN: The liver, gallbladder, pancreas, and spleen are \nunremarkable. There are no intra- or extra-hepatic biliary duct \ndilation. The portal venous system is patent. The bilateral \nadrenals are unremarkable. The bilateral kidneys are \nunremarkable and enhance and excrete contrast appropriately. The \nstomach is distended. The small bowel is also distended from the \nproximal duodenum through to a transition point best seen in \nimage 2, 43. There were no masses seen adjacent to the \ntransition point. Distal to this transition point is completely \ncollapsed small bowel. This is consistent with an early complete \nsmall bowel obstruction. There is fecalization of the small \nbowel contents directly proximal to the obstruction. There is no \nfree air or ascites in the abdomen. The large bowel is \nunremarkable and noted to have stool from the rectum to the \ncecum. This could mean that the obstruction is either early or \npartial, but given the severity of the distal small bowel \ncollapse, it likely is an early complete obstruction. There is \nminimal stranding in the mesentery. There are small periaortic \nlymph nodes, none of which meet criteria for pathological \nenlargement. There are multiple surgical clips in the abdomen. \nThe patient appears to be status post omentectomy. The \nurinary bladder is not distended, but unremarkable. There is no \nfree fluid in the pelvis. There is no pelvic or inguinal \nlymphadenopathy. The patient is s/p total abdominal \nhysterectomy. \nOSSEOUS STRUCTURES: There are no concerning lytic or sclerotic \nbony lesions. \nSOFT TISSUES: The patient is status post left mastectomy with \nbreast implant. There are no soft tissue nodules or hernias. \nIMPRESSION: \n1. Early complete small bowel obstruction with transition point \nin the left upper quadrant. Of note, the colon is not yet \ncollapsed and has stool \nthroughout, which indicates early obstruction. \n\nPortable abdominal radiograph (___): FINDINGS: Portable supine \nand upright views of the abdomen are provided. There is a \npaucity of small bowel gas consistent with the finding of a \nsmall-bowel obstruction. There is no free air or pneumotosis \nidentified in this film. \nCONCLUSION: No signs of free air. Bowel gas pattern consistent \nwith \nsmall-bowel obstruction. \n\nPortable chest radiograph (___): The lungs are low in volume \nand show bilateral lower lobe opacities. The cardiac silhouette \nis enlarged. The mediastinal silhouette and hilar contours are \nnormal. No pleural effusions or pneumothorax. A left-sided \nsubclavian line terminates with its tip in the cavoatrial \njunction. An NG tube passes out of view below the diaphragm. \nIMPRESSION: Bibasilar opacities could represent sequelae of \naspiration or atelectasis \n\nCT Chest/Abdomen (___): CT OF THE CHEST WITH AND WITHOUT \nCONTRAST: The imaged portion of the thyroid gland is normal in \nappearance. There is no axillary, hilar, mediastinal or \nsupraclavicular pathologic lymphadenopathy with scattered \nnonenlarged nodes seen. Heart and pericardium are unremarkable \nwithout pericardial effusion. The aorta and major branches are \npatent with normal three-vessel arch. Central venous catheter \nis seen terminating in the superior cavoatrial junction with no \nacute aortic pathology identified. No pulmonary embolism is \nseen. Trace right pleural effusion with resultant atelectasis is \nseen. Hypoenhancing consolidative process is seen in the left \nbase concerning for aspiration. The remainder of the lungs are \nclear. Nasogastric tube is seen coursing through the esophagus \nand terminating in the stomach. \nCT OF THE ABDOMEN WITH CONTRAST: The liver is normal in \nappearance without \nfocal lesion or intra- or extra-hepatic biliary ductal \ndilatation. Portal and hepatic veins appear patent. Gallbladder, \npancreas, spleen, and bilateral adrenal glands are unremarkable. \nThe kidneys enhance and excrete contrast symmetrically without \nhydronephrosis or focal lesion. \nStomach is not as distended as on the prior study after \ndecompression with \nnasogastric tube. Proximal small bowel loops are dilated, \nslightly less so \nthan on the prior study with likely transition point within the \nleft upper \nquadrant and decompressed distal loops compatible with \nsmall-bowel \nobstruction. Compared to the prior study, there is some passage \nof oral \ncontrast administered at that time one day prior with contrast \nseen within \nloops of distal ileum as well as in large bowel. There is a \ndecrease degree of intraperitoneal fluid since the prior study. \nNo free air is seen. No mesenteric or retroperitoneal pathologic \nlymphadenopathy is identified with scattered nonenlarged likely \nare reactive in nature. Atherosclerotic calcification of the \naorta is seen with patent appearing vessels. A small fat \ncontaining ventral hernia is again seen. Post surgical \nappearance from bowel resections and likely omentectomy noted. \nCT OF THE PELVIS WITH CONTRAST: Foley catheter is seen in the \nbladder with a large amount of air, likely related to Foley \ncatheter replacement. Patient is status post hysterectomy. The \nrectum is unremarkable. No free pelvic fluid is seen. There is \nno pelvic or inguinal pathologic lymphadenopathy. \nOSSEOUS STRUCTURES: No lytic or sclerotic bony lesions seen \nconcerning for \nosseous malignant process. Patient is status post left \nmastectomy with breast implant. \nIMPRESSION: \n1. No pulmonary embolism. \n2. Left base opacification is new and concerning for aspiration \nor pneumonia. \nTrace right effusion is seen. \n3. Small-bowel obstruction with decompressed distal loops and \ntransition \npoint in the left mid abdomen as before with slight apparent \ninterval \nimprovement with a small amount of contrast passing into the \ndistal ileum and large bowel. \n\nPortable Chest Radiograph (___): \nLeft Port-A-Cath catheter tip is at the level of cavoatrial \njunction. The NG tube tip is in the stomach. Heart size is \nnormal. Mediastinum is normal. Bibasilar opacities are noted \nassociated with small amount of bilateral pleural effusion. \nThere is no evidence of pneumothorax. \nThe increased opacity in the left lower lobe might represent \naspiration \nprocess and should be closely monitored. \n\nMICROBIOLOGY:\nUrine culture (___): no growth\nBlood cultures (___): no growth x 2\n\nPERTINENT LABS:\nOn admission:\n___ 09:15AM WBC-9.8 RBC-3.62* HGB-10.9* HCT-32.5* MCV-90 \nMCH-30.1 MCHC-33.5 RDW-17.7*\n___ 09:15AM NEUTS-74.6* ___ MONOS-5.9 EOS-0.1 \nBASOS-0.4\n___ 09:15AM PLT COUNT-234\n___ 09:15AM ___ PTT-18.6* ___\n___ 09:15AM LIPASE-19 GGT-38*\n___ 09:15AM TOT PROT-6.3* ALBUMIN-4.5 GLOBULIN-1.8* \nCALCIUM-9.7 MAGNESIUM-1.9\n___ 09:15AM CA125-460*\n___ 09:15AM LD(LDH)-242 AMYLASE-59\n___ 09:15AM UREA N-22* CREAT-0.7 SODIUM-140 POTASSIUM-3.8 \nCHLORIDE-98\n___ 09:15AM GLUCOSE-153*\n\nHD#2 (FICU transfer) \nGlucose 241 \nUrea Nitrogen 22 \nCreatinine 0.8 \nSodium 136 \nPotassium 3.0\nChloride 100 \nBicarbonate 28 \nAnion Gap 11 \nCreatine Kinase (CK) 27 Creatine Kinase, MB Isoenzyme 2 \nTroponin T <0.01 \nCalcium, Total 8.1 \nPhosphate 1.8\nMagnesium 1.2 \n\nWhite Blood Cells 1.3\nRed Blood Cells 2.68\nHemoglobin 8.0\nHematocrit 23.1\nMCV 86\nMCH 29.9 \nMCHC 34.6 \nRDW 18.1 \nDIFFERENTIAL \nNeutrophils 59 \nBands 12 \nLymphocytes 27 \nMonocytes 2 \nEosinophils 0 \nBasophils 0 \nAtypical Lymphocytes 0 \nMetamyelocytes 0 \nMyelocytes 0 \n\nDay of discharge:\n \nWhite Blood Cells 4.7 \nRed Blood Cells 3.63 \nHemoglobin 11.1 \nHematocrit 31.2\nMCV 86 \nMCH 30.5 \nMCHC 35.4 \nRDW 15.8\nPlatelet Count 215 \n\nUrea Nitrogen 9 \nCreatinine 0.5 \nSodium 141 \nPotassium 2.9 \nChloride 100 \nBicarbonate 28 \nAnion Gap 16 \nCalcium, Total 8.5 \nPhosphate 2.7 \nMagnesium 1.7\nMs. ___ was admitted to the Gyn-Oncology service for further \nmanagement of a small bowel obstruction. Her hospital course is \nas follows:\n\n*Small Bowel Obstruction: Given that Ms. ___ was initially \nhemodynamically stable with a soft abdomen, surgical management \nwas deferred. A nasogastric tube was placed for conservative \nmanagement of her symptoms. She was made NPO and received \nintravenous fluids, scheduled anti-emetics, and IV Dilaudid & \nAtivan prn. On hospital day #2, Ms. ___ developed acute onset \ntachycardia, desaturation to 86%, temperature of 102, and \naltered mental status. She was subsequently transferred to the \nSurgical Intensive Care Unit for 3 days where a thorough work-up \nwas negative for bowel perforation, pulmonary embolism, and \nsepsis. A chest radiograph and CT chest were consistent with \nwhat was likely an aspiration pneumonia and/or atelectasis. Ms. \n___ was started on levofloxacin and metronidazole in order to \nbroadly cover possible intrabdominal process and/or aspiration \npneumonia. All blood and urine culture data was negative. She \nwas transferred back to the floor in stable condition on \nhospital day #4 (afebrile, normal heart rate, stable on room \nair, intact mental status). Upon transfer to the floor, she was \nnoted to have minimal nasogastric output and improved nausea \nwith evidence of good bowel function. Her nasogastric tube was \nsubsequently clamped and discontinued. She was advanced to a \nregular diet slowly which she tolerated well with improved bowel \nfunction. \n\n*) Cardiovascular : Ms. ___ home Lisinopril was initially \nheld while NPO and restarted on day of discharge. She was given \nIV hydralazine as needed for blood pressure spikes. An EKG \nperformed during the acute episode on hospital day #2 showed \nnon-specific ST changes which was likely secondary to her \ntachycardia at that point. Cardiac enzymes were negative.\n.\n*) Pulmonary : Following the desaturation on room air as noted \nabove, Ms. ___ was initially placed on 2L nasal canula and was \neasily weaned to room air prior to transfer back to the floor. \nAs outlined above, a CTA was negative for pulmonary embolism. \nFindings on this CT and a chest radiograph were suspicious for a \npossible aspiration pneumonia. \n.\n*) Renal: A foley catheter was placed during her SICU stay, with \nadequate urine output throughout her stay. Patient's creatinine \nwas stable throughout stay. \n.\n*) Hematology: During the acute episode on hospital day #2, Ms. \n___ was noted to have a hematocrit drop from 29.9 to 23.1 She \nwas given 2 units of packed red blood cells in the SICU, with a \nsubsequent improvement in hematocrit to 32. On day of discharge \nher hematocrit and vital signs were stable. \n.\n*) Endocrine: Prior to admission, Ms. ___ was taking 15 mg \nprednisone daily as prescribed by her oncologist for oral \nmucosal lesions. As she was steroid dependent on admission and \ngiven her acute medical status, she was initially given 2 doses \nof stress steroids intravenously ( IV dexamethasone 10___ -> \n___ IV hydrocortisone 100). She was then placed on IV \nhydrocortisone 20 every 8 hours (equivalent to home prednisone \ndose) for maintenance. She had no adrenal symptoms while \ninpatient. She was transitioned to PO Prednisone 10mg when she \nstarted tolerating a regular diet. \n\n*) Hypokalemia, hypomagnesemia: Despite daily repletion (both \nintravenously and orally) Ms. ___ was peristently hypokalemic \nand hypomagnesemic. Per oncology, this was likely related to her \ncisplatin treatment. She will follow up with her oncologist to \nobtain labs to recheck her electrolytes on ___. She \nwas discharged home with a prescription for PO potassium. \n\n*) Oncology: Per Ms. ___ primary medical oncology team, she \nis still eligible for the current clinical trial she is enrolled \nin for cisplatin vs. olaparib in advanced solid tumors. She will \nfollow up with Dr. ___ discharge. \n.\n*) Prophylaxis: Ms. ___ was given subcutaneous heparin and \npneumatic boots. \n\nMs. ___ was discharged home on hospital day #5 in stable \ncondition- afebrile, stable vital signs, tolerating a regular \ndiet with evidence of good bowel function, ambulating and \nvoiding without difficulty."}}
{'final_diagnoses': ['Small Bowel Obstruction', 'Possible aspiration pneumonia'], 'procedures': ['None'], 'visit_summary': "Ms. ___ was admitted to the Gyn-Oncology service for further \nmanagement of a small bowel obstruction. Her hospital course is \nas follows:\n\n*Small Bowel Obstruction: Given that Ms. ___ was initially \nhemodynamically stable with a soft abdomen, surgical management \nwas deferred. A nasogastric tube was placed for conservative \nmanagement of her symptoms. She was made NPO and received \nintravenous fluids, scheduled anti-emetics, and IV Dilaudid & \nAtivan prn. On hospital day #2, Ms. ___ developed acute onset \ntachycardia, desaturation to 86%, temperature of 102, and \naltered mental status. She was subsequently transferred to the \nSurgical Intensive Care Unit for 3 days where a thorough work-up \nwas negative for bowel perforation, pulmonary embolism, and \nsepsis. A chest radiograph and CT chest were consistent with \nwhat was likely an aspiration pneumonia and/or atelectasis. Ms. \n___ was started on levofloxacin and metronidazole in order to \nbroadly cover possible intrabdominal process and/or aspiration \npneumonia. All blood and urine culture data was negative. She \nwas transferred back to the floor in stable condition on \nhospital day #4 (afebrile, normal heart rate, stable on room \nair, intact mental status). Upon transfer to the floor, she was \nnoted to have minimal nasogastric output and improved nausea \nwith evidence of good bowel function. Her nasogastric tube was \nsubsequently clamped and discontinued. She was advanced to a \nregular diet slowly which she tolerated well with improved bowel \nfunction. \n\n*) Cardiovascular : Ms. ___ home Lisinopril was initially \nheld while NPO and restarted on day of discharge. She was given \nIV hydralazine as needed for blood pressure spikes. An EKG \nperformed during the acute episode on hospital day #2 showed \nnon-specific ST changes which was likely secondary to her \ntachycardia at that point. Cardiac enzymes were negative.\n.\n*) Pulmonary : Following the desaturation on room air as noted \nabove, Ms. ___ was initially placed on 2L nasal canula and was \neasily weaned to room air prior to transfer back to the floor. \nAs outlined above, a CTA was negative for pulmonary embolism. \nFindings on this CT and a chest radiograph were suspicious for a \npossible aspiration pneumonia. \n.\n*) Renal: A foley catheter was placed during her SICU stay, with \nadequate urine output throughout her stay. Patient's creatinine \nwas stable throughout stay. \n.\n*) Hematology: During the acute episode on hospital day #2, Ms. \n___ was noted to have a hematocrit drop from 29.9 to 23.1 She \nwas given 2 units of packed red blood cells in the SICU, with a \nsubsequent improvement in hematocrit to 32. On day of discharge \nher hematocrit and vital signs were stable. \n.\n*) Endocrine: Prior to admission, Ms. ___ was taking 15 mg \nprednisone daily as prescribed by her oncologist for oral \nmucosal lesions. As she was steroid dependent on admission and \ngiven her acute medical status, she was initially given 2 doses \nof stress steroids intravenously ( IV dexamethasone 10___ -> \n___ IV hydrocortisone 100). She was then placed on IV \nhydrocortisone 20 every 8 hours (equivalent to home prednisone \ndose) for maintenance. She had no adrenal symptoms while \ninpatient. She was transitioned to PO Prednisone 10mg when she \nstarted tolerating a regular diet. \n\n*) Hypokalemia, hypomagnesemia: Despite daily repletion (both \nintravenously and orally) Ms. ___ was peristently hypokalemic \nand hypomagnesemic. Per oncology, this was likely related to her \ncisplatin treatment. She will follow up with her oncologist to \nobtain labs to recheck her electrolytes on ___. She \nwas discharged home with a prescription for PO potassium. \n\n*) Oncology: Per Ms. ___ primary medical oncology team, she \nis still eligible for the current clinical trial she is enrolled \nin for cisplatin vs. olaparib in advanced solid tumors. She will \nfollow up with Dr. ___ discharge. \n.\n*) Prophylaxis: Ms. ___ was given subcutaneous heparin and \npneumatic boots. \n\nMs. ___ was discharged home on hospital day #5 in stable \ncondition- afebrile, stable vital signs, tolerating a regular \ndiet with evidence of good bowel function, ambulating and \nvoiding without difficulty.", 'medications_prescribed': ['nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day) as needed for oral discomfort.', 'lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'levofloxacin 750 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours).\nDisp:*4 Tablet(s)* Refills:*0*', 'prednisone 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Dulcolax 10 mg Suppository Sig: One (1) suppository Rectal \nonce a day as needed for constipation.', 'potassium chloride 20 % Liquid Sig: Fifteen (15) mL PO once a \nday: Please adjust according to potassium level check on ___.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 36, 'gender': 'F', 'symptoms': 'increasing SOB', 'medical_history': ['Aortic Stenosis', 'Coronary Artery Disease, s/p PCI/stenting LAD ___', 'Hypertension', 'Dyslipidemia', 'Ocular migraines', 'Prostate Cancer, s/p XRT ___', 'Benign Prostatic Hypertrophy', 'Urinary incontinence, wears depends', 'Colon Polyps', 'Peripheral Neuropathy involving feet/legs', 'Gait abnormality consistent with minor vestibulopathy', 'ADHD', 'Osteoarthritis', 'Left Rotator Cuff Tear', 'Actinic Keratosis', 'Basal Cell Carcinoma', 'Erectile Dysfunction', 'Suicide attempt (per ___ records, pt denies)', 'Right femur fracture'], 'family_history': 'non-contributory', 'present_illness': '___ male s/p AVR ___ with uncomplicated post-op course. Was\ntransferred to rehab on POD#5.\nHe presented to the ER this evening from rehab with complaint of\nSOB with minimal activity and states he has been unable to\nprogress with rehab due to his activity intolerance. He also\nstates he has occasionally has panic attacks and was ordered for\nativan at rehab.\nHe went to his scheduled cardiology appointment on ___ and an\necho was done which reportedly showed a small/moderate\npericardial effusion without tamponade physiology, a well seated\naortic valve and perserved LV function. He was re-started on\nlasix 40mg po yesterday and he betablocker was decreased.\nHe is admitted today for work-up of his dyspnea and to rule out\ntamponade.', 'medications': [{'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bacitracin Ophthalmic Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'BP: 124/76. Heart Rate: 72. Resp. Rate: 18. O2 Saturation%: 98%\non 2LNP.\n\nGeneral: Pleasant very articulate elderly male lying flat on ER\nstretcher in no acute distress. \nSkin: Warm [x] Dry [x] Intact [x]\nHEENT: PERRL [x] EOMI [x]\nNeck: Supple [x] Full ROM [x] JVD []\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur [] Crisp heart sounds\nascultated\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds\n+[x]\nExtremities: Warm [x], well-perfused [x] Edema: Trace\nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: 2 Left: 2\nDP Right: 1 Left: 1\n___ Right: 1 Left: 1\nRadial Right: 2 Left: 2\nCarotid Bruit: none appreciated', 'diagnoses': [{'icd_code': '1600', 'desc': 'Malignant neoplasm of nasal cavities'}], 'summary': '___ 04:08PM BLOOD WBC-6.3 RBC-3.85* Hgb-11.9* Hct-36.9* \nMCV-96 MCH-31.0 MCHC-32.3 RDW-13.4 Plt ___\n___ 04:08PM BLOOD Neuts-66.0 ___ Monos-6.8 Eos-3.4 \nBaso-0.7\n___ 04:08PM BLOOD Plt ___\n___ 04:08PM BLOOD Glucose-107* UreaN-14 Creat-0.7 Na-138 \nK-4.5 Cl-101 HCO3-25 AnGap-17\n___ 05:02PM BLOOD D-Dimer-2656*\n___ 04:08PM BLOOD cTropnT-<0.01\n___ 04:08PM BLOOD proBNP-807\n___ 04:08PM BLOOD GreenHd-HOLD\n\n___ CTA\n1. No evidence of pulmonary embolism or aortic dissection. \n \n2. Status post aortic valve replacement with reactive \nmediastinal nodes and \nsmall pericardial fluid. \n \n3. Attenuation of the left brachiocephalic vein with multiple \nmediastinal \ncollateral vessels, suggestive of left brachiocephalic vein \nstenosis. \n \n4. Scattered nodular fibrosis and pleural thickening of the \nlungs. No focal \nconsolidation. \n \n5. Nodular thickening of the left adrenal gland, which may \nrepresent adrenal \nhypertrophy. \n \n6. Sequelae of prior granulomatous disease with calcified hilar \nlymph nodes \nand lung, liver, and spleen granulomas. \n \nPA&Lat ___\nNear-complete resolution of the previously noted small pleural \neffusions, with \nonly a trace amount of pleural fluid seen on the left. No acute \n\ncardiopulmonary abnormality otherwise identified. \n\nTTE ___\nLimited echocardiogram by on call fellow to assess for worsening \nof pericardial effusion. Due to suboptimal technical quality, a \nfocal wall motion abnormality cannot be fully excluded. Right \nventricular chamber size and free wall motion are normal. A \nmechanical aortic valve prosthesis is present. There is a \ntrivial/physiologic pericardial effusion. There is an anterior \nspace which most likely represents a prominent fat pad. Overal \nleft ventricular systolic function appears normal. \n\nIMPRESSION: Suboptimal image quality. Trivial pericardial \neffusion. \n\nPRELIMINARY REPORT developed by a Cardiology Fellow. Not \nreviewed/approved by the Attending Echo Physician. \nPatient was admitted for observation from rehab with increasing \nSOB on ___. His in hospital work-up did not reveal an acute \netiology for his SOB. CTA, TTE. CXR were unremarkable. His TTE \necho revealed a stable trivial pericardial effusion. Clinically \nhe remained stable overnight with good oxygenation and minimal \nSOB noted. It was felt that his breathing issues were related to \nhis deconditioning after surgery. He was encouraged to use his \nIS more and to continue ambulating as tolerated to increase his \nendurance. He was discharged back to ___ in \n___ ___ for further monitoring and rehabilitation. '}}
{'final_diagnoses': ['Aortic stenosis'], 'procedures': ['___ Aortic valve replacement with a 19 mm ___ tissue valve. Reference number is ___. ___'], 'visit_summary': 'Patient was admitted for observation from rehab with increasing \nSOB on ___. His in hospital work-up did not reveal an acute \netiology for his SOB. CTA, TTE. CXR were unremarkable. His TTE \necho revealed a stable trivial pericardial effusion. Clinically \nhe remained stable overnight with good oxygenation and minimal \nSOB noted. It was felt that his breathing issues were related to \nhis deconditioning after surgery. He was encouraged to use his \nIS more and to continue ambulating as tolerated to increase his \nendurance. He was discharged back to ___ in \n___ ___ for further monitoring and rehabilitation. ', 'medications_prescribed': ['Acetaminophen 650 mg PO Q4H:PRN pain', 'Albuterol-Ipratropium ___ PUFF IH Q6H:PRN sob/wheezing', 'Aspirin 81 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'Metoprolol Tartrate 25 mg PO BID', 'Potassium Chloride 20 mEq PO DAILY Duration: 7 Days', 'Simvastatin 20 mg PO DAILY', 'Tamsulosin 0.4 mg PO HS', 'Tolterodine 2 mg PO DAILY', 'Venlafaxine 375 mg PO DAILY', 'Furosemide 40 mg PO DAILY Duration: 7 Days']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 41, 'gender': 'M', 'symptoms': 'Hemoptysis', 'medical_history': ['Chronic Inflammatory Demyelinating Polyradiculoneuropathy\n(CIDP)', 'Cervical Myelopathy s/p Posterior cerival decompression C4-6, \nPosterior cervical fusion C3-T1 ___', 'Chronic renal insufficiency, baseline Cr 1.2-1.4', 'Possible myelodysplastic syndrome (persistently low blood \ncounts), followed by Dr. ___', '___', 'T8 compression fracture.', 'Squamous cell carcinoma', 'Irritable bowel syndrome, with chronic constipation\nalternating with diarrhea', 'Right and Left upper extremitiy VTEs', 'HTN'], 'family_history': 'Father died age ___ of CAD, mother in ___ with Alzheimers. No one \nwith other neurologic disease.', 'present_illness': "___ yo man with CIDP, cervical myelopathy s/p recent cervical \nfusion one month ago and post-op course complicated by subacute \nDVT's in both of arms and admission ___ for aspiration \npneumonia, now presents from ___ for evaluation of \nhemoptysis and possible SVC filter placement. Was on lovenox for \nhis DVT and has had multiple episodes of hemoptysis. The \nhemoptysis is felt most likely to be related to his \nanticoagulation and resolves with discontinuation of lovenox. \nHas not had further evaluation as to the cause of his \nhemoptysis. He is being admitted for CTA with pre-imaging \nhydration given his poor renal function (baseline Cr 1.2-1.4, Cr \n1.6 today). Has also had trouble with dysphagia (s/p multiple \nNGT at ___ attributed to his cervical myelopathy. He \nreports that he was evaluated by speech and swallow at rehab \nyesterday and was cleared for thin liquids. His outpatient \nphysician is also requesting that the patient be evaluated for \nSVC filter given b/l subacute blood clots and hemoptysis on \nanticoagulation.\n.\nOn ROS, pt notes occasional cough productive of white/green \nsputum x 1 month. Recent weight loss ___ decreased appetite. \nNumbness in fingers, toes, abdomen, and nose as well as RUE and \nb/l ___ weakness ___ his polyneuropathy.\n.\nED Course: T: 97.6, BP: 126/53, HR: 78, RR: 18, O2: 97% RA. \nReceived NS at 250cc/hr. Received kayexelate 30mg x 1 for K = \n5.4. Received ativan 0.5mg x 1.", 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'EPINEPHrine (EpiPEN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'ONCE MR1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone Graded Challenge', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'EPINEPHrine (EpiPEN)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '2.18', 'valuenum': 2.18, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.7', 'valuenum': 45.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76.7', 'valuenum': 76.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.46', 'valuenum': 5.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.15', 'valuenum': 0.15, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.58', 'valuenum': 0.58, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.89', 'valuenum': 9.89, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SM*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REFRACTOMETER.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '40.3', 'valuenum': 40.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T: 98.3, BP: 150/60, HR: 80, RR: 18, O2: 97% RA\nGEN: middle-aged male lying in bed, NAD\nHEENT: EOMI, poor dentition, mildly dry MM, OP clear\nNECK: supple, no cervical or supraclavicular LAD, well-healed \nanterior and posterior surgical incisions\nCHEST: crackles ___ up bilaterally, no wheeze or rhonchi\nCV: RRR, no m/r/g\nABD: soft, +BS, nontender, nondistended\nEXT: no ___ edema, LUE PICC line\nNEURO: A+O x3, R forearm ___ (able to prop hand up on elbow), \n___ strength in R hand, unable to lift R upper arm off of bed, \n___ motor LUE, ___ motor ___', 'diagnoses': [{'icd_code': 'T85638A', 'desc': 'Leakage of other specified internal prosthetic devices, implants and grafts, initial encounter'}, {'icd_code': 'K9189', 'desc': 'Other postprocedural complications and disorders of digestive system'}, {'icd_code': 'H527', 'desc': 'Unspecified disorder of refraction'}, {'icd_code': 'Y838', 'desc': 'Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}], 'summary': "PERTINENT LABS:\n___ WBC-3.8 Hgb-10.0 Hct-28.7 MCV-89 Plt ___\n___ Plt Ct-72\n___ Plt Ct-58\n___ ___ PTT-30.0 ___\n___ Glucose-255 UreaN-30 Creat-1.6 Na-138 K-5.4 Cl-104 \nHCO3-23\n___ Calcium-9.4 Phos-3.3 Mg-1.5\n.\n___ Urinalysis Color-Yellow Appear-Clear Sp ___\nBlood-NEG Nitrite-NEG Protein-TR Glucose-250 Ketone-TR \nBilirub-NEG Urobiln-NEG pH-5.0 Leuks-TR RBC-0 ___ \nBacteri-FEW Yeast-NONE ___\n.\nSTUDIES:\nCTA Chest (___): \nThere is minimal dependent atelectasis at the lung bases. There \nare scattered subcentimeter mediastinal lymph nodes. There is no \npericardial or pleural effusion.\nThere is extensive coronary atherosclerosis, most marked in the \nleft anterior descending coronary artery. There is no pulmonary \nembolism or aortic dissection.\nThe visualized liver and spleen appear unremarkable.\n.\nBilateral UE Ultrasound (___): A PIC line is detected in the \nleft basilic vein. Normal flow, compression, augmentation and \nwaveforms are demonstrated on the left. In one of the right \nbrachial veins, there is echogenic material within, and no flow \non doppler evaluation consistent with continued occlusive \nthrombus within the vessel. The remainder of the aforementioned \nveins are patent with wall-to-wall flow.\nMr. ___ is a ___ year-old man with PMH of CIDP, cervical \nmyelopathy s/p anterior and posterior cervical decompression \nwith post-op course complicated by dysphagia and RUE \nPICC-associated DVT as well as hemoptysis on anticoagulation, \nadmitted for evaluation of hemoptysis.\n.\n#. Hemoptysis: The patient has had multiple episodes of coughing \nup blood at rehab since initiation on ___. It is unclear \nwhether these episodes represented hemoptysis or UGI bleed. This \nwas felt to be most likely related to anticoagulation in the \nsetting of chronic thrombocytopenia. Per the doctor at ___, \nthe bleeding episodes tend to coincide with NGT trauma and so \nmay represent nasopharyngeal trauma as well. He did have guaiac \npositive stools, though no gross BRBPR or melena, so cannot \nrule-out a GI source. He has a history of a bleeding duodenal \nulcer. Most recent colonoscopy in ___ revealed an adenoma but \nwas otherwise unremarkable. CTA of his chest was negative for PE \nor other underlying pulmonary pathology. Lovenox was held. He \nhad no episodes of hemoptysis during his admission. GI consult \nwas considered but deferred given his lack of symptoms. If he \ndevelops further bleeding episodes in the future, GI consult can \nbe considered as an outpatient.\n.\n#. UE DVTs: Patient developed a PICC-associated DVT in his RUE \nnoted on ___ and has been on anticoagulation, most recently \nlovenox. There is also mention of a left UE DVT however no \ndocumentation can be found in our system. Anticoagulation has \nbeen complicated by hemoptysis while at rehab (as above) and \nlovenox was discontinued. Repeat US during this admission showed \nthat he still has residucal clot in his right brachial vein. No \nLUE DVT was visualized. Case was discussed with the patient's \noutpatient hematologist, Dr. ___ felt that the patient \nhas completed a sufficient 6 week course of anti-coagulation for \nthe RUE DVT. There is no indication for further anticoagulation \nor SVC filter at this time. If he develops new clot for any \nreason or develops symptoms related to his RUE DVT this can be \nre-assessed.\n.\n#. CIDP: He is followed by Dr. ___ Dr. ___ Neurology \nhere. Dr. ___ came to see the patient while he was admitted. \nHe receives 35g IVIG infusion for 2 consecutive days every 2 \nweeks. He had received his first dose on the day prior to \nadmission. He received a second dose on ___. Per Dr. ___ \nwill receive another dose on the day of discharge upon returning \nto ___. He was continued on his prednisone alternating 15mg \nand 10mg daily. \n.\n#. DM: He was continued on an insulin sliding scale.\n.\n#. Hypertension: He was continued on amlodipine and metoprolol. \nHCTZ was held given the dye load he received for the CTA and his \nunderlying chronic kidney disease.\n.\n#. Gout: Colchicine was held for renal protection given the dye \nload with his CTA and his underlying chronic kidney disease.\n.\n#. ?Heparin allergy: The patient notes that he has an allergy to \nheparin. Heparin products (PICC line heparin flushes) were held \nand HIT antibody was sent. HIT antibody is pending at the time \nof discharge and should be follow-up as an outpatient.\n.\n#. PPX: Pt refuses heparin citing he is allergic. Pneumoboots \nwere used for DVT prophylaxis.\n.\n#. Dispo: He was discharged back to ___ rehab. Treatment \nplan was discussed with his doctor at ___, Dr. ___.\n."}}
{'final_diagnoses': ['Hemoptysis', 'subacute RUE DVT', 'CIDP', 'DM', 'HTN', 'cervical myelopathy'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ year-old man with PMH of CIDP, cervical \nmyelopathy s/p anterior and posterior cervical decompression \nwith post-op course complicated by dysphagia and RUE \nPICC-associated DVT as well as hemoptysis on anticoagulation, \nadmitted for evaluation of hemoptysis.\n.\n#. Hemoptysis: The patient has had multiple episodes of coughing \nup blood at rehab since initiation on ___. It is unclear \nwhether these episodes represented hemoptysis or UGI bleed. This \nwas felt to be most likely related to anticoagulation in the \nsetting of chronic thrombocytopenia. Per the doctor at ___, \nthe bleeding episodes tend to coincide with NGT trauma and so \nmay represent nasopharyngeal trauma as well. He did have guaiac \npositive stools, though no gross BRBPR or melena, so cannot \nrule-out a GI source. He has a history of a bleeding duodenal \nulcer. Most recent colonoscopy in ___ revealed an adenoma but \nwas otherwise unremarkable. CTA of his chest was negative for PE \nor other underlying pulmonary pathology. Lovenox was held. He \nhad no episodes of hemoptysis during his admission. GI consult \nwas considered but deferred given his lack of symptoms. If he \ndevelops further bleeding episodes in the future, GI consult can \nbe considered as an outpatient.\n.\n#. UE DVTs: Patient developed a PICC-associated DVT in his RUE \nnoted on ___ and has been on anticoagulation, most recently \nlovenox. There is also mention of a left UE DVT however no \ndocumentation can be found in our system. Anticoagulation has \nbeen complicated by hemoptysis while at rehab (as above) and \nlovenox was discontinued. Repeat US during this admission showed \nthat he still has residucal clot in his right brachial vein. No \nLUE DVT was visualized. Case was discussed with the patient's \noutpatient hematologist, Dr. ___ felt that the patient \nhas completed a sufficient 6 week course of anti-coagulation for \nthe RUE DVT. There is no indication for further anticoagulation \nor SVC filter at this time. If he develops new clot for any \nreason or develops symptoms related to his RUE DVT this can be \nre-assessed.\n.\n#. CIDP: He is followed by Dr. ___ Dr. ___ Neurology \nhere. Dr. ___ came to see the patient while he was admitted. \nHe receives 35g IVIG infusion for 2 consecutive days every 2 \nweeks. He had received his first dose on the day prior to \nadmission. He received a second dose on ___. Per Dr. ___ \nwill receive another dose on the day of discharge upon returning \nto ___. He was continued on his prednisone alternating 15mg \nand 10mg daily. \n.\n#. DM: He was continued on an insulin sliding scale.\n.\n#. Hypertension: He was continued on amlodipine and metoprolol. \nHCTZ was held given the dye load he received for the CTA and his \nunderlying chronic kidney disease.\n.\n#. Gout: Colchicine was held for renal protection given the dye \nload with his CTA and his underlying chronic kidney disease.\n.\n#. ?Heparin allergy: The patient notes that he has an allergy to \nheparin. Heparin products (PICC line heparin flushes) were held \nand HIT antibody was sent. HIT antibody is pending at the time \nof discharge and should be follow-up as an outpatient.\n.\n#. PPX: Pt refuses heparin citing he is allergic. Pneumoboots \nwere used for DVT prophylaxis.\n.\n#. Dispo: He was discharged back to ___ rehab. Treatment \nplan was discussed with his doctor at ___, Dr. ___.\n.", 'medications_prescribed': ['Prednisone 5 mg Tablet Sig: Three (3) Tablet PO EVERY OTHER \nDAY (Every Other Day): alternate daily with 10mg dose.', 'Prednisone 10 mg Tablet Sig: One (1) Tablet PO EVERY OTHER \nDAY (Every Other Day): alternate daily with 15mg dose.', 'Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at \nbedtime).', 'Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times a \nday).', 'Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', 'Lansoprazole 30 mg Capsule, Delayed Release(E.C.) Sig: One \n(1) Capsule, Delayed Release(E.C.) PO once a day.', 'Cyanocobalamin 500 mcg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', 'Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed.', 'Citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily).', 'Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO once a day.', 'Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO \nonce a day.', 'Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO ___.', 'Calcium 500 with Vitamin D 500 (1,250)-200 mg-unit Tablet \nSig: One (1) Tablet PO three times a day.', 'Insulin Regular Human 100 unit/mL Cartridge Sig: as per \nsliding scale Injection four times a day.', 'IVIG Sig: ___ (35) mg once for 1 doses: to be \ngiven today, last dose was 35mg given on ___.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 61, 'gender': 'M', 'symptoms': 'Fevers', 'medical_history': ["s/p Roux-en-Y gastrojejunostomy, antrectomy and vagotomy ___ \nfor 'severe gastritis or gastroparesis' at ___ in \n___", 's/p cholecystectomy ___', 's/p ex-lap for LOA with resection of distal stomach, redo \nRoux-enY anastomosis, resection of previous jejunojejunostomy w \nreanastamosis', 'chronic afferent loop syndrome s/p ex lap for LOA with excision \nand reconstruction of both anastomoses ___', 'Polycythemia ___', '___', 'Hepatitis C, untreated. Prior liver biopsy apparently showed \nminimal inflammation', 'Chronic Stable Asthma/COPD', 'Recurrent UTIs on Amoxicillin prophylaxis', 'Rheumatoid arthritis; s/p multiple R hand operations'], 'family_history': 'Stomach cancer in maternal aunt and cousin. No other family \nhistory of any GI or liver conditions. Her father died of CAD at \n___ and her mother is alive and well.', 'present_illness': 'Patient presented from ___ where she was \ntreated for fevers and chills beginning on approx ___, per \npatient. States she had been doing well and improving when last \n___ or ___ she developed fevers, which were per patient \nmaximal at 102.5. On ___ she was transferred to ___ \n___, where it was recommended she be sent to ___ \nbut the patient refused following discussion of risks and \nbenefits. Pt had a CT done which demonstrated 2 abscess in the \nright flank and pelvis along with ___ fluid collection around \nher pancreas. Her pressures dropped into the ___, though she \nremained asymptomatic and was given IVF, made NPO, and started \non Vanc and Zosyn.\n\nShe describes the pain as new, sharp, and worse with movement or \npalpation, maximally in her lower abdomen but present diffusely. \n She denies radiation of the pain. She denies pain with eating, \ndefecation or urine. Denies back or flank pain. She denies \nnausea currently, though states she vomitted one time yesterday. \nDenies SOB, CP, or cough. Denies urinary symptoms. Denies \nchange in bowel habit character. Denies feelings of light \nheadedness or palpitations.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Tobramycin-Dexamethasone Ophth Susp', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Propoxyphene Nap.-Apap (N-100)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.1', 'valuenum': 76.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 187.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.07, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.11', 'valuenum': 4.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 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None}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '51.4', 'valuenum': 51.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52.9', 'valuenum': 52.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.3', 'valuenum': 43.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.45', 'valuenum': 3.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52.7', 'valuenum': 52.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55.7', 'valuenum': 55.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72.1', 'valuenum': 72.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.9', 'valuenum': 53.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '258', 'valuenum': 258.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61.1', 'valuenum': 61.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen: Alert and oriented, no acute distress, cachectic\nCV: RRR\nPulm: no respiratory distress\nAbd: Soft, non-tender, non-distended, tube (in the roux limb) in \nplace with no signs of infection around the tube site and is \ndraining bile\nExt: warm and well perfused', 'diagnoses': [{'icd_code': '1420', 'desc': 'Malignant neoplasm of parotid gland'}, {'icd_code': '5185', 'desc': 'Pulmonary insufficiency following trauma and surgery'}, {'icd_code': '41511', 'desc': 'Iatrogenic pulmonary embolism and infarction'}, {'icd_code': '99812', 'desc': 'Hematoma complicating a procedure'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '2771', 'desc': 'Disorders of porphyrin metabolism'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '71690', 'desc': 'Arthropathy, unspecified, site unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '4580', 'desc': 'Orthostatic hypotension'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}], 'summary': '___ 11:34PM GLUCOSE-172* UREA N-13 CREAT-0.5 SODIUM-133 \nPOTASSIUM-3.1* CHLORIDE-104 TOTAL CO2-23 ANION GAP-9\n___ 11:34PM estGFR-Using this\n___ 11:34PM ALT(SGPT)-30 AST(SGOT)-24 ALK PHOS-90 \nAMYLASE-66 TOT BILI-0.4\n___ 11:34PM LIPASE-64*\n___ 11:34PM CALCIUM-7.1* PHOSPHATE-2.4* MAGNESIUM-1.7\n___ 11:34PM WBC-9.3 RBC-3.77* HGB-10.3* HCT-31.3* MCV-83 \nMCH-27.4 MCHC-33.0 RDW-16.5*\n___ 11:34PM NEUTS-94.7* LYMPHS-3.7* MONOS-1.3* EOS-0 \nBASOS-0.2\n___ 11:34PM PLT COUNT-330\nMs. ___ was admitted ___ after being treated at an \noutside hospital for fevers and finding of right sided pelvic \nabscess on CT scan. On admission, she was maintained on \nvancomycin and zosyn, kept npo and on IV fluids. Her CT scan \nfrom the outside hospital was uploaded in our OMR system. Labs \nwere also sent on admission which revealed a normalized WBC of \n9.3. After careful review of her CT scan, it decided that there \nwas no intervention needed given the size and location of the \nabscess as well as normal WBC and being afebrile. On HOD#1 \nevening, she was advanced to a CLD which she tolerated well. \nShe was also started on a bowel regimen. On HOD#3, given her \nsocial situation and the need to take care of her mother who is \nsoon to undergo surgery it was decided that she would be \ndischarged home with ___ services. On the day of discharge, she \nwalked with the nursing staff and was stable on her feet. She \nremained afebrile, voiding freely, having normal bowel movement, \ntube draining appropriately, and with good pain control.'}}
{'final_diagnoses': ['Intra-abdominal collection'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ was admitted ___ after being treated at an \noutside hospital for fevers and finding of right sided pelvic \nabscess on CT scan. On admission, she was maintained on \nvancomycin and zosyn, kept npo and on IV fluids. Her CT scan \nfrom the outside hospital was uploaded in our OMR system. Labs \nwere also sent on admission which revealed a normalized WBC of \n9.3. After careful review of her CT scan, it decided that there \nwas no intervention needed given the size and location of the \nabscess as well as normal WBC and being afebrile. On HOD#1 \nevening, she was advanced to a CLD which she tolerated well. \nShe was also started on a bowel regimen. On HOD#3, given her \nsocial situation and the need to take care of her mother who is \nsoon to undergo surgery it was decided that she would be \ndischarged home with ___ services. On the day of discharge, she \nwalked with the nursing staff and was stable on her feet. She \nremained afebrile, voiding freely, having normal bowel movement, \ntube draining appropriately, and with good pain control.', 'medications_prescribed': ['TraMADOL (Ultram) 50 mg PO Q4H:PRN pain \nRX *tramadol 50 mg ___ tablet(s) by mouth q4hrs:prn Disp #*30 \nTablet Refills:*1', 'Aspirin 81 mg PO DAILY', 'Montelukast Sodium 5 mg PO DAILY', 'Nicotine Patch 14 mg TD DAILY', 'Zolpidem Tartrate 5 mg PO HS', 'Docusate Sodium 100 mg PO BID', 'Multivitamins 1 TAB PO DAILY', 'Senna 1 TAB PO BID:PRN constipation', 'Amoxicillin 500 mg PO DAILY', 'Omeprazole 40 mg PO DAILY', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \nInhalation BID', 'Amoxicillin-Clavulanic Acid ___ mg PO Q8H \nRX *amoxicillin-pot clavulanate 500 mg-125 mg 1 by mouth three \ntimes a day Disp #*52 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['Stage IV Breast CA', 'Lumpectomy, chemo/radiation ___', 'Mastectomy, chemo radiation, mets to liver/chest wall ___', 'GERD', 'Hypothyroidism'], 'family_history': 'Father: prostate cancer, CHF, MI, died at age ___\nMother: multiple TIAs', 'present_illness': '___ female with hx of stage IV breast CA with mets to \nlivier and chest wall presenting with chest pain. Pt reports that \nchest pain began at 5pm at night while lying in bed. Describes \nthe pain as the feeling of a "grapefruit sitting on her chest," \n___ in intensity at its worst. Also describes pain as feeling \nof food stuck in chest although it was not exacerbated by \neating. Associated with nausea; had one episode of NBNB emesis \nafter dinner that night. Pain waxed and waned until this \nmorning, ranging from ___ to ___, lasting ___ minutes at its \nworst. Also had numbness/tingling down both forearms; unclear if \nthis coincided with chest pain. No associated SOB or \ndiaphoresis. At baseline, pt has no cardiac history. Denies \nprevious episodes of CP. Reports DOE since ___ when she \nhad nosebleeds ___ chemo and was put on Procrit; reports anemia \nthat never resolved. States that exercise tolerance has never \nreached normal levels. \n. \nOf note, pt states that she has been several chemo regimens for \nher breast cancer, most recently Gemzar, with which she has had \nsevere myalgias. She had ___ cycles of Gemzar but third cycle \nwas postponed due to leukopenia. She also has had mets on chest \nwall but reports no chest pain with that. Has severe GERD but \nstates that sxs of GERD are cough and not chest pain. On review \nof systems, she denies any prior history of stroke, TIA, deep \nvenous thrombosis, pulmonary embolism, cough, hemoptysis, black \nstools or red stools. She denies recent fevers, chills or \nrigors. He denies exertional buttock or calf pain. Cardiac \nreview of systems is notable for absence of chest pain, \nparoxysmal nocturnal dyspnea, orthopnea, palpitations, syncope \nor presyncope. \n. \nAt ED vitals were 97.4 ___ 16 100%RA. She received GI \ncocktail, aspirin and tylenol which helped alleviate pain; \nmorphine resolved pain altogether. CTA chest was negative for \nPE. EKG was unremarkable; first troponin was 0.88 (baseline \nunknown). She was started on heparin gtt. At ED BP rose to \nsystolic 180s. She received 50mg metoprolol po x 1. Pt has no hx \nof HTN but reports that BP is often elevated at hospital \n(systolic 140s).', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mouth Care Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PHENObarbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'PHENObarbital - ICU Alcohol Withdrawal (Initial Load / Rescue Dose)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'PHENObarbital - ICU Alcohol Withdrawal (Initial Load / Rescue Dose)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mouth Care Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol 1000mg/100mL 100mL VIAL', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'FoLIC Acid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl 2.5mg 50mL Bag', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.53', 'valuenum': 1.53, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '57.4', 'valuenum': 57.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.32', 'valuenum': 0.32, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.76', 'valuenum': 2.76, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '54.4', 'valuenum': 54.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.47', 'valuenum': 4.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52.7', 'valuenum': 52.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'POS*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'POS*. First-time positive HCV Ab will automatically reflex HCV viral load.. See results in Chemistry section..'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.6, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '0.443', 'valuenum': 0.443, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.006', 'valuenum': 0.006, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.64', 'valuenum': 32.64, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.08', 'valuenum': 1.08, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.4', 'valuenum': 51.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.0', 'valuenum': 50.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS - Tc 98.4 Tmax 98.4 BP 137/88 (131-180/83-103) HR 73 (64-81) \nRR 18 O2 sat 98%RA\nGen: WDWN middle aged female in NAD. Oriented x3. Mood, affect \nappropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa.\nNeck: Supple, no JVD\nCV: B/l mastectomy scars. PMI located in ___ intercostal space, \nmidclavicular line. RRR, normal S1, S2. No m/r/g. No thrills, \nlifts. No S3 or S4.\nChest: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi.\nAbd: Soft, NT, ND.\nExt: No c/c/e.\nSkin: No stasis dermatitis, ulcers, scars, or xanthomas.\n.\nPulses:\nRight: DP 2+ ___ 2+\nLeft: DP 2+ ___ 2+', 'diagnoses': [{'icd_code': 'S0240FA', 'desc': 'Zygomatic fracture, left side, initial encounter for closed fracture'}, {'icd_code': 'S0219XA', 'desc': 'Other fracture of base of skull, initial encounter for closed fracture'}, {'icd_code': 'W1830XA', 'desc': 'Fall on same level, unspecified, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'S0003XA', 'desc': 'Contusion of scalp, initial encounter'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'K769', 'desc': 'Liver disease, unspecified'}], 'summary': 'On admission:\n\n___ 02:10PM BLOOD WBC-6.6 RBC-3.60* Hgb-9.7* Hct-30.8* \nMCV-86 MCH-27.1 MCHC-31.7 RDW-21.9* Plt ___\n___ 02:10PM BLOOD Neuts-70.2* ___ Monos-7.0 Eos-1.3 \nBaso-0.2\n___ 02:10PM BLOOD ___ PTT-27.1 ___\n___ 02:10PM BLOOD Glucose-98 UreaN-12 Creat-0.6 Na-137 \nK-4.1 Cl-102 HCO3-26 AnGap-13\n___ 02:10PM BLOOD CK(CPK)-477*\n___ 02:10PM BLOOD cTropnT-0.88*\n___ 09:36PM BLOOD CK(CPK)-364*\n___ 09:36PM BLOOD CK-MB-48* MB Indx-13.2* cTropnT-1.14*\n___ 05:51AM BLOOD CK(CPK)-264*\n___ 05:51AM BLOOD CK-MB-31* MB Indx-11.7* cTropnT-1.00*\n___ 11:53PM BLOOD CK(CPK)-143\n___ 11:53PM BLOOD CK-MB-12* MB Indx-8.4*\n___ 05:49AM BLOOD CK(CPK)-129\n___ 05:49AM BLOOD CK-MB-10 MB Indx-7.8* cTropnT-1.08*\n___ 05:51AM BLOOD Calcium-9.1 Phos-3.2 Mg-2.0 Cholest-236*\n___ 05:51AM BLOOD Triglyc-128 HDL-55 CHOL/HD-4.3 \nLDLcalc-155*\n.\nOn discharge:\n\n___ 05:49AM BLOOD WBC-7.2 RBC-3.64* Hgb-9.8* Hct-31.2* \nMCV-86 MCH-26.9* MCHC-31.4 RDW-21.0* Plt ___\n___ 05:49AM BLOOD Glucose-92 UreaN-11 Creat-0.6 Na-138 \nK-4.0 Cl-102 HCO3-30 AnGap-10\n___ 05:49AM BLOOD Calcium-9.1 Phos-3.8 Mg-1.9\n.\nECG ___:\nSinus rhythm. Modest lateral lead ST segment junctional \ndepression is \nnon-specific and tracing may be within normal limits. Clinical \ncorrelation is suggested. No previous tracing available for \ncomparison. \n.\nCTA Chest ___:\nFINDINGS: There is no pulmonary embolus or acute aortic \nsyndrome. The heart is normal in size. There is no pericardial \neffusion. \n \nA right subclavian line terminates in the inferior SVC. \n \nSome focal pleural thickening and pleural parenchymal scarring \nis noted within the anterior left upper lobe (3:15), likely due \nto chest wall radiation. Mild atelectasis is present at the lung \nbases. There is no focal consolidation or pleural effusions. \n \nChanges of total bilateral mastectomy are noted. There is no \naxillary, \nmediastinal, or hilar adenopathy. \n \nExamination is not tailored for subdiaphragmatic evaluation, but \nreveals a \nvague 2.4 x 1.4 cm hypoenhancing mass in hepatic segment IV \n(3:17) as well as coarse calcification in the right lobe likely \nreflecting prior granulomatous infection. \n \nMild degenerative changes are noted in the thoracolumbar spine, \nwith slight thoracic dextroscoliosis that is likely positional. \n \nIMPRESSION: \n1. No pulmonary embolus. \n2. Bilateral mastectomy with left upper lobe pleural parenchymal \nscarring. \n3. Incompletely characterized liver hypodense lesion. \nCorrelation with any outside imaging is recommended, or further \nevaluation with MRI can be obtained for better characterization. \n\n.\nCardiac Cath ___:\nCOMMENTS: \n1. Selective angiography of this right dominant system \ndemonstrated single vessel coronary artery disease. The left \nmain coronary artery was normal in appearence. The LAD had mild \nluminal luminal irregularities in the distal vessel. The LCx \ndemonstrated a total occlusion in the proximal segment of hte \nupper pole branch of OM1, wiht disstal filling via left to left \ncollaterals. There was no significant RCA disease. \n2. Resting limited hemodynamics showed normal systemic blood \npressure of 137/67 mm Hg with a mean pressure of 96 mmHg. \n3. Successful PTCA only of the proximal total occlusion of the \nupper pole branch of OM1 with both an Apex Flew OTW 1.5x8mm and \nApex Rx 1.5x12mm balloons. Final angiography revealed continued \nnormal flow, no angiographically apparent dissection and 30% \nresidual stenosis in the PTCA segment. (see ___ comments for \ndetails) \n4. R ___ femoral artery angioseal closure device deployed \nwithout complications. \n \nFINAL DIAGNOSIS: \n1. Single vessel coroary artery disease. \n2. Successful PTCA of proximal segment of upper pole branch of \nOM1 which remained a small vessel. \n3. ASA indefinitely; no need for plavix (clopidogrel) therapy \n.\nTTE ___:\nThe left atrium is normal in size. Left ventricular wall \nthicknesses and cavity size are normal. There is mild regional \nleft ventricular systolic dysfunction with mild hypokinesis of \nthe mid to distal inferolateral and inferior walls. The inferior \nwall has marginally better function. Right ventricular chamber \nsize and free wall motion are normal. The aortic valve leaflets \n(3) are mildly thickened but aortic stenosis is not present. No \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. Trivial mitral regurgitation is seen. The \ntricuspid valve leaflets are mildly thickened. The pulmonary \nartery systolic pressure could not be determined. There is a \ntrivial/physiologic pericardial effusion.\n\nIMPRESSION: Mild focal LV systolic dysfunction consistent with \nsingle vessel CAD. No pathologic valvular abnormality seen.\n___ female with hx of stage IV breast CA with mets to \nlivier and chest wall presenting with chest pain. \n. \n#. Chest pain: \nPt had no cardiac history but presented with chest pain \nassociated with nausea and numbness/tingling down both arms. EKG \nwas unremarkable but troponin on admission was elevated at 0.88 \nand peaked at 1.14. Pt was placed on a heparin gtt and plavix \nloaded prior to cardiac catheterization on ___. Cardiac \ncath showed single vessel CAD with total occlusion in the \nproximal segment of OM1. TTE revealed mild focal LV systolic \ndysfunction consistent with single vessel CAD; EF 45-50%. She \nwas started on an aspirin, statin (LDL 155), and beta blocker. \nLow dose ACEi was also added for elevated blood pressures during \nhospital stay. \n. \n#. Breast CA:\nNo acute issues. Pt with history of stage IV breast CA and \nclose follow-up with heme/onc. \n.\n#. Hypothyroidism: \nNo acute issues. She was continued on her home dose of \nlevothyroxine.'}}
{'final_diagnoses': ['CAD', 'Breast CA', 'GERD', 'Hypothyroidism'], 'procedures': ['Cardiac Catheterization', 'Percutaneous transluminal coronary angioplasty of OM1'], 'visit_summary': '___ female with hx of stage IV breast CA with mets to \nlivier and chest wall presenting with chest pain. \n. \n#. Chest pain: \nPt had no cardiac history but presented with chest pain \nassociated with nausea and numbness/tingling down both arms. EKG \nwas unremarkable but troponin on admission was elevated at 0.88 \nand peaked at 1.14. Pt was placed on a heparin gtt and plavix \nloaded prior to cardiac catheterization on ___. Cardiac \ncath showed single vessel CAD with total occlusion in the \nproximal segment of OM1. TTE revealed mild focal LV systolic \ndysfunction consistent with single vessel CAD; EF 45-50%. She \nwas started on an aspirin, statin (LDL 155), and beta blocker. \nLow dose ACEi was also added for elevated blood pressures during \nhospital stay. \n. \n#. Breast CA:\nNo acute issues. Pt with history of stage IV breast CA and \nclose follow-up with heme/onc. \n.\n#. Hypothyroidism: \nNo acute issues. She was continued on her home dose of \nlevothyroxine.', 'medications_prescribed': ['Ranitidine HCl 150 mg Tablet Sig: 0.5 Tablet PO HS (at \nbedtime).', 'Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*', 'Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*0*', 'Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO once a \nday: Please resume your previous levothyroxine regimen or 112 \nmcg daily plus ___ tab once weekly.', 'Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*0*', 'Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO once a day.\nDisp:*30 Tablet Sustained Release 24 hr(s)* Refills:*0*', 'Omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO twice a day.', 'Amitriptyline 100 mg Tablet Sig: One (1) Tablet PO at \nbedtime.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 79, 'gender': 'F', 'symptoms': 'Transfer with rising creatinine. Fevers/hematuria/weakness.', 'medical_history': ['ESRD ___ diabetic nephropathy s/p DDRT in ___', 'HTN', 'DM on insulin c/b nephropathy, retinopathy', 'Gout', 'Carpal Tunnel', 'Cataracts', 'Multiple CVA/TIA with righ hemiparesis with last in \n___ with new CVA in the inferior pons on the right \nat the level of the middle cerebellar artery, ischemic', 'HLD', 'History of seizures', 'GERD', 'dCHF'], 'family_history': 'His four brothers and one sister all have adult onset diabetes \nand both parents had diabetes, as well. He is the first person \nwith diabetic end stage renal failure in his family.', 'present_illness': '___ yo M with PMHx of DDRT on ___ and recent CVA in ___ \nwith a CVA in the right inferior pons presented to ___ from \nrehab on ___ with hematuria and fevers. He was found to be \nflu negaitve but with the hematuria and his history fo a renal \ntransplant he was initally covered with CTX but he was found to \nhave non-lactose fermenting bacteria in urin. He was switched to \nzosyn on ___ but his creatinine has rise to the 3s and he has \na leukocytosis to 18. At this time he was felt to need to be \ntransfered to ___. Of note, he has suffered from prograf \ntoxicity and was switched to sirolimus. His baseline creatinine \nis 1.4-1.9. \n\nOn arrival to ___ he reprots that he continue to be weak but \notherwise feels at his baseline. He reports not fever or chills, \nlightheadedness, dizziness, or urinary smyptoms of any kind. \nROS: per HPI, denies fever, chills, night sweats, headache, \nvision changes, rhinorrhea, congestion, sore throat, cough, \nshortness of breath, chest pain, abdominal pain, nausea, \nvomiting, diarrhea, constipation, BRBPR, melena, hematochezia, \ndysuria, hematuria. ', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxybutynin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Timolol Maleate 0.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '256', 'valuenum': 256.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVS: 98.5, 104/52, 68, 20, 100% 2L NC \nGeneral: NAD, laying in bed, ___\n___: MMM, EOMI, PERRL \nNeck: Supple, no stiffness \nCV: RRR, no murumur \nLungs: CTAB, no w/r/rh \nAbdomen: +BS, soft, NT/ND. \nExt: No ___ edema \nNeuro: Slight right sided weakness ___ on the right and ___ on \nthe left \nSkin: no rashes noted \n\nDISCHARGE PHYSICAL EXAM:\nVS: 98.5 (Tmax 99.1) 160/68 18 94RA\nIn/Out: 240/300+ in AM shift; ___ yesterday 24 hours\nGeneral: NAD, laying in bed. A&O x 3\n___: MMM, EOMI\nNeck: Supple, no stiffness \nCV: RRR, ___ systolic murmur loudest at RUSB\nLungs: CTAB, no w/r/rh \nAbdomen: +BS, mildly distended (stable since admission) but soft \nand nontender. \nExt: trace to 1+ ___ edema in bilatearl ankles\nNeuro: face symmetric, tongue midline, A&O x 3, moves all four \nextremities (mild left sided weakness)\nSkin: no rashes noted ', 'diagnoses': [{'icd_code': '53511', 'desc': 'Atrophic gastritis, with hemorrhage'}, {'icd_code': '5303', 'desc': 'Stricture and stenosis of esophagus'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2249', 'desc': 'Benign neoplasm of eye, part unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '5533', 'desc': 'Diaphragmatic hernia without mention of obstruction or gangrene'}, {'icd_code': '78830', 'desc': 'Urinary incontinence, unspecified'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '37515', 'desc': 'Tear film insufficiency, unspecified'}, {'icd_code': '7862', 'desc': 'Cough'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'V4364'}], 'summary': "ADMISSION LABS\n===========================\n___ 08:50PM BLOOD WBC-17.7*# RBC-2.85*# Hgb-7.9* Hct-24.5*# \nMCV-86 MCH-27.8 MCHC-32.3 RDW-15.3 Plt ___\n___ 04:58AM BLOOD Neuts-91.3* Lymphs-4.0* Monos-2.8 Eos-1.9 \nBaso-0\n___ 08:50PM BLOOD ___ PTT-29.4 ___\n___ 08:50PM BLOOD Glucose-185* UreaN-50* Creat-3.6*# \nNa-130* K-3.7 Cl-97 HCO3-24 AnGap-13\n___ 08:50PM BLOOD Calcium-8.4 Phos-4.2# Mg-1.5*\n___ 05:04AM BLOOD ALT-34 AST-21 AlkPhos-175* TotBili-0.4\n___ 05:04AM BLOOD GGT-93*\n___ 04:58AM BLOOD Osmolal-292\n___ 04:58AM BLOOD rapmycn-6.3\n___ 09:55AM URINE Color-RED Appear-Cloudy Sp ___\n___ 09:55AM URINE Blood-LG Nitrite-NEG Protein-100 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG\n___ 09:55AM URINE RBC->182* WBC-175* Bacteri-MOD Yeast-NONE \nEpi-4\n___ 12:19PM URINE Osmolal-392\n\nDISCHARGE LABS\n===========================\n___ 05:35AM BLOOD WBC-7.9 RBC-2.91* Hgb-7.9* Hct-25.2* \nMCV-87 MCH-27.3 MCHC-31.5 RDW-14.7 Plt ___\n___ 05:20AM BLOOD Neuts-74.8* Lymphs-13.9* Monos-8.5 \nEos-2.5 Baso-0.2\n___ 05:35AM BLOOD Plt ___\n___ 05:35AM BLOOD ___ PTT-30.0 ___\n___ 05:35AM BLOOD Glucose-276* UreaN-26* Creat-1.6* Na-136 \nK-4.2 Cl-101 HCO3-24 AnGap-15\n___ 05:35AM BLOOD Calcium-8.9 Phos-3.6 Mg-1.7\n___ 09:14AM URINE Color-Yellow Appear-Clear Sp ___\n___ 09:14AM URINE Blood-LG Nitrite-NEG Protein-100 \nGlucose-300 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-MOD\n___ 09:14AM URINE RBC-3* WBC-34* Bacteri-NONE Yeast-NONE \nEpi-<1\n\nMICROBIOLOGY\n===========================\nBlood culture x 2 No Growth (final)\nUrine culture x 2 No Growth (final)\n___ 1:15 pm Immunology (CMV)\n\n **FINAL REPORT ___\n\n CMV Viral Load (Final ___: \n CMV DNA detected, less than 137 IU/mL. \n Performed by Cobas Ampliprep / Cobas Taqman CMV Test. \n Linear range of quantification: 137 IU/mL - 9,100,000 \nIU/mL. \n Limit of detection 91 IU/mL. \n This test has been verified for use in the ___ patient \npopulation. \n Reported to and read back by ___ ON ___, \n14:34. \n\nRADIOLOGY\n========================\nCXR \nFINDINGS: \nThere is mild diffuse engorgement of pulmonary vessels which are \nill-defined, consistent with interstitial pulmonary edema. \nThere is small left pleural effusion. Cardiomegaly is noted. \nIncreased AP diameter of the chest and flattening of diaphragm \ncould reflect possible COPD. \n\nTRANSPLANT ULTRASOUND\nIMPRESSION: \n1. Patent vascularity with elevated resistive indices to the \ntransplant kidney that are slightly increased compared to prior \nstudy. \n2. Air within collecting system likely related to reflux from \nFoley catheter, although a emphysematous pyelitis cannot \nentirely be excluded if this is clinically suspected. \n3. Elevated velocities in main renal artery. In the absence of \nsecondary signs of stenosis suggest short interval followup. \n\nCXR REPEAT \nIMPRESSION: \nIn comparison with the study of ___, there appears to be \nsome improvement in pulmonary edema in this patient with \ncontinued enlargement of the cardiac silhouette and bilateral \npleural effusions seen on the lateral view. No evidence of acute \nfocal pneumonia. \n \n\nECHO (not performed with agitated saline)\nThe left atrium is moderately dilated. No evidence for an atrial \nseptal defect or patent foramen ovale is seen by 2D, color flow \nDoppler, or agitated saline at rest or with maneuvers. The \nestimated right atrial pressure is ___ mmHg. Normal left \nventricular wall thickness, cavity size, and regional/global \nsystolic function (biplane LVEF = 63 %). Tissue Doppler imaging \nsuggests an increased left ventricular filling pressure \n(PCWP>18mmHg). The right ventricular cavity is mildly dilated \nwith normal free wall contractility. The aortic valve leaflets \n(3) are mildly thickened. There is a minimally increased \ngradient consistent with minimal aortic valve stenosis. Trace \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is moderate pulmonary artery systolic \nhypertension. There is no pericardial effusion. \n\nIMPRESSION: Normal left ventricular cavity size with preserved \nregional/global systolic function. Moderate pulmonary artery \nsystolic hypertension. Right ventricular cavity dilation with \npreserved free wall motion. Minimal aortic valve stenosis. \nIncreased PCWP. No 2D echo evidence for endocarditis. No \nechocardiographic evidence for an intracardiac shunt identified.\n\nCLINICAL IMPLICATIONS: \nThe patient has mild aortic valve stenosis. Based on ___ \nACC/AHA Valvular Heart Disease Guidelines, a follow-up \nechocardiogram is suggested in ___ years. \nMr. ___ is a ___ yo M with PMHx of DDRT on ___ and \nrecent CVA in ___ (in the right inferior pons) presented to \n___ from rehab on ___ with hematuria and fevers found to \nhave UTI complicated by sepsis and hematuria. \n\n# SEPSIS FROM URINARY SOURCE: Was hypotensive, febrile, with \nelevated white count on presentation to OSH (T max documented \n101.8). Initially covered with vanc and zosyn as well as ___ \nfor double pseudomonas, narrowed to ___ alone after E. coli \nsensitive to levofloxacin speciated at ___. \nUltrasound with air in pelvis, likely from foley but can't rule \nout emphasematous infection. Plan to treat for 2 weeks \n(___), bactrim suppression held while on treatment, this \nwill need to be restarted after ___ course finished.\n\n# ___: Urine electrolytes showed a mixed picture believed to be \ncombination of mild ATN from hypotension on presentation on top \nof CKD (poor overall concentrating ability). Diuretics and \nanti-hypetensives held for several days until hypertension \nreturned. Resolved and Cr returned to baseline of 1.6, Cr max \nwas 3.6. See below for transplant renal discussion. Home lasix \nand losartan were resumed three and two days (respectively) \nprior to discharge, which he tolerated well. \n \n# ESRD s/p DDRT ___: Given resolution of ___, very low \nsuspicion for rejection. Mycophenolate Mofetil decreased from \n1000mg BID to ___ given infection, with plan to continue lower \ndose given he is ___ years out from transplant. Renal Txp \nUltrasound shwoed resistive indicies slightly higher than prior, \nwhich will need short-term repeat imaging. CMV positive, but \nonly <137 copies and not felt to be contributnig clinically \n(more likely reactivation in sick patient). Adenovirus was \nnegative. BK blood/urine negative. Sirolimus dosing changed from \n1mg BID to 3mg daily, with next trough level due to be checked \n___. DSA was sent but pending at discharge. Bactrim held \nwhile on ___ need to be restarted after UTI treatment.\n\n# URINARY RETENTION: Likely due to combination of poor \nneurologic innervation from DM and partial obstruction from BPH. \n Post-void residuals of 280-350, started schedule voiding (q Am \nand q 4 hour while awake) as well as straight caths in AM after \nfirst void. If residuals at that time are >300, will need TID \nstraight caths to minimize infection risk and urinary retention. \nTamsulosin was increased to 0.8mg ___. Should follow up with \nUrology for enlarged prostate. \n\n# Hematuria: Initially gross hematuria in the setting of \ninfection. This improved with treatment of UTI, with discharge \nUA with 3 RBC on micro. Will need repeat UA with micro within 1 \nweek. \n \n# HTN: Prior to transfer, he had SBP pressures in the ___ to low \n100s. His anti-hypertensives were held on transfer. After 2 \ndays, his blood pressure trended up and his home \nanti-hypertensives were restarted. His labetalol 600mg QID was \nkept at TID given low benefit at higher doses. Ideally, goal BP \n< 140/90 (occasional excursions into 150's OK), howevr ongoing \ntitration of antihypertensives as outpatient will be required. \nRestarted labetalol 600mg TID, imdur 30, amlodipine 5mg, \nlosartan 100mg daily. Resumed hydralazine at discharge.\n\n# RECENT CVA: Multiple CVA/TIA with right hemiparesis with the \npast. Most recent CVA ___ in the inferior pons on \nthe right at the level of the middle cerebellar artery, \nischemic. Home medication list had ASA 325mg and plavix, his \noutpatient PCP and neurologist were consulted and it was \nclarified that he is supposed to be on plavix alone. In \ndiscussion with outpatient neurologist, Dr. ___ (phone \n___ fax ___, TTE with bubble, event monitor, and \nhypercoaguable work up were recommended. He was discharged with \na 2 week ___ of Hearts monitor. A TTE was performed, but \nunfortunately not with agitated saline, and will likely need to \nbe repeated to evaluate for PFO/ASD/VSD. Hypercoaguable state \nwas deferred to outpatient work up.\n\n# DM: Continued home 12 units NPH q AM with insulin sliding \nscale in house.\n\n# dCHF: Redemonstrated on repeat ECHO. Euvolemic top mildly \nhypervolemic. Restarted home diuretics, beta blockers, ___ when \nblood pressures improved. \n\n# ENCEPHALOPATHY: He was confused and only oriented x ___ on \nadmission. This resolved with reorientation and treatment of \ninfection. Likely due to serious illness and poor vision \n(legally blind). No new focality or vertiginous sx to suggest \nrepeat stroke at this time. \n\n# Glaucoma: Continued home eye drops. \n\n# CXR abnormalities: Bilateral apical infiltrates seen on 2 OSH \nCXR, however not redemonstrated on our CXR (and repeat CXR when \nless edematous). PCP office did not have records of previous \nPPD or Quant Gold. Pre-transplant nephrology note had \nrecommended ID consult with Quant Gold, however it appears he \nnever went to his appointment. Only risk factor is foreign \nbirth, he has no symptoms (aside from fever due to UTI). Quant \ngold sent, pending at discharge. Histoplasma urine antigen was \nsent for hematuria + CXR abnl (prior to in-house repeat CXR \nshowing no apical infiltrates) was mildly elevated at 1.0 \n(normal range <0.5). Given improvement in clinical status with \nanti-bacterials, low suspicion of histoplasmosis. Serum histo \nantibodies were added on and urine histo antigen was repeated \nprior to discharge. These will need to be followed up at next \ntransplant visit. If persistently positive, consider ID referral \nfor further input. \n \n#CONTACT: wife: ___ Phone number: ___ "}}
{'final_diagnoses': ['Sepsis due to urinary source', 'UTI', 'Urinary Retention', 's/p Renal Transplant', 'Diabetes Mellitus'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ yo M with PMHx of DDRT on ___ and \nrecent CVA in ___ (in the right inferior pons) presented to \n___ from rehab on ___ with hematuria and fevers found to \nhave UTI complicated by sepsis and hematuria. \n\n# SEPSIS FROM URINARY SOURCE: Was hypotensive, febrile, with \nelevated white count on presentation to OSH (T max documented \n101.8). Initially covered with vanc and zosyn as well as ___ \nfor double pseudomonas, narrowed to ___ alone after E. coli \nsensitive to levofloxacin speciated at ___. \nUltrasound with air in pelvis, likely from foley but can't rule \nout emphasematous infection. Plan to treat for 2 weeks \n(___), bactrim suppression held while on treatment, this \nwill need to be restarted after ___ course finished.\n\n# ___: Urine electrolytes showed a mixed picture believed to be \ncombination of mild ATN from hypotension on presentation on top \nof CKD (poor overall concentrating ability). Diuretics and \nanti-hypetensives held for several days until hypertension \nreturned. Resolved and Cr returned to baseline of 1.6, Cr max \nwas 3.6. See below for transplant renal discussion. Home lasix \nand losartan were resumed three and two days (respectively) \nprior to discharge, which he tolerated well. \n \n# ESRD s/p DDRT ___: Given resolution of ___, very low \nsuspicion for rejection. Mycophenolate Mofetil decreased from \n1000mg BID to ___ given infection, with plan to continue lower \ndose given he is ___ years out from transplant. Renal Txp \nUltrasound shwoed resistive indicies slightly higher than prior, \nwhich will need short-term repeat imaging. CMV positive, but \nonly <137 copies and not felt to be contributnig clinically \n(more likely reactivation in sick patient). Adenovirus was \nnegative. BK blood/urine negative. Sirolimus dosing changed from \n1mg BID to 3mg daily, with next trough level due to be checked \n___. DSA was sent but pending at discharge. Bactrim held \nwhile on ___ need to be restarted after UTI treatment.\n\n# URINARY RETENTION: Likely due to combination of poor \nneurologic innervation from DM and partial obstruction from BPH. \n Post-void residuals of 280-350, started schedule voiding (q Am \nand q 4 hour while awake) as well as straight caths in AM after \nfirst void. If residuals at that time are >300, will need TID \nstraight caths to minimize infection risk and urinary retention. \nTamsulosin was increased to 0.8mg ___. Should follow up with \nUrology for enlarged prostate. \n\n# Hematuria: Initially gross hematuria in the setting of \ninfection. This improved with treatment of UTI, with discharge \nUA with 3 RBC on micro. Will need repeat UA with micro within 1 \nweek. \n \n# HTN: Prior to transfer, he had SBP pressures in the ___ to low \n100s. His anti-hypertensives were held on transfer. After 2 \ndays, his blood pressure trended up and his home \nanti-hypertensives were restarted. His labetalol 600mg QID was \nkept at TID given low benefit at higher doses. Ideally, goal BP \n< 140/90 (occasional excursions into 150's OK), howevr ongoing \ntitration of antihypertensives as outpatient will be required. \nRestarted labetalol 600mg TID, imdur 30, amlodipine 5mg, \nlosartan 100mg daily. Resumed hydralazine at discharge.\n\n# RECENT CVA: Multiple CVA/TIA with right hemiparesis with the \npast. Most recent CVA ___ in the inferior pons on \nthe right at the level of the middle cerebellar artery, \nischemic. Home medication list had ASA 325mg and plavix, his \noutpatient PCP and neurologist were consulted and it was \nclarified that he is supposed to be on plavix alone. In \ndiscussion with outpatient neurologist, Dr. ___ (phone \n___ fax ___, TTE with bubble, event monitor, and \nhypercoaguable work up were recommended. He was discharged with \na 2 week ___ of Hearts monitor. A TTE was performed, but \nunfortunately not with agitated saline, and will likely need to \nbe repeated to evaluate for PFO/ASD/VSD. Hypercoaguable state \nwas deferred to outpatient work up.\n\n# DM: Continued home 12 units NPH q AM with insulin sliding \nscale in house.\n\n# dCHF: Redemonstrated on repeat ECHO. Euvolemic top mildly \nhypervolemic. Restarted home diuretics, beta blockers, ___ when \nblood pressures improved. \n\n# ENCEPHALOPATHY: He was confused and only oriented x ___ on \nadmission. This resolved with reorientation and treatment of \ninfection. Likely due to serious illness and poor vision \n(legally blind). No new focality or vertiginous sx to suggest \nrepeat stroke at this time. \n\n# Glaucoma: Continued home eye drops. \n\n# CXR abnormalities: Bilateral apical infiltrates seen on 2 OSH \nCXR, however not redemonstrated on our CXR (and repeat CXR when \nless edematous). PCP office did not have records of previous \nPPD or Quant Gold. Pre-transplant nephrology note had \nrecommended ID consult with Quant Gold, however it appears he \nnever went to his appointment. Only risk factor is foreign \nbirth, he has no symptoms (aside from fever due to UTI). Quant \ngold sent, pending at discharge. Histoplasma urine antigen was \nsent for hematuria + CXR abnl (prior to in-house repeat CXR \nshowing no apical infiltrates) was mildly elevated at 1.0 \n(normal range <0.5). Given improvement in clinical status with \nanti-bacterials, low suspicion of histoplasmosis. Serum histo \nantibodies were added on and urine histo antigen was repeated \nprior to discharge. These will need to be followed up at next \ntransplant visit. If persistently positive, consider ID referral \nfor further input. \n \n#CONTACT: wife: ___ Phone number: ___ ", 'medications_prescribed': ['Acetaminophen 650 mg PO Q4H:PRN pain/fever', 'Amlodipine 10 mg PO DAILY', 'Bisacodyl 10 mg PO DAILY:PRN constipation', 'Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES DAILY', 'Clopidogrel 75 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'NPH 12 Units Breakfast\nInsulin SC Sliding Scale using HUM Insulin', 'Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY', 'Labetalol 600 mg PO TID', 'Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES ___', 'Multivitamins 1 TAB PO DAILY', 'Mycophenolate Mofetil 500 mg PO BID', 'Omeprazole 40 mg PO DAILY', 'Sirolimus 3 mg PO DAILY', 'Tamsulosin 0.8 mg PO ___', 'Furosemide 40 mg PO DAILY', 'Ciprofloxacin HCl 750 mg PO Q24H Duration: 6 Days \n___', 'Atorvastatin 40 mg PO QPM', 'Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID', 'Ferrex ___ (polysaccharide iron complex) 150 mg iron oral \nTID', 'Fleet Enema ___AILY:PRN constipatino', 'HydrALAzine 100 mg PO TID', 'Milk of Magnesia 30 mL PO DAILY:PRN constipation', 'Ondansetron 4 mg PO Q8H:PRN n/v', 'Senna 17.2 mg PO ___', 'Valsartan 160 mg PO BID', 'Outpatient Lab Work\nPlease draw rapamycin trough, Chem 10, and UA with micro between \n___, results to be sent to ___ renal transplant \ncoordinator ___ fax ___, phone ___']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 69, 'gender': 'M', 'symptoms': 'LEFT extratesticular mass with scrotal thickening, pain, fever', 'medical_history': ['MEDS: Lisinopril 20mg PO Qday'], 'family_history': 'Non-contributory', 'present_illness': '___ Black ___ male direct admitted from Dr. ___ for \nscrotal abscess, pain, fever. Initial onset was ___ \nwith pain limited to "pimple" or "ingrown hair" area of left \nhemiscrotum. Pain and size increased daily. By ___ the pain \nwas much more intense and the hemiscrotum was painful with \nradiation of pain to bilateral inguinal creases, especially when \nambulatory. No fever, chills. No other painful lesions. No other \nperson at home sick or with similar problems. ___ he \npresented to ___ where he underwent CT scan, U/s and was given \nIV antibiotics. He was sent home with pain pill prescription. \n___ night he had shaking chills and temperature repoted >100. \nHe presented this morning ___ to his PCP who urgently referred \nhim to Dr. ___. \nPer PCP note the ___ U/s showed extratesticular mass with \nscrotal thickening.', 'medications': [{'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.7', 'valuenum': 88.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.81', 'valuenum': 4.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '360', 'valuenum': 360.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.005', 'valuenum': 1.005, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.8,. Estimated GFR = 38 if non African-American (mL/min/1.73 m2). Estimated GFR = 46 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.49', 'valuenum': 4.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'WdWn male, NAD, pleasant, articulate \nAfebrile, AVSS, \nsedate \nabdomen benign, soft\nleft lateral thigh and posterior lateral thigh with two \nabscesses. Distal posterior lesion has unroofed and is healing \nwell with reduced pain and induration to touch. Proximal \nposterior-lateral lesion has a central scab present from prior \nunroofing but continues to be markedly TTP, indurated and \nslightly erythemetous--would expect to unroof in next ___\nbilateral groins with less tenderness reported at inguinal nodes \n\nuncircumcised penis\nhemiscrotum with wick replaced this morning. Induration (scotal \nthickening) persists at hemiscrotum area. Minimal pain to \npalpation.', 'diagnoses': [{'icd_code': '95203', 'desc': 'C1-C4 level with central cord syndrome'}, {'icd_code': '7211', 'desc': 'Cervical spondylosis with myelopathy'}, {'icd_code': '85011', 'desc': 'Concussion, with loss of consciousness of 30 minutes or less'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'E8121', 'desc': 'Other motor vehicle traffic accident involving collision with motor vehicle injuring passenger in motor vehicle other than motorcycle'}], 'summary': "___ 09:40AM BLOOD WBC-9.3 RBC-4.57* Hgb-12.6* Hct-39.4* \nMCV-86 MCH-27.5 MCHC-31.9 RDW-13.6 Plt ___\n___ 09:30AM BLOOD WBC-15.6* RBC-5.10 Hgb-14.0 Hct-44.0 \nMCV-86 MCH-27.5 MCHC-31.9 RDW-13.7 Plt ___\n___ 12:45PM BLOOD WBC-15.2*# RBC-4.86 Hgb-13.4* Hct-41.1 \nMCV-85 MCH-27.6 MCHC-32.7 RDW-13.8 Plt ___\n___ 12:45PM BLOOD Glucose-98 UreaN-16 Creat-0.9 Na-137 \nK-4.1 Cl-102 HCO3-27 AnGap-12\n___ 12:45PM BLOOD Calcium-9.7 Mg-2.0\n\n___ MRSA SCREEN MRSA SCREEN-PENDING INPATIENT \n\n___ SWAB WOUND CULTURE-PRELIMINARY {STAPH AUREUS \nCOAG +} INPATIENT \n\n___ SWAB WOUND CULTURE-PRELIMINARY {STAPH AUREUS \nCOAG +} INPATIENT \n\n___ URINE URINE CULTURE-FINAL INPATIENT \n\n___ BLOOD CULTURE Blood Culture, Routine-PENDING \nINPATIENT\nMr. ___ is a pleasant ___ admitted to Dr. ___ \nservice from clinic after urgent referral from his PCP ___. \nHe was started on IV antibiotics and fever trend and labs were \nmonitored. He was voiding without difficulty, and his pain was \nless severe upon arrival to the floor. He was tolerating a \nregular \ndiet. He did not have nausea and did not mount a fever since \nadmission. His pain was controlled with IV morphine and then \noral oxycodone. Urine culture was negative and at the time of \nthis script blood and wound cultures were pending/preliminary as \nlisted above. On the date of admission his hemiscrotal abscess \nwith incised and drained at bedside and wicked. He had daily \ndressing changes and he was kept in house pending improvement in \nWBC, pain. On HD2 he developed to large left lateral and left \nposterior-lateral skin abscesses, one of which unroofed with \nminimal pressure. Cultures were sent from the thigh abscess and \nscrotal abscess drainage.\nHe remained until HD3 and was discharged home with a 14 day \ncourse of Bactrim DS pending cultures from the blood/wounds. At \ndischarge, patient's pain well controlled with oral pain \nmedications, he tolerating regular diet, ambulating without \nassistance, and voiding without difficulty. He is given explicit \ninstructions to call Dr. ___ follow-up as needed and to call \nhis PCP as well. He will refrain from operating dangerous \nmachinery, driving, plumbing while taking narcotics. He was \ngiven verbal and written instructions on wound management and \nwith regard to removing his scrotal drainage wick (he refused \n___ services). Addendum will be \nmade as necessary reflecting any changes in management plan \nshould culture reports confirm MRSA. All of his questions were \nanswered and it was a delight participating in Mr. ___ \ncare."}}
{'final_diagnoses': ['Scrotal abscess/cellulitis', 'thigh abscesses x 2', 'pain', 'fever'], 'procedures': ['Bedside incision and drainage of left hemiscrotal abscess'], 'visit_summary': "Mr. ___ is a pleasant ___ admitted to Dr. ___ \nservice from clinic after urgent referral from his PCP ___. \nHe was started on IV antibiotics and fever trend and labs were \nmonitored. He was voiding without difficulty, and his pain was \nless severe upon arrival to the floor. He was tolerating a \nregular \ndiet. He did not have nausea and did not mount a fever since \nadmission. His pain was controlled with IV morphine and then \noral oxycodone. Urine culture was negative and at the time of \nthis script blood and wound cultures were pending/preliminary as \nlisted above. On the date of admission his hemiscrotal abscess \nwith incised and drained at bedside and wicked. He had daily \ndressing changes and he was kept in house pending improvement in \nWBC, pain. On HD2 he developed to large left lateral and left \nposterior-lateral skin abscesses, one of which unroofed with \nminimal pressure. Cultures were sent from the thigh abscess and \nscrotal abscess drainage.\nHe remained until HD3 and was discharged home with a 14 day \ncourse of Bactrim DS pending cultures from the blood/wounds. At \ndischarge, patient's pain well controlled with oral pain \nmedications, he tolerating regular diet, ambulating without \nassistance, and voiding without difficulty. He is given explicit \ninstructions to call Dr. ___ follow-up as needed and to call \nhis PCP as well. He will refrain from operating dangerous \nmachinery, driving, plumbing while taking narcotics. He was \ngiven verbal and written instructions on wound management and \nwith regard to removing his scrotal drainage wick (he refused \n___ services). Addendum will be \nmade as necessary reflecting any changes in management plan \nshould culture reports confirm MRSA. All of his questions were \nanswered and it was a delight participating in Mr. ___ \ncare.", 'medications_prescribed': ['1. acetaminophen 500 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain, fever. ', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '3. lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '4. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*25 Tablet(s)* Refills:*0*', '5. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a \nday for 14 days.\nDisp:*28 Tablet(s)* Refills:*0*', '6. multivitamin Oral', '7. WICK REMOVAL ___\nTomorrow morning, ___ a warm shower and while in the \nshower slowly withdraw (remove) the packing that was placed in \nthe scrotum. This may sting a little but should come out easily. \nGently irrigate/wash the scrotum w/ warm/soapy water and then \npat dry', '8. WORKING\nYou have described yourself as a ___; please refrain from \nputting yourself in situations that may compromise your health \nor safety while your wounds are healing AND while you are taking \nnarcotics', '9. Return to Work\nYou may return to work on ___ IF your pain is \ncontrolled w/out the use of narcotics, you have not had a fever \nAND if your wounds are mostly healed and no longer oozing or \nrequire dressings.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 32, 'gender': 'F', 'symptoms': 'melena, coffee ground emesis', 'medical_history': ['-recurrent esophageal variceal bleeding', '-alcoholic cirrhosis', '-hepatic encephalopathy', '-hypertension', '-asthma'], 'family_history': 'Mother and father both considered healthy', 'present_illness': "___ yo man with history of ETOH cirrhosis c/b esophageal varices, \nhepatic encephalopathy, admitted to ___ on ___ with \nhematemesis, melena, and anemia who is being transferred to \n___ for UGIB. \n\nHe reports being diagnosed with cirrhosis in late ___, when he \npresented with jaundice and weakness, found to have alcoholic \nhepatitis. Since then, he estimates that he has been \nhospitalized approximately 5 separate times and has had multiple \nEGD and bandings for bleeding esophageal varices. Per \n___ notes, his first esophageal variceal bleed was \n___, with transfusion of 5 units pRBCs and banding. Second \nbanding performed ___. Recurrent upper GI bleed ___ trated \nwith 4 units pRBCs and banding. Repeat banding ___. \nTypically presents on these admissions with melena for ___ days, \nfollowed by coffee-ground emesis or hematemesis. He has also had \nan episode of hepatic encephalopathy and takes lactulose. Has \nhad attempted paracentesis, but states that no fluid was able to \nbe drained. No history of SBP or hepatic hydrothorax. \n\nHe states that prior to this current admission, he had several \nepisodes of melena on ___ and ___, and overnight between ___ \nand ___ he had 2 episodes of coffee ground emesis, prompting \nhis presentation and admission to ___. He denied \nheadache, altered mental status, abdominal pain, chest pain, \ndyspnea, palpitations, lightheadedness, cough, fevers, chills, \ndiarrhea. Only notable pertinent positive was increased \nabdominal distention for the several days prior to admission. \n\nAt ___, initial labs showed WBC 19, Hgb 7.8 (down from \n11.6 ___, plt count 124 ___ 18.4, INR 1.5, Na 132, Albumin \n2.7\n\nEGD ___ revealed esophageal and gastric varices with \nquestionable signs of recent bleeding from an esophageal varix \n(red ___, which was banded. Continued to pass bloody stools. \nReceived 5 units pRBCs in total prior to transfer. Also treated \nwith PPI IV, octreotide infusion, and ceftriaxone. \n\nPostprocedure the patient's Hgb continued to drift down from an \ninitial high of 9.8 on ___ after 3 units of packed red cells \ntransfusion to 8.3 on ___. Patient continued to have melenic \nstools and had one episode of bright red blood per rectum. In \naddition to the initial 3 units of packed red cells patient was \ntransfused an additional 2 units of blood. \n\nPer report, patient had no hemodynamic compromise, with normal \nheart rate and blood pressure. He was noted to be awake, alert, \nappropriately conversant, without ascites by physical exam. \n\nDue to continued bloody stools, he was transferred to ___ for \nfurther management and consideration of TIPS.\n\nOn arrival to the MICU, he is asymptomatic. States that his last \nmelenic stool was this morning. Initial Hgb here 8.7; he was \ncontinued on pantoprazole, octreotide and ceftriaxone.", 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE-Acetaminophen Elixir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methylene Blue 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n=========================\nVitals: T: reviewed in metavision \nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear. Skin tan, not \njaundiced. \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, non-tender, non-distended, bowel sounds present, no \nrebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: warm and dry, no rashes\nNEURO: alert and fully oriented. No asterixis. Moves all \nextremities well. ___ strength and full sensation in upper and \nlower extremities. No tremor or dysmetria. \n\nDISCHARGE PHYSICAL EXAM:\n=======================\nVITALS: 98.2 129/77 54 18 100%RA\nGENERAL: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM. Skin tan, not jaundiced. \nNECK: supple, JVP not elevated \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, non-tender, non-distended, no rebound tenderness or \nguarding, no organomegaly \nEXT: Warm, well perfused, no edema \nSKIN: warm and dry, no rashes\nNEURO: alert and fully oriented. No asterixis. Moves all \nextremities well.', 'diagnoses': [{'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '7871', 'desc': 'Heartburn'}], 'summary': "ADMISSION LABS:\n================\n___ 09:45PM BLOOD WBC-9.9 RBC-2.94* Hgb-8.7* Hct-26.7* \nMCV-91 MCH-29.6 MCHC-32.6 RDW-16.8* RDWSD-55.7* Plt ___\n___ 09:45PM BLOOD ___ PTT-36.2 ___\n___ 09:45PM BLOOD Glucose-88 UreaN-10 Creat-0.7 Na-135 \nK-4.0 Cl-102 HCO3-24 AnGap-13\n___ 09:45PM BLOOD ALT-24 AST-34 AlkPhos-100 TotBili-1.4\n___ 09:45PM BLOOD Calcium-7.9* Phos-3.8 Mg-2.0\n\nIMAGING:\n========\n___ EGD:\n3 cords of large varices were seen in the lower third of the \nesophagus with red ___ sign on at least one cord. 3 bands were \nsuccessfully placed between 37-39cm from the incisors. \nVarices at the lower third of the esophagus (ligation)\nEsophageal ulcer\nA prominent fold was noted in the fundus suspicious for gastric \nvarix vs. submucosal lesion.\nErythema and mosaic appearance in the whole stomach compatible \nwith portal hypertensive gastropathy\nOtherwise normal EGD to third part of the duodenum\n\n___ ECHO: \nIMPRESSION: Mild right ventricular cavity dilation with \npreserved regional and global biventricular systolic function. \nNo valvular pathology or pathologic flow identified.\n\n___ Abd US: \nIMPRESSION: Mild right ventricular cavity dilation with \npreserved regional and global biventricular systolic function. \nNo valvular pathology or pathologic flow identified. \n\nDISCHARGE LABS:\n===============\n___ 06:35AM BLOOD WBC-6.7 RBC-2.93* Hgb-8.6* Hct-26.2* \nMCV-89 MCH-29.4 MCHC-32.8 RDW-15.6* RDWSD-51.5* Plt Ct-99*\n___ 06:35AM BLOOD ___ PTT-38.9* ___\n___ 06:35AM BLOOD Glucose-105* UreaN-8 Creat-0.7 Na-136 \nK-3.9 Cl-102 HCO3-26 AnGap-12\n___ 06:35AM BLOOD ALT-20 AST-23 AlkPhos-108 TotBili-1.1\n___ 06:35AM BLOOD Calcium-7.7* Phos-4.2 Mg-2.0\nPatient is a ___ yo man with history of ETOH cirrhosis c/b \nesophageal varices, hepatic encephalopathy, admitted to \n___ on ___ with hematemesis, melena, and anemia who is \nbeing transferred to ___ for recurrent UGIB.\n\n#Acute/blood loss anemia: Secondary to recurrent esophageal \nvariceal bleed. Status post total 5 units packed red cells \ntransfusion at ___, but continued to have downtrending \nHgb and melenic stools. He has had multiple EGD and variceal \nbanding since initial diagnosis of cirrhosis in ___. EGD ___ \nshowed 3 cords large varices that were banded as well as PHG. No \nindication for TIPS at this time as he is tolerant of EGDs and \notherwise currently well-compensated. He was managed with \noctreotide, IV pantoprazole, Carafate x 14 days (day 1 = ___, \nand Ceftriaxone (day 1 = ___ for SBP prophylaxis. After EGD \nwas given clear liquid diet ___, soft diet ___, regular the \nday after. He needs repeat EGD in 3 weeks. \n\n#Cirrhosis: Alcoholic, last drink ___. Child's B \ncirrhosis, MELDNa 16. Decompensated with hepatic encephalopathy, \ncoagulopathy, GI bleeding. Currently sober >6mo undergoing \ncurrent evaluation for a possible liver transplant, about to \nestablish care with Dr. ___ at ___. He was continued \non lactulose and home nadolol. There was no indication for \ndiuretics or paracentesis\n\n#Thrombocytopenia: Likely secondary portal hypertension. \n\n#Hx of ascites: No significant ascites on exam. Patient treated \nwith ceftriaxone for SBP prophlaxis. \n\n#Asthma: No acute exacerbation. Continued on albuterol nebs PRN \nand home Advair.\n\n#Hypertension: Held home lisinopril while inpatient"}}
{'final_diagnoses': ['GI bleed', 'Varices', 'EtOH cirrhosis'], 'procedures': ['EGD ___'], 'visit_summary': "Patient is a ___ yo man with history of ETOH cirrhosis c/b \nesophageal varices, hepatic encephalopathy, admitted to \n___ on ___ with hematemesis, melena, and anemia who is \nbeing transferred to ___ for recurrent UGIB.\n\n#Acute/blood loss anemia: Secondary to recurrent esophageal \nvariceal bleed. Status post total 5 units packed red cells \ntransfusion at ___, but continued to have downtrending \nHgb and melenic stools. He has had multiple EGD and variceal \nbanding since initial diagnosis of cirrhosis in ___. EGD ___ \nshowed 3 cords large varices that were banded as well as PHG. No \nindication for TIPS at this time as he is tolerant of EGDs and \notherwise currently well-compensated. He was managed with \noctreotide, IV pantoprazole, Carafate x 14 days (day 1 = ___, \nand Ceftriaxone (day 1 = ___ for SBP prophylaxis. After EGD \nwas given clear liquid diet ___, soft diet ___, regular the \nday after. He needs repeat EGD in 3 weeks. \n\n#Cirrhosis: Alcoholic, last drink ___. Child's B \ncirrhosis, MELDNa 16. Decompensated with hepatic encephalopathy, \ncoagulopathy, GI bleeding. Currently sober >6mo undergoing \ncurrent evaluation for a possible liver transplant, about to \nestablish care with Dr. ___ at ___. He was continued \non lactulose and home nadolol. There was no indication for \ndiuretics or paracentesis\n\n#Thrombocytopenia: Likely secondary portal hypertension. \n\n#Hx of ascites: No significant ascites on exam. Patient treated \nwith ceftriaxone for SBP prophlaxis. \n\n#Asthma: No acute exacerbation. Continued on albuterol nebs PRN \nand home Advair.\n\n#Hypertension: Held home lisinopril while inpatient", 'medications_prescribed': ['1. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', '2. Lactulose 30 mL PO DAILY', '3. Nadolol 20 mg PO DAILY', '4. Multivitamins 1 TAB PO DAILY', '5. Thiamine 100 mg PO DAILY', '6. Sucralfate 1 gm PO QID Duration: 14 Days \nRX *sucralfate 1 gram 1 tablet(s) by mouth four times a day Disp \n#*50 Tablet Refills:*0', '7. Albuterol Inhaler 2 PUFF IH Q6H:PRN dyspnea', '8. Ferrous Sulfate 325 mg PO BID', '9. Lisinopril 5 mg PO DAILY', '10. Magnesium Oxide 400 mg PO BID', '11. Omeprazole 40 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 73, 'gender': 'M', 'symptoms': 'Anemia', 'medical_history': ['CKD Stage 5 secondary to hypertensive nephrosclerosis', 'HTN', 'Dyslipidemia', 'Hemoglobin SC disease', 'Possible uveitis', 'Positive PPD, Latent TB'], 'family_history': 'Father has sickle cell trait.', 'present_illness': 'Ms. ___ is a ___ year old female with a PMH of hemoglobin SC \ndisease, HTN, HL, and CKD stage 5 secondary to hypertension, who \nwas admitted from pre-op for severe anemia. \n\nShe presented to ___ on ___ for an elective cholecystectomy \nas well as a peritoneal dialysis catheter placement. On \npresentation, she felt well with no complaints. She was found to \nhave a hemoglobin of 5.8. She was not able to be transfused in \nthe pre-op area because of her hemoglobin SC disease, so she was \nadmitted for transfusion and PD catheter placement. \n\nShe has a history of anemia with a baseline Hb of around 7. She \nreports that she "feels fine." Denies fatigue, chest pain, \nshortness of breath, nausea, vomiting, diarrhea. She reports \nthat her stools are dark from her iron pill, but she does not \nhave tarry or bloody stools. She does have a history of a \nreaction to an IV iron transfusion, but she does not have any \nhistory of a blood transfusion reaction. She is followed by Dr. \n___. She is on iron pills for her anemia. \n\nRegarding her CKD, she sees Dr. ___ at ___. The CKD is \nstage 5 and thought secondary to hypertension. She is in the \nprocess of being worked up for a kidney transplant by Dr. \n___ at ___. She was also found to have latent TB. She \nsees ID at ___. The plan was to start her on INH treatment \nafter PD catheter placement. \n\nFurther, she reports that she recently saw an ophthalmologist \nand was diagnosed with uveitis. She has been taking several \ndifferent types of eye drops for one week. She reports that she \nwas told to take these eye drops until she followed up with \nophthalmology in about a month.', 'medications': [{'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '144', 'valuenum': 144.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '497', 'valuenum': 497.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 226.1, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Measured by ___.'}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '398', 'valuenum': 398.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.5', 'valuenum': 47.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '378', 'valuenum': 378.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.40', 'valuenum': 5.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.0', 'valuenum': 46.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.32', 'valuenum': 1.32, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.6', 'valuenum': 45.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83.2', 'valuenum': 83.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '356', 'valuenum': 356.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.15', 'valuenum': 5.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.56', 'valuenum': 0.56, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.38', 'valuenum': 1.38, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.27', 'valuenum': 17.27, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '45.7', 'valuenum': 45.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '455', 'valuenum': 455.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '377', 'valuenum': 377.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n======================== \nVS: 97.5 PO 139 / 73 68 97 \nGENERAL: NAD, resting comfortably in bed\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pale conjunctiva, \nMMM, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema, moving all 4 \nextremities with purpose \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes \n\nDISCHARGE PHYSICAL EXAM\n=======================\nVS: 99.0 PO 140 / 79 64 18 97 Ra \nGENERAL: NAD, resting comfortably in bed\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, resolution of pale \nconjunctiva, MMM, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema, moving all 4 \nextremities with purpose \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes', 'diagnoses': [{'icd_code': 'K869', 'desc': 'Disease of pancreas, unspecified'}, {'icd_code': 'R590', 'desc': 'Localized enlarged lymph nodes'}, {'icd_code': 'R21', 'desc': 'Rash and other nonspecific skin eruption'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E7800', 'desc': 'Pure hypercholesterolemia, unspecified'}, {'icd_code': 'I77819', 'desc': 'Aortic ectasia, unspecified site'}, {'icd_code': 'I745', 'desc': 'Embolism and thrombosis of iliac artery'}], 'summary': "ADMISSION LAB RESULTS\n=====================\n___ 01:13PM BLOOD WBC-7.7 RBC-2.17*# Hgb-5.5*# Hct-16.7*# \nMCV-77* MCH-25.3* MCHC-32.9 RDW-20.8* RDWSD-57.5* Plt ___\n___ 01:13PM BLOOD ___ PTT-27.9 ___\n___ 01:13PM BLOOD Ret Aut-8.4* Abs Ret-0.18*\n___ 01:13PM BLOOD Glucose-162* UreaN-88* Creat-6.5*# Na-140 \nK-4.0 Cl-105 HCO3-19* AnGap-20\n___ 01:13PM BLOOD ALT-9 AST-11 LD(LDH)-198 AlkPhos-59 \nTotBili-0.8\n___ 01:13PM BLOOD Calcium-8.8 Phos-5.1* Mg-2.0\n\nDISCHARGE LAB RESULTS\n=====================\n___ 05:48AM BLOOD WBC-8.6 RBC-2.90*# Hgb-7.8*# Hct-22.8*# \nMCV-79* MCH-26.9 MCHC-34.2 RDW-19.2* RDWSD-54.1* Plt ___\n___ 05:48AM BLOOD Glucose-94 UreaN-90* Creat-6.4* Na-142 \nK-4.1 Cl-106 HCO3-18* AnGap-22*\n___ 05:48AM BLOOD Albumin-3.9 Calcium-9.0 Phos-4.8* Mg-2.0\nMs. ___ is a ___ year old female with a PMH of hemoglobin SC \ndisease, HTN, HL, and CKD stage 5 secondary to hypertension, who \nwas admitted from pre-op for severe anemia. She presented for \nelective cholecystectomy and PD catheter placement. She was \nfound to have a Hemoglobin of 5.5. Her surgeries were cancelled. \nThere were no active signs of bleeding, this was deemed \nsecondary to CKD, iron deficiency anemia, and sickle cell \ndisease. She was transfused two units of pRBCs, and her \nhemoglobin increased to 7.8. She was discharged with a plan to \nreschedule the elective cholecystectomy and peritoneal dialysis \ncatheter placement. \n\n#Microcytic Anemia. Patient was found to incidentally have a \nhemoglobin of 5.5. She was completely asymptomatic, which \nsuggests that it was a slow downtrend. She has known iron \ndeficiency anemia, sickle cell disease, and CKD, all of which \ncan be contributing to the patient's anemia. There were no signs \nof bleeding. She was transfused 2U pRBCs, and her hemoglobin \nincreased to 7.8. She was discharged with instructions to \nfollow-up with her primary care doctor. \n\n#CKD, Stage 5. Patient has known CKD, likely secondary to \nuncontrolled hypertension. She is currently being worked up for \nrenal transplant. Was supposed to get PD catheter placed during \nan elective procedure on ___, but this will be rescheduled by \nthe transplant surgery team for a later date. \n\n#Porcelain gallbladder. The patient presented on ___ for \nelective cholecystectomy. When she was found to be anemic, the \nelective surgery was cancelled. Transplant surgery will contact \nher to reschedule the two elective surgeries. \n\n#Latent TB. The patient has known latent TB diagnosed with a \npositive Quantiferon Gold. She is followed by ___ ID. The plan \nis for her to start INH treatment as an outpatient once PD \ncatheter is placed and cholecystectomy is completed. \n\n#Uveitis. Patient was recently seen by ___ ophthalmology and \ndiagnosed with uveitis. She was continued on PrednisoLONE \nAcetate 1% Ophth. Susp. 1 DROP LEFT EYE QID, Flurbiprofen 0.03% \n1 DROP LEFT EYE QID. She should follow-up with outpatient \nophthalmology as scheduled. \n\n#Hyperlipidemia. Continued Atorvastatin 20 mg PO QPM."}}
{'final_diagnoses': ['Severe anemia', 'Hemoglobin SC disease', 'CKD stage 5', 'Latent TB'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is a ___ year old female with a PMH of hemoglobin SC \ndisease, HTN, HL, and CKD stage 5 secondary to hypertension, who \nwas admitted from pre-op for severe anemia. She presented for \nelective cholecystectomy and PD catheter placement. She was \nfound to have a Hemoglobin of 5.5. Her surgeries were cancelled. \nThere were no active signs of bleeding, this was deemed \nsecondary to CKD, iron deficiency anemia, and sickle cell \ndisease. She was transfused two units of pRBCs, and her \nhemoglobin increased to 7.8. She was discharged with a plan to \nreschedule the elective cholecystectomy and peritoneal dialysis \ncatheter placement. \n\n#Microcytic Anemia. Patient was found to incidentally have a \nhemoglobin of 5.5. She was completely asymptomatic, which \nsuggests that it was a slow downtrend. She has known iron \ndeficiency anemia, sickle cell disease, and CKD, all of which \ncan be contributing to the patient's anemia. There were no signs \nof bleeding. She was transfused 2U pRBCs, and her hemoglobin \nincreased to 7.8. She was discharged with instructions to \nfollow-up with her primary care doctor. \n\n#CKD, Stage 5. Patient has known CKD, likely secondary to \nuncontrolled hypertension. She is currently being worked up for \nrenal transplant. Was supposed to get PD catheter placed during \nan elective procedure on ___, but this will be rescheduled by \nthe transplant surgery team for a later date. \n\n#Porcelain gallbladder. The patient presented on ___ for \nelective cholecystectomy. When she was found to be anemic, the \nelective surgery was cancelled. Transplant surgery will contact \nher to reschedule the two elective surgeries. \n\n#Latent TB. The patient has known latent TB diagnosed with a \npositive Quantiferon Gold. She is followed by ___ ID. The plan \nis for her to start INH treatment as an outpatient once PD \ncatheter is placed and cholecystectomy is completed. \n\n#Uveitis. Patient was recently seen by ___ ophthalmology and \ndiagnosed with uveitis. She was continued on PrednisoLONE \nAcetate 1% Ophth. Susp. 1 DROP LEFT EYE QID, Flurbiprofen 0.03% \n1 DROP LEFT EYE QID. She should follow-up with outpatient \nophthalmology as scheduled. \n\n#Hyperlipidemia. Continued Atorvastatin 20 mg PO QPM.", 'medications_prescribed': ['amLODIPine 10 mg PO DAILY', 'Atenolol 25 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Calcitriol 0.25 mcg PO 5X/WEEK (___)', 'Ferrous Sulfate 325 mg PO BID', 'Flurbiprofen 0.03% 1 DROP LEFT EYE QID', 'FoLIC Acid 1 mg PO DAILY', 'Lisinopril 40 mg PO DAILY', 'PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP LEFT EYE QID uveitis', 'Sodium Bicarbonate 650 mg PO BID', 'Torsemide 20 mg PO DAILY', 'Vitamin D ___ UNIT PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 63, 'gender': 'M', 'symptoms': 'cough and new O2 requirements', 'medical_history': ['h/o PE s/p IVC filter', 'MS', 'chronic back pain', 's/p spinal fusion', 'depression', 'bipolar disorder', 'hypothyroidism', 'henia repair', 'multiple spinal compression fractures (thought to be secondary \nto prednisone use)', 'COPD with 2L NC at home', 'OSA with CPAP at home'], 'family_history': 'FAMILY HISTORY: \nnon-contributory', 'present_illness': '___ h/o esophageal dysmotility, aspiration PNA s/p PEG \ntube,Churg ___, COPD and MS presents with 1 day of SOB and \nfevers. Today 7 AM at ___ pt looked disheveled, \nglassy eyes, flushed, temp 100.4 HR 99. RR 28. Put in bed and on \nO2 at ___ but never really got into the ___ (around 88%). Pt \nwas coughing and nurse heard expiratory wheeze on the right with \ndecreased sounds on the right. Gave duoneb and he coughed up \nyellow thick sputum. Pt never lost consciousness. He then \ncomplained of midsternal discomfort, then developed nausea prior \nto arrival of EMTs but no vomiting. Then c/o L sided chest pain \nwithout radiation. Of note, pt does get 25mg morphine q6hrs prn \nfor chronic back pain (usually receives all doses) and also uses \na fentanyl patch.\n.\nIn addition, he was recently treated for a urinary tract \ninfection - OSH Ucx ___: Proteus ___ to cefepime. He also \nreports having a chronic right ear infection that he told was \n"granuloma" and has been using cipro ear drops for this.\n.\nOn arrival to the ED, vital signs were 100.6 97 107/54 28 \n92%10L.\nPt was noted to be tachypneic, uncomfortable, with loud wet \ncough on exam. Had bilateral diffuse rhonchi and wheezing. G \ntube with mild purulent discharge.\nLabs showed \n8.8>37.1<241. PMNs 81%, eos 5.5% \nTrop-T: 0.02 \nchemistry: 139/4.1; 101/28; ___ 111 \nproBNP: 83\nUA negative \nABG while on bipap ___\nCXR showed bilateral lower lobe infiltrates.\nPt ws given methylpred 125mg IV, nebs, vanc/cefepime/flagyl. \nReceived 2mg IV morphine for chest pain whch subsequently \nimproved. He was started on Bipap for respiratory distress which \nwas discontinued after 30 minutes. Pt was admitted to the ICU \nfor presumed COPD exacerbation vs pneumonia. Vitals prior to \ntransfer: 98.5 °F (36.9 °C), Pulse: 85, RR: 20, BP: 97/47, \nO2Sat: 93, O2Flow: NRB.\n.\nIn the FICU, pt satting low ___ on NRB and 6L NC. Within the \nfirst 20 minutes of his arrival pt was actively becoming \nincreasingly somnolent. He had to be shaken to arouse and answer \nquestions but was arousable. BP 110s/70s HR ___. Repeat ABG \nshowed ___. Lactate:0.7. After roughly 1 hour of \nsleeping pt woke up and was fully alert, oriented and \ninteractive. Reported feeling tired after not sleeping all \nnight.', 'medications': [{'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ON ADMISSION:\nVitals: T: 98.9 BP:108/54 P:87 R:15 O2: 91% 100% facemask and \n6L NC.\nGeneral: no acute distress. somnolent but arousable.\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: very poor air movemment throughout but clear to \nauscultation bilaterally.\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops. distant heart sounds \nAbdomen: NTND, hypoactive bowel sounds, Gtube site without \ndrainage or erythema.\nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema.\nPt with asterixis. \n\nON DISCHARGE ___:\nVitals: T 98.2, P 71 (50-70s), BP 116/69 (90-130/60-70s), R 18, \nO2 95% on 4L NC.\nGen: alert, well appearing, NAD\nPsych: normal affect/mood\nCV: RRR no m/g\nChest: fentanyl patch noted on anterior R chest\nLung: slight bibasilar crackles, no wheeze, good air movement. \nOccasional "junky" cough but no rhonchi on exam.\nAbdomen: PEG tube noted, +BS, nondistended, mild R abd \ntenderness (which pt says is chronic since PEG placement)\nExtremities: no ___ edema', 'diagnoses': [{'icd_code': '5409', 'desc': 'Acute appendicitis without mention of peritonitis'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}], 'summary': "CXR ___: \nIMPRESSION: Bibasilar opacities likely represent combination of \natelectasis and scarring given patient's history of chronic \naspiration. However, underlying pneumonia in the lower lobes \ncannot be ruled out. \n.\n___ RUQ U/S\nIMPRESSION: \n1. Minimally heterogeneous liver. Echogenic portal triads. \n2. Soft tissue lesion in the gallbladder fundus with \ncalcification. \nMalignancy should be considered. This should be further \nevaluated by MRCP. \n\nMRCP ___:\nFindings consistent with gallbladder adenomyomatosis \n(hyperplastic \ncholecystosis). \n\n___ 06:20AM BLOOD WBC-5.4 RBC-3.35* Hgb-10.5* Hct-33.1* \nMCV-99* MCH-31.3 MCHC-31.6 RDW-16.5* Plt ___\n___ 06:20AM BLOOD Glucose-113* UreaN-23* Creat-0.5 Na-140 \nK-3.7 Cl-107 HCO3-25 AnGap-12\n___ 04:32AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 06:20AM BLOOD Calcium-8.9 Phos-2.4*# Mg-2.2\n# hypoxia/respiratory failure secondary to pneumonia with sepsis \n- Pt with severe COPD on 2L O2 at baseline at home, now with new \nO2 requirement necessitating BIPAP for 30 minutes in the ED. \nRemained hemodynamically stable. H/o recurrent aspiration pna \nfor which a Gtube was placed previously. Current presentation of \nfever, productive cough, hypoxia --> consistent w/ aspiration \nPNA. Given COPD and smoking history COPD flare was also \nconsidered. Pt was initially started on vanc/cefepime/flagyl for \npna but transitioned to levoquin/flagyl as he did not have \nelevated white count and was afebrile during hospital admission. \nAlso, he was able to maintain stable respiratory status and \nimproved after 1 night of monitoring in the ICU. PE was \nconsidered given history of PE s/p IVC filter however his Wells \nscore was quite low and it was not felt that this was high on \nthe differential. Steroids (prednisone 60mg) and nebs were \nstarted. \nAt time of discharge he is feeling well with an ongoing mild \nproductive cough but no dyspnea or wheezing. He will continue ___ \nlevofloxacin + metronidazole through ___ (day 1 of \nantibiotics was ___. He will also continue a steroid taper \nregimen of: prednisone 40mg x 3 days starting ___, then 20mg \nx 2 days starting ___, then 10mg x 2 days starting ___, then \noff.\nHe has not weaned off oxygen yet and remains on 4L NC. We \nanticipate that with steroid tapering and chest ___, he will wean \nback to his baseline. \n.\n#chest pain - pt c/o sharp left sided chest pain resolved with \nmorphine in ED. Serial ECGs showed no evidence of changes and \nserial cardiac enzymes negative x3. He had missed several doses \nof home morphine for his chronic back pain while in the ED and \nbeing transported and it was felt that he got behind on his pain \ncontrol. Possibly a pleuritic component of pain from pneumonia \nbut this was less likely. Chest pain resolved after pt was \nre-initiated on home regimen of SL morphine with fentanyl patch.\n.\n# AMS - On arrival to the ICU was sleepy but arousable. ABG was \nnormal. After sleeping for roughly 30 minutes he was fully awake \nand alert. He stated he was just tired from being up all night \nnot feeling well the night before. Electrolytes were within \nnormal limits. Some component of lethargy also attributed to the \n2mg IV morphine he received for chest pain in the ED. Pt did \nhave asterixis on exam however and there was concern for \ncirrhosis/hepatic encephalopathy, although coags and LFTs were \nnormal. RUQ u/s was ordered, see re gallblader mass below. Pt \nalso has history of depression, MS, and h/o ECT; all of which \ncould have predisposed him to any mental status changes by other \ninciting factors.\n.\n# gallbladder mass - RUQ US done to eval for cirrhosis; showed \nnormal liver but a mass in the gallbladder. MRCP done on ___ \nwas reassuring as it showed gallbladder adenomyomatosis (aka \nhyperplastic cholecystosis) without concern for malignancy.\n.\n#dysuria - pt c/o several days of dysuria which felt to him like \nhis last UTI. UA neg and culture showed only bacterial growth \nsuggestive of skin/fecal contamination. \n\n# Eosinophilic pneumonia vs ___: He is on \nazathioprine, and his last visit with a pulmonologist at ___ \nwas in ___. He should have ___ with Dr. ___ \n(___). \n\n# Back pain: continued home fentanyl patch \n.\n# Hypothyroidism: Continued levothyroxine \n.\n# OSA: Continue home CPAP. \n.\n# Esophageal dysmotility: Continue Reglan \n\n# HLD: continued pravastatin\n.\n# Depression: continue celexa 30 mg qday \n.\n# Bipolar d/o: continue quetiapine 12.5 mg hs prn, trazodone 50 \nmg \nhs prn \n.\n# Osteopenia: continue home Ca + Vit D \n\n# DISPO: back to ___."}}
{'final_diagnoses': ['Aspiration/Bacterial Pneumonia with COPD exacerbation', 'Back Pain', 'Gallbladder mass', 'Multiple sclerosis', 'Dysphagia with chronic G-tube'], 'procedures': ['none'], 'visit_summary': '# hypoxia/respiratory failure secondary to pneumonia with sepsis \n- Pt with severe COPD on 2L O2 at baseline at home, now with new \nO2 requirement necessitating BIPAP for 30 minutes in the ED. \nRemained hemodynamically stable. H/o recurrent aspiration pna \nfor which a Gtube was placed previously. Current presentation of \nfever, productive cough, hypoxia --> consistent w/ aspiration \nPNA. Given COPD and smoking history COPD flare was also \nconsidered. Pt was initially started on vanc/cefepime/flagyl for \npna but transitioned to levoquin/flagyl as he did not have \nelevated white count and was afebrile during hospital admission. \nAlso, he was able to maintain stable respiratory status and \nimproved after 1 night of monitoring in the ICU. PE was \nconsidered given history of PE s/p IVC filter however his Wells \nscore was quite low and it was not felt that this was high on \nthe differential. Steroids (prednisone 60mg) and nebs were \nstarted. \nAt time of discharge he is feeling well with an ongoing mild \nproductive cough but no dyspnea or wheezing. He will continue ___ \nlevofloxacin + metronidazole through ___ (day 1 of \nantibiotics was ___. He will also continue a steroid taper \nregimen of: prednisone 40mg x 3 days starting ___, then 20mg \nx 2 days starting ___, then 10mg x 2 days starting ___, then \noff.\nHe has not weaned off oxygen yet and remains on 4L NC. We \nanticipate that with steroid tapering and chest ___, he will wean \nback to his baseline. \n.\n#chest pain - pt c/o sharp left sided chest pain resolved with \nmorphine in ED. Serial ECGs showed no evidence of changes and \nserial cardiac enzymes negative x3. He had missed several doses \nof home morphine for his chronic back pain while in the ED and \nbeing transported and it was felt that he got behind on his pain \ncontrol. Possibly a pleuritic component of pain from pneumonia \nbut this was less likely. Chest pain resolved after pt was \nre-initiated on home regimen of SL morphine with fentanyl patch.\n.\n# AMS - On arrival to the ICU was sleepy but arousable. ABG was \nnormal. After sleeping for roughly 30 minutes he was fully awake \nand alert. He stated he was just tired from being up all night \nnot feeling well the night before. Electrolytes were within \nnormal limits. Some component of lethargy also attributed to the \n2mg IV morphine he received for chest pain in the ED. Pt did \nhave asterixis on exam however and there was concern for \ncirrhosis/hepatic encephalopathy, although coags and LFTs were \nnormal. RUQ u/s was ordered, see re gallblader mass below. Pt \nalso has history of depression, MS, and h/o ECT; all of which \ncould have predisposed him to any mental status changes by other \ninciting factors.\n.\n# gallbladder mass - RUQ US done to eval for cirrhosis; showed \nnormal liver but a mass in the gallbladder. MRCP done on ___ \nwas reassuring as it showed gallbladder adenomyomatosis (aka \nhyperplastic cholecystosis) without concern for malignancy.\n.\n#dysuria - pt c/o several days of dysuria which felt to him like \nhis last UTI. UA neg and culture showed only bacterial growth \nsuggestive of skin/fecal contamination. \n\n# Eosinophilic pneumonia vs ___: He is on \nazathioprine, and his last visit with a pulmonologist at ___ \nwas in ___. He should have ___ with Dr. ___ \n(___). \n\n# Back pain: continued home fentanyl patch \n.\n# Hypothyroidism: Continued levothyroxine \n.\n# OSA: Continue home CPAP. \n.\n# Esophageal dysmotility: Continue Reglan \n\n# HLD: continued pravastatin\n.\n# Depression: continue celexa 30 mg qday \n.\n# Bipolar d/o: continue quetiapine 12.5 mg hs prn, trazodone 50 \nmg \nhs prn \n.\n# Osteopenia: continue home Ca + Vit D \n\n# DISPO: back to ___.', 'medications_prescribed': ['albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation Q6H (every 6 hours) as \nneeded for shortness of breath or wheezing. ', 'ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation \nQ6H (every 6 hours) as needed for shortness of breath or \nwheezing. ', 'pravastatin 20 mg Tablet Sig: Two (2) Tablet ___ \n(___). ', 'citalopram 20 mg Tablet Sig: 1.5 Tablets ___. ', 'trazodone 50 mg Tablet Sig: 0.5 Tablet ___ HS (at bedtime) as \nneeded for insomnia. ', 'metoclopramide 5 mg/5 mL Solution Sig: One (1) ___ QIDACHS (4 \ntimes a day (before meals and at bedtime)). ', 'fentanyl 50 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr \nTransdermal Q72H (every 72 hours). ', 'sulfamethoxazole-trimethoprim 200-40 mg/5 mL Suspension Sig: \nOne (1) Tablet ___ QOD (). ', 'azathioprine 50 mg Tablet Sig: Three (3) Tablet ___ \n(___). ', 'levothyroxine 25 mcg Tablet Sig: One (1) Tablet ___ \n(___). ', 'calcium carbonate 200 mg calcium (500 mg) Tablet, Chewable \nSig: One (1) Tablet, Chewable ___ TID (3 times a day). ', 'cholecalciferol (vitamin D3) 400 unit Tablet Sig: One (1) \nTablet ___. ', 'bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \n___ as needed for constipation. ', 'prednisone 20 mg Tablet Sig: Three (3) Tablet ___ \n(___) for 7 days: 40mg x 3 days starting ___, then 20mg x 2 \ndays starting ___, then 10mg x 2 days starting ___, then off. ', 'levofloxacin 750 mg Tablet Sig: One (1) Tablet ___ once a day \nfor 4 days: final day ___. ', 'metronidazole 500 mg Tablet Sig: One (1) Tablet ___ Q8H \n(every 8 hours) for 4 days: final date ___. ', 'lansoprazole 30 mg Tablet,Rapid Dissolve, ___ Sig: One (1) \nTablet,Rapid Dissolve, ___ ___. ', 'morphine concentrate 100 mg/5 mL (20 mg/mL) Solution Sig: \n1.25 mL ___ Q4 () as needed for pain. ', 'Seroquel 100 mg Tablet Sig: One (1) Tablet ___ at bedtime. ', 'gabapentin 800 mg Tablet Sig: One (1) Tablet ___ three times \na day. ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'Left knee pain', 'medical_history': ['- IDDM since age ___ on insulin pump', '-h/o of "borderline" ovarian cancer-treated with TAH, no chemo\nat ___ (no longer in followup)', '- subaceous cyst of R breast-- ___ year hx, recently became \ninfected in ___, pt had surgery for drainage and removal', '- rotator cuff injury in L shoulder-- awaiting surgery in late \n___.', '- urge incontinence', '- hypothyroidism', '- hypertension', '- glaucoma', '- foot surgery', '- sinus surgery ___ pt still has significant congestion \nand post-nasal drip', '- hx of intestinal obstruction'], 'family_history': 'NC', 'present_illness': '___ is a ___ year old with progressive left knee pain. \nAfter failure of conservative management she elected for total \nknee arthroplasty.', 'medications': [{'medication': 'Aluminum Hydroxide Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Caspofungin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Desmopressin Acetate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Papain 2.5 % Solution', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Desmopressin Acetate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Desmopressin Acetate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'HD PROTOCOL', 'doses_per_24_hrs': 0.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'HD PROTOCOL', 'doses_per_24_hrs': 0.0}, {'medication': 'Caspofungin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Caspofungin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'HD PROTOCOL', 'doses_per_24_hrs': 0.0}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Desmopressin Acetate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Caspofungin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Caspofungin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Citrate Dextrose 3% (ACD-A) CRRT', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Carbamazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'ASDIR', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'DWELL', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'PB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Alteplase (Catheter Clearance)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 14.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.0,. Estimated GFR = 16 if non African-American (mL/min/1.73 m2). Estimated GFR = 19 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '214', 'valuenum': 214.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 72.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.7', 'valuenum': 88.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.1', 'valuenum': 40.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-16', 'valuenum': -16.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.22, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21-50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Cloudy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11-20', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '322', 'valuenum': 322.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LESS THAN 10. VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 32.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, SLIGHTLY.'}, {'value': '43.7', 'valuenum': 43.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79.8', 'valuenum': 79.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 42.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.57', 'valuenum': 2.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 13.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '-14', 'valuenum': -14.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-12', 'valuenum': -12.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.15, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 20.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 43.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'umol/L', 'ref_range_lower': 12.0, 'ref_range_upper': 47.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-10', 'valuenum': -10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5575', 'valuenum': 5575.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '975', 'valuenum': 975.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.0.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 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'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL. MANUALLY COUNTED.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15311', 'valuenum': 15311.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 500.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'As of ___ see Chemistry for D-Dimer results.'}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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{'value': '20.5', 'valuenum': 20.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.7,. Estimated GFR = 18 if non African-American (mL/min/1.73 m2). Estimated GFR = 22 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN HCT. SPUN HEMATOCRIT PERFORMED.'}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 20.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.03', 'valuenum': 3.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '173', 'valuenum': 173.0, 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98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 20.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11-20', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Cloudy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11-20', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84.0', 'valuenum': 84.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 41.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '___', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 43.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 10.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.3,. Estimated GFR = 14 if non African-American (mL/min/1.73 m2). Estimated GFR = 17 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 291.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87.1', 'valuenum': 87.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 22.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC.'}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 49.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '374', 'valuenum': 374.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 20.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC.'}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '332', 'valuenum': 332.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '131750', 'valuenum': 131750.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1300', 'valuenum': 1300.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'umol/L', 'ref_range_lower': 12.0, 'ref_range_upper': 47.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 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'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION. ICTERIC SAMPLE.'}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '3+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN.'}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SMUDGE CELLS PRESENT.'}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '___', 'valuenum': 14.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, GROSSLY.'}, {'value': '46.1', 'valuenum': 46.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 54.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.4,. Estimated GFR = 21 if non African-American (mL/min/1.73 m2). Estimated GFR = 25 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 156.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '476', 'valuenum': 476.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 6.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 21.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '556', 'valuenum': 556.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58750', 'valuenum': 58750.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1000', 'valuenum': 1000.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 21.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, GROSSLY.'}, {'value': '___', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPUN.'}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '___', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS. ANION GAP VERIFIED.'}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-5', 'valuenum': -5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '/26.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 36.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CELLULAR HGB.'}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.27', 'valuenum': 7.27, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '74', 'valuenum': 74.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, GROSSLY.'}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR. LARGE PLATELETS NOTED ON SMEAR.'}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 58.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 17.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '>50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.24, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION. INTERFERENCES MINIMIZED.'}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'L/min', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/14.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'Well appearing in no acute distress \nAfebrile with stable vital signs \nPain well-controlled \nRespiratory: CTAB \nCardiovascular: RRR \nGastrointestinal: NT/ND \nGenitourinary: Voiding independently \nNeurologic: Intact with no focal deficits \nPsychiatric: Pleasant, A&O x3 \nMusculoskeletal Lower Extremity: \n* Incision healing well with staples \n* Scant serosanguinous drainage \n* Thigh full but soft \n* No calf tenderness \n* ___ strength \n* SILT, NVI distally \n* Toes warm', 'diagnoses': [{'icd_code': '03849', 'desc': 'Other septicemia due to gram-negative organisms'}, {'icd_code': '56723', 'desc': 'Spontaneous bacterial peritonitis'}, {'icd_code': '07044', 'desc': 'Chronic hepatitis C with hepatic coma'}, {'icd_code': '5724', 'desc': 'Hepatorenal syndrome'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '2866', 'desc': 'Defibrination syndrome'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '78959', 'desc': 'Other ascites'}, {'icd_code': '2841', 'desc': 'Pancytopenia'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '99811', 'desc': 'Hemorrhage complicating a procedure'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '2869', 'desc': 'Other and unspecified coagulation defects'}, {'icd_code': '45621', 'desc': 'Esophageal varices in diseases classified elsewhere, without mention of bleeding'}, {'icd_code': '5601', 'desc': 'Paralytic ileus'}, {'icd_code': '99673', 'desc': 'Other complications due to renal dialysis device, implant, and graft'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '4275', 'desc': 'Cardiac arrest'}, {'icd_code': 'V667'}, {'icd_code': 'V707'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': '47831', 'desc': 'Unilateral paralysis of vocal cords or larynx, partial'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '3004', 'desc': 'Dysthymic disorder'}, {'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': 'E8794', 'desc': 'Aspiration of fluid as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'E8791', 'desc': 'Kidney dialysis as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}], 'summary': "___ 07:55AM BLOOD WBC-6.8 RBC-3.14* Hgb-9.3* Hct-29.7* \nMCV-95 MCH-29.7 MCHC-31.4 RDW-14.0 Plt ___\n___ 05:55AM BLOOD WBC-8.9 RBC-3.30* Hgb-10.0* Hct-31.2* \nMCV-95 MCH-30.4 MCHC-32.2 RDW-14.0 Plt ___\n___ 06:00AM BLOOD WBC-9.0 RBC-3.35* Hgb-9.7* Hct-31.3* \nMCV-93 MCH-28.9 MCHC-31.0 RDW-13.9 Plt ___\n___ 07:55AM BLOOD ___\n___ 05:55AM BLOOD ___\n___ 06:00AM BLOOD ___\n___ 06:00AM BLOOD Glucose-220* UreaN-15 Creat-0.9 Na-135 \nK-3.5 Cl-99 HCO3-29 AnGap-11\n___ 06:00AM BLOOD Calcium-8.2* Phos-2.8 Mg-1.9\nThe patient was admitted to the orthopedic surgery service and \nwas taken to the operating room for above described procedure. \nPlease see separately dictated operative report for details. The \nsurgery was uncomplicated and the patient tolerated the \nprocedure well. Patient received perioperative IV antibiotics.\n\nPostoperative course was remarkable for the following:\n\n1. Insulin Pump managed by patient\n\n2. Lovenox bridge to Coumadin x 6 weeks for goal INR ___. \nUsing Coumadin for DVT prophylaxis due questionable absorption \nof Lovenox in patient with insulin pump.\n\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The foley was \nremoved on POD#2 and the patient was voiding independently \nthereafter. The surgical dressing was changed on POD#2 and the \nsurgical incision was found to be clean and intact without \nerythema or abnormal drainage. The patient was seen daily by \nphysical therapy. Labs were checked throughout the hospital \ncourse and repleted accordingly. At the time of discharge the \npatient was tolerating a regular diet and feeling well. The \npatient was afebrile with stable vital signs. The patient's \nhematocrit was acceptable and pain was adequately controlled on \nan oral regimen. The operative extremity was neurovascularly \nintact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity.\n \n___ is discharged to home with services in stable \ncondition."}}
{'final_diagnoses': ['Left knee osteoarthritis'], 'procedures': ['___: Left total knee arthroplasty'], 'visit_summary': "The patient was admitted to the orthopedic surgery service and \nwas taken to the operating room for above described procedure. \nPlease see separately dictated operative report for details. The \nsurgery was uncomplicated and the patient tolerated the \nprocedure well. Patient received perioperative IV antibiotics.\n\nPostoperative course was remarkable for the following:\n\n1. Insulin Pump managed by patient\n\n2. Lovenox bridge to Coumadin x 6 weeks for goal INR ___. \nUsing Coumadin for DVT prophylaxis due questionable absorption \nof Lovenox in patient with insulin pump.\n\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The foley was \nremoved on POD#2 and the patient was voiding independently \nthereafter. The surgical dressing was changed on POD#2 and the \nsurgical incision was found to be clean and intact without \nerythema or abnormal drainage. The patient was seen daily by \nphysical therapy. Labs were checked throughout the hospital \ncourse and repleted accordingly. At the time of discharge the \npatient was tolerating a regular diet and feeling well. The \npatient was afebrile with stable vital signs. The patient's \nhematocrit was acceptable and pain was adequately controlled on \nan oral regimen. The operative extremity was neurovascularly \nintact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity.\n \n___ is discharged to home with services in stable \ncondition.", 'medications_prescribed': ['1. Albuterol Inhaler ___ PUFF IH Q6H:PRN wheeze/cough', '2. enalapril maleate 40 oral daily', '3. Fluticasone Propionate NASAL 2 SPRY NU DAILY', '4. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS', '5. Levothyroxine Sodium 88 mcg PO DAILY', '6. Multivitamins 1 TAB PO DAILY', '7. NIFEdipine CR 30 mg PO DAILY', '8. Psyllium 1 PKT PO TID:PRN constipation', '9. Vitamin D 400 UNIT PO DAILY', '10. Acetaminophen 1000 mg PO Q8H', '11. Docusate Sodium 100 mg PO BID', '12. Gabapentin 300 mg PO TID', '13. Morphine Sulfate ___ ___ mg PO Q4H:PRN pain', '14. Senna 8.6 mg PO BID', '15. Aspirin 81 mg PO DAILY', '16. Citracal + D 250 mg calcium- 250 unit oral BID', '17. Combigan (brimonidine-timolol) 0.2-0.5 % ophthalmic TID', '18. Flovent HFA (fluticasone) 220 mcg/actuation inhalation \nBID:PRN cough', '19. Oxybutynin 10 mg PO DAILY', '20. Insulin Pump SC (Self Administering Medication)Insulin \nAspart (Novolog) (non-formulary)\nBasal rate minimum: 0.4 units/hr\nBasal rate maximum: 0.7 units/hr\nTarget glucose: ___\nFingersticks: QAC and HS', '21. ___ MD to order daily dose PO DAILY16 *Goal INR ___']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 77, 'gender': 'F', 'symptoms': 'Right hand pain', 'medical_history': ['PMH: None', 'PSH: None'], 'family_history': 'NC', 'present_illness': 'Patient is a ___ y/o right hand dominant male who was transferred \nfrom an outside hospital with right metacarpal fractures. \nPatient reportedly came home from work and tripped on his kids \ntoy and ended up punching the ground out of anger where he felt \nimmediate pain in his right hand an went to outside hospital for \nfurther evaluation. Currently claims to have some \nnumbness/decreased sensation over the middle and small figers. \nDenies f/c/n/v.', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydroxychloroquine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aripiprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BusPIRone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Upon Admission:\n\nVitals: 98.9, 88, 150/86, 16, 96% RA\nGen: NAD, AOx3\nPulm: unlabored respirations\nHand: Right hand grossly swollen and tense. Skin intact. SILT\nradial and ulnar nerve distribution but has some decreased\nsensation in the median nerve distributions. AIN/PIN/U motor\nfunction intact but ROM limited due to pain. Patient placed in\ntemporary volar hand splint with ACE wrap.', 'diagnoses': [{'icd_code': '80131', 'desc': 'Closed fracture of base of skull with other and unspecified intracranial hemorrhage, with no loss of consciousness'}, {'icd_code': '3572', 'desc': 'Polyneuropathy in diabetes'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': '8026', 'desc': 'Closed fracture of orbital floor (blow-out)'}, {'icd_code': 'E8844', 'desc': 'Accidental fall from bed'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}, {'icd_code': '7291', 'desc': 'Myalgia and myositis, unspecified'}, {'icd_code': '25060', 'desc': 'Diabetes with neurological manifestations, type II or unspecified type, not stated as uncontrolled'}], 'summary': '___ 02:45PM BLOOD WBC-12.3* RBC-4.70 Hgb-15.1 Hct-44.9 \nMCV-96 MCH-32.2* MCHC-33.7 RDW-13.1 Plt ___\n___ 02:45PM BLOOD ___ PTT-28.1 ___\n___ 02:45PM BLOOD Glucose-77 UreaN-10 Creat-0.8 Na-139 \nK-3.9 Cl-104 HCO3-24 AnGap-15\nPatient was admitted to the hand surgery service following \nclosed reducrtion right ___ and ___ metacarpals and \nopen carpal tunnel release. For full details of this procedure, \nplease refer to the operative report. His right hand was placed \nin a splint and elevated postoperatively. He was started on a \nregular diet which he tolerated well, and given oral pain \nmedications with good effect. He was observed overnight, and on \nPOD1 his exam remained stable with normal sensation in his \ndistal fingertips, and cap refill less than 2 seconds \nthroughout. He was counciled on the importance of keeping his \nhand elevated when he goes home, as well as what danger signs to \nlook for. He was deemed appropriate for discharge, and will \nfollow up in hand clinic on __.'}}
{'final_diagnoses': ['Fractures of ___ and ___ metacarpals, and dislocations of the ___ and ___ CMC joints, as well as median nerve compression'], 'procedures': ['closed reduction right ___ and ___ metacarpals and open carpal tunnel release'], 'visit_summary': 'Patient was admitted to the hand surgery service following \nclosed reducrtion right ___ and ___ metacarpals and \nopen carpal tunnel release. For full details of this procedure, \nplease refer to the operative report. His right hand was placed \nin a splint and elevated postoperatively. He was started on a \nregular diet which he tolerated well, and given oral pain \nmedications with good effect. He was observed overnight, and on \nPOD1 his exam remained stable with normal sensation in his \ndistal fingertips, and cap refill less than 2 seconds \nthroughout. He was counciled on the importance of keeping his \nhand elevated when he goes home, as well as what danger signs to \nlook for. He was deemed appropriate for discharge, and will \nfollow up in hand clinic on __.', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN Pain ', '2. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth Q3-4HRS Disp #*80 \nTablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 60, 'gender': 'F', 'symptoms': 'Morbid obesity', 'medical_history': ['PAST MEDICAL HISTORY: Notable for gastroesophageal reflux, type\n2 diabetes, obstructive sleep apnea, hypothyroidism,\nfibromyalgia, atrial fibrillation, and depression, now well\ncontrolled.'], 'family_history': 'Her family history is noted for both parents living father age \n___ with hyperlipidemia; mother age ___ with history of stroke and \narthritis; brother living age ___ with diabetes', 'present_illness': '___ has class III morbid obesity with weight of 243.5 pounds \nas a ___ (her initial screen weight on ___ was 244 \npounds), height of 61 inches and BMI of 46. Her previous weight \nloss efforts have included Weight Watchers, Nutrisystem, RD \nvisits, over-the-counter ephedra-containing Metabolife, \nover-the-counter dietary supplement Dexatrim and prescription \nweight loss medication Redux now off the market for one month \nwith no weight loss. Her weight at age ___ was 140 pounds her \nlowest adult weight with her initial screen weight of 244 pounds \nbeing her highest weight. She weighed 230 pounds one year ago. \nShe states she has been struggling with weight since her late \n___/early ___ and cites as factors contributing to her excess \nweight large portions, inconsistent meal pattern on weekends, \ntoo many carbohydrates and lack of exercise. Her current \nactivity is walking 15 minutes twice per day 5 days per week. \nShe denied history of eating disorders and does have depression \nthat is reactive but has not seen a therapist or been \nhospitalized for mental health issues and she is on psychotropic \nmedication (Celexa).', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Clobetasol Propionate 0.05% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrocerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 425.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.2', 'valuenum': 47.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 286.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Vital signs: T 97.5, HR 83, BP 121/44, RR 18, O2 97%RA\n\nConstitutional: NAD, pleasant\nNeuro: Alert and oriented to person, place and time\nCardiac: RRR, No MRG, NL S1,S2\nLungs: CTA B\nAbdomen: Soft, non-tender, non-distended, no rebound tenderness/ \nguarding\nWounds: Abd incision open to air with staples, no periwound \nerythema or drainage; JP w/ serosanguinous drainage; Gtube \nclamped\nExt: No edema', 'diagnoses': [{'icd_code': 'L270', 'desc': 'Generalized skin eruption due to drugs and medicaments taken internally'}, {'icd_code': 'N151', 'desc': 'Renal and perinephric abscess'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'R7881', 'desc': 'Bacteremia'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'B9620', 'desc': 'Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere'}, {'icd_code': 'T361X5A', 'desc': 'Adverse effect of cephalosporins and other beta-lactam antibiotics, initial encounter'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}, {'icd_code': 'Z7982', 'desc': 'Long term (current) use of aspirin'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'R601', 'desc': 'Generalized edema'}, {'icd_code': 'M170', 'desc': 'Bilateral primary osteoarthritis of knee'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6834', 'desc': 'Body mass index [BMI] 34.0-34.9, adult'}], 'summary': "___:\nBAS/UGI AIR/SBFT:\nIMPRESSION: No evidence of leaks or holdup at the gastrojejunal \nanastomosis\nThe patient presented to pre-op on ___. Pt was \nevaluated by anaesthesia and taken to the operating room for \nlaparoscopic Roux-en-Y gastric bypass. There were no adverse \nevents in the operating room; please see the operative note for \ndetails. Pt was extubated, taken to the PACU where she was noted \nto have bloody NGT output, hematemesis and a decreased \nhematocrit level consistent with acute blood loss anemia. The \npatient received 2 units of PRBCs and was taken back to the \noperating room where she underwent an exploratory laparatomy, \noversew of staple lines, placement of a gastrostomy tube and \nrepeat upper endoscopy by GI; see operative report for details. \nThe patient remained intubated and was transferred to the SICU \nfor further management. \n\nNeuro: Post-operatively, the patient was sedated with propofol \nwhich was discontinued upon extubation. On POD 2, the patient \nbecame delerious requiring discontinuation of both lorazepam and \ndilaudid PCA; pain was subsequently managed with intravenous \nfentanyl while in the ICU. Her mental status grandually \nimproved to baseline and she remained alert and oriented \nthroughout the remainder her hospitalization; once on the floor \nand tolerating a stage 2 diet pain was managed with oral Roxicet \nand then oral acetaminophen. \nCV: The patient remained stable from a cardiovascular \nstandpoint. Of note she complained of palpitations on POD7; an \nEKG showed normal sinus rhythm and cardiac enzymes were \nnegative; intravenous metoprolol was initiated on POD1 and \ntransitioned to the patient's home atenolol dose on POD6. Upon \ndiscussion with the patient's PCP, the patient may discontinue \natenolol altogether. \nPulmonary: The patient was extubated on POD1 without incident. \nShe subsequently remained stable from a pulmonary standpoint; \nvital signs were routinely monitored. Good pulmonary toilet, \nearly ambulation and incentive spirometry were encouraged \nthroughout hospitalization. \nGI/GU/FEN: She was initially kept NPO with intravenous Protonix. \n An NGT, maintained to low intermittent suction, was \ndiscontinued on POD1. Her g-tube remained to low intermittent \nsuction. Her diet was advanced to a bariatric stage 1 diet, \nwhich was advanced sequentially to stage 3, and well tolerated. \nPatient's intake and output were closely monitored. An upper GI \nstudy was performed on post-operative day ___ and was negative for \na leak. \nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's received a total of 4 units PRBCs on POD0 \ndue to acute blood loss anemia as described above. On POD 2, \nher hematocrit trended downward, however, she remained \nclinically stable. Her hematocrit levels were closely monitored \nand remained stable throughout the remainder of her \nhospitalization and remained stable. \nProphylaxis: Subcutaneous heparin was held due to concerns for \nbleeding; ___ dyne boots were used during this stay; she was \nencouraged to get up and ambulate as early as possible.\nRehab: Pt was seen by both ___ and OT who felt the patient was \nindependent with mobility and ADLs without needs for home \nservices.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a stage 3 \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan."}}
{'final_diagnoses': ['Obesity, body mass index of 45..', 'Type 2 diabetes.', 'Reflux.', 'Sleep apnea.', 'Acute blood loss anemia'], 'procedures': ['___: Laparascopic Roux-en-Y gastric bypass'], 'visit_summary': "The patient presented to pre-op on ___. Pt was \nevaluated by anaesthesia and taken to the operating room for \nlaparoscopic Roux-en-Y gastric bypass. There were no adverse \nevents in the operating room; please see the operative note for \ndetails. Pt was extubated, taken to the PACU where she was noted \nto have bloody NGT output, hematemesis and a decreased \nhematocrit level consistent with acute blood loss anemia. The \npatient received 2 units of PRBCs and was taken back to the \noperating room where she underwent an exploratory laparatomy, \noversew of staple lines, placement of a gastrostomy tube and \nrepeat upper endoscopy by GI; see operative report for details. \nThe patient remained intubated and was transferred to the SICU \nfor further management. \n\nNeuro: Post-operatively, the patient was sedated with propofol \nwhich was discontinued upon extubation. On POD 2, the patient \nbecame delerious requiring discontinuation of both lorazepam and \ndilaudid PCA; pain was subsequently managed with intravenous \nfentanyl while in the ICU. Her mental status grandually \nimproved to baseline and she remained alert and oriented \nthroughout the remainder her hospitalization; once on the floor \nand tolerating a stage 2 diet pain was managed with oral Roxicet \nand then oral acetaminophen. \nCV: The patient remained stable from a cardiovascular \nstandpoint. Of note she complained of palpitations on POD7; an \nEKG showed normal sinus rhythm and cardiac enzymes were \nnegative; intravenous metoprolol was initiated on POD1 and \ntransitioned to the patient's home atenolol dose on POD6. Upon \ndiscussion with the patient's PCP, the patient may discontinue \natenolol altogether. \nPulmonary: The patient was extubated on POD1 without incident. \nShe subsequently remained stable from a pulmonary standpoint; \nvital signs were routinely monitored. Good pulmonary toilet, \nearly ambulation and incentive spirometry were encouraged \nthroughout hospitalization. \nGI/GU/FEN: She was initially kept NPO with intravenous Protonix. \n An NGT, maintained to low intermittent suction, was \ndiscontinued on POD1. Her g-tube remained to low intermittent \nsuction. Her diet was advanced to a bariatric stage 1 diet, \nwhich was advanced sequentially to stage 3, and well tolerated. \nPatient's intake and output were closely monitored. An upper GI \nstudy was performed on post-operative day ___ and was negative for \na leak. \nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's received a total of 4 units PRBCs on POD0 \ndue to acute blood loss anemia as described above. On POD 2, \nher hematocrit trended downward, however, she remained \nclinically stable. Her hematocrit levels were closely monitored \nand remained stable throughout the remainder of her \nhospitalization and remained stable. \nProphylaxis: Subcutaneous heparin was held due to concerns for \nbleeding; ___ dyne boots were used during this stay; she was \nencouraged to get up and ambulate as early as possible.\nRehab: Pt was seen by both ___ and OT who felt the patient was \nindependent with mobility and ADLs without needs for home \nservices.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a stage 3 \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan.", 'medications_prescribed': ['acetaminophen 325 mg/10.15 mL Solution Sig: Twenty (20) ml PO \nevery six (6) hours as needed for pain: Do not exceed 3000 mg \nper 24 hour period.\nDisp:*300 ml* Refills:*0*', 'omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day: Open capsule, \nsprinkle contents onto applesauce, swallow whole.\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*', 'docusate sodium 50 mg/5 mL Liquid Sig: Ten (10) ml PO twice a \nday as needed for constipation.\nDisp:*300 ml* Refills:*0*', 'multivitamin with minerals Tablet Sig: One (1) Tablet PO \nonce a day: Chewable/ crushable. ', 'pravastatin 20 mg Tablet Sig: One (1) Tablet PO once a day: \nPlease crush. ', 'tramadol 50 mg Tablet Sig: One (1) Tablet PO once a day: \nPlease crush. ', 'levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO once a \nday: Please crush. ', 'zoledronic acid-mannitol&water Intravenous', 'Celexa 10 mg Tablet Sig: One (1) Tablet PO once a day: Please \ncrush. ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 70, 'gender': 'M', 'symptoms': 'Dark tarry stools, symptomatic anemia', 'medical_history': ['PE ___', '1. H/o PE, DVTs s/p IVC filter ___', '2. Gout', '3. Multiple GI bleeds: ___ treated with embolization of the \ndistal middle colic artery; then ___ at which time ___ \nshowed some blood but no clear source of bleeding', '4. HLD', '5. Morbid obesity', '6. HTN', '7. Asthma', '8. Venous stasis disease', '9. Pulmonary nodules on CT done ___', '10. Colonic diverticulosis', '11. History of colonic polyps', '12. OA', '13. Chronic back pain', '14. mucinous adenocarcinoma s/p wide excision w/o local \nrecurrence ___', '15. Mallet finger ___'], 'family_history': 'Mother with HTN, CAD, MI. Sister with ovarian cancer. No h/o \ncolonic malignancy.', 'present_illness': "Ms ___ is a ___ with a h/o PE s/p IVC filter in ___, multiple \nGI bleeds, on coumadin with INR goal 1.5-2.0, who presents with \nmultiple week hx of intermittent episodes of burning epigastric \npain (worse following meals, resolves spontaneously in ~5 \nminutes) and dark tarry stools accompanied by new 2 day hx of \nfatigue and shortness of breath with exertion and intermittent \nleft sided sharp chest pain at rest. Pt was concerned that she \nmight be anemic because this is similar to a prior history of \nGIB and so went to her PCP's office, where CBC was drawn showing \nHCT 22 from baseline 30.\n\nOf note, she has a history of clots in the past for which an IVC \nfilter was placed at the ___ in ___. Unclear if \nthe filter has been evaluated since then. She was placed on \nCoumadin as well with an INR goal 1.5-2.0 given her history of \nGI bleed, which per patient, started after her daughter died \nfrom cervical cancer at ___ several years ago. In ___, she \nwas found to have LLL PE on CT chest after presenting with \ndyspnea and lower extremity edema. Just prior to that \npresentation, she was seen at ___ for abdominal \npain and BRBPR and found to have diffuse diverticulosis with \nmild diverticulitis of the descending colon which responded to \nflagyl. \n\nIn the ED, initial VS 97.6 84 133/70 18 99% 6L Nasal Cannula. O2 \nwas quickly weaned to 100% RA. Rectal exam in the ED guaiac \npositive. Labs notable for hemoglobin 7.0, baseline ~10 as \noutpt, and plts of 15 which is new (prior baseline 2 months \nprior was 220). EKG unremarkable, trop negative. Was T&Cx4, 2u \nFFP, 1u Plts, given 10mg PO vit K. Ordered 2u pRBC but not \ngiven. \n\nCurrently, on the floor, patient is complaining of severe neck \npain especially on movement, which she notes began after she \nheard a 'pop' when she tried to hoist herself up her bed in the \nED here. She otherwise notes no more tarry stools, and denies \nany ongoing dizziness, SOB, or epigastric pain.", 'medications': [{'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAM\nVitals- 98.0F, 125/55, 92, 20, 100% 3L I&O MN NPO/BRP \nGeneral- Alert, oriented, obese, in moderate distress from neck \npain \nHEENT- Sclerae anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD, point tenderness to \npalpation in mid posterior region, full ROM on passive movement \n\nLungs- Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV- Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen- soft, protruberant, non-tender to palpation, bowel \nsounds present, no rebound tenderness or guarding, no \norganomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema, venous stasis changes in L lower extremity to upper calf, \necchymoses in upper extremities \nNeuro- CNs2-12 intact, motor function grossly normal \n\nDISCHARGE PHYSICAL EXAM\nVITALS: 97.7, 78, 158/88, 20, 98% on RA\nGENERAL: obese ___ lady in NAD, pleasant\nHEENT: no oral ulcers or lesions\nLUNGS: clear to auscultation bilaterally\nHEART: RRR, no murmurs/rubs/gallops\nABDOMEN: NABS, soft/NT/ND\nEXTREMITIES: WWP, 2+ pedal pulses in bilateral ___, venous stasis \nchanges LLE\nSKIN: no rashes', 'diagnoses': [{'icd_code': 'K55042', 'desc': 'Diffuse acute infarction of large intestine'}, {'icd_code': 'K55022', 'desc': 'Diffuse acute infarction of small intestine'}, {'icd_code': 'K551', 'desc': 'Chronic vascular disorders of intestine'}, {'icd_code': 'Z515', 'desc': 'Encounter for palliative care'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'I739', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'Z951', 'desc': 'Presence of aortocoronary bypass graft'}], 'summary': "ADMISSION LABS\n==============\n___ 06:30PM ___ PTT-27.1 ___\n___ 06:30PM PLT SMR-RARE PLT COUNT-15*#\n___ 06:30PM NEUTS-42.4* LYMPHS-48.3* MONOS-5.0 EOS-4.0 \nBASOS-0.2\n___ 06:30PM WBC-4.0 RBC-2.39* HGB-7.0* HCT-22.7* MCV-95 \nMCH-29.4 MCHC-31.0 RDW-20.7*\n___ 06:30PM ALBUMIN-3.8\n___ 06:30PM cTropnT-<0.01\n___ 06:30PM ALT(SGPT)-12 AST(SGOT)-20 ALK PHOS-50 TOT \nBILI-0.3\n___ 06:30PM estGFR-Using this\n___ 06:30PM GLUCOSE-96 UREA N-26* CREAT-0.9 SODIUM-140 \nPOTASSIUM-3.4 CHLORIDE-105 TOTAL CO2-27 ANION GAP-11\n___ 09:25PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 09:25PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 09:25PM URINE GR HOLD-HOLD\n___ 09:25PM URINE UHOLD-HOLD\n___ 09:25PM URINE HOURS-RANDOM\n___ 09:25PM URINE HOURS-RANDOM\n\nDISCHARGE LABS\n==============\n___ 12:00AM BLOOD WBC-3.0* RBC-3.09* Hgb-9.6* Hct-28.7* \nMCV-93 MCH-31.1 MCHC-33.5 RDW-19.3* Plt Ct-10*\n___ 12:00AM BLOOD Glucose-255* UreaN-33* Creat-1.3* Na-135 \nK-4.5 Cl-98 HCO3-24 AnGap-18\n___ 12:00AM BLOOD ALT-13 AST-14 LD(LDH)-426* AlkPhos-49 \nTotBili-0.8\n___ 12:00AM BLOOD Calcium-9.5 Phos-2.9 Mg-1.9\n\nCARDIOLOGY\n==========\n___ - ECHO (TTE)\nThe left atrium is mildly dilated. No atrial septal defect is \nseen by 2D or color Doppler. Left ventricular wall thickness, \ncavity size, and global systolic function are normal (LVEF>55%). \nRight ventricular chamber size and free wall motion are normal. \nThere is abnormal septal motion/position. The aortic valve \nleaflets (3) are mildly thickened but aortic stenosis is not \npresent. No aortic regurgitation is seen. The mitral valve \nleaflets are mildly thickened. An eccentric, posteriorly \ndirected jet of mild (1+) mitral regurgitation is seen. The \nestimated pulmonary artery systolic pressure is normal. There is \na small pericardial effusion measuring up to 0.6 cm in greatest \ndimension. The effusion appears circumferential. There are no \nechocardiographic signs of tamponade. \n\nIMPRESSION: Small, circumferential pericardial effusion without \nechocardiographic evidence of tamponade. Preserved biventricular \nsystolic function. Mild mitral regurgitation. Normal pulmonary \nartery systolic pressure.\n\n___ - EKG\nSinus rhythm. Normal ECG. Compared to the previous tracing of \n___ ST-T wave changes are no longer present.\n\nRADIOLOGY\n=========\n___ - MR ___ PLEXUS ___ CONTRAST\nNo brachial plexopathy, mass lesion, or alternative etiology to \naccount for patient's left arm weakness. Multilevel degenerative \nchange in the cervical spine is better evaluated on ___. \n\n___ - MR CERVICAL SPINE W/O CONTRAST\n1. Multilevel degenerative spondylosis within the cervical and \nupper thoracic spine including remodeling of the cord at the \nC3-C4 and C6-C7 levels, severe right neural foraminal narrowing \nat the C3-C4 level with possible impingement of the exiting \nright C4 nerve root, and severe right neural foraminal narrowing \nat the T1-T2 level with possible impingement of the exiting \nright T1 nerve root. \n2. Heterogenous T1 marrow signal hypointensity wiithout STIR \ncorrelate, much of which may be related to discogenic endplate \nchanges, although a component of marrow replacement is not \nexcluded, particularly involving the T2 and T3 vertebrae, and \nclose correlation with the results of recent recent bone marrow \nbiopsy is recommended. \n\n___ - MR HEAD W/O CONTRAST\n1. No evidence of acute intracranial hemorrhage, mass effect, or \nacute ischemia. \n2. Mild cerebral atrophy and presumed sequelae of chronic small \nvessel ischemic disease. \n\n___ - CTA ABD & PELVIS\n1. There is no evidence of hemorrhage, infection, mass. \n2. Small paraesophageal hernia. \n\n___ - CT Neck w/o contrast\n1. No fracture or traumatic malalignment the cervical spine.\n2. No neck hematoma.\n3. Multilevel degenerative disc disease.\n\nOTHER STUDIES\n=============\n___ - EMG\nClinical Interpretation: Abnormal study, limited technically by \nbody habitus and thrombocytopenia. The electrophysiologic data \nare most consistent with a severe, chronic left ulnar neuropathy \nwith evidence for axonal loss. The ulnar neuropathy is proximal \nto the innervation of the flexor digitorum profundus, but cannot \nbe localized further. In addition, a moderate, non- localized \nmedian neuropathy is noted. The data are not suggestive of lower \ntrunk or medial cord brachial plexopathy.\nMs. ___ is a ___ lady with a history of PE s/p IVC \nfilter in ___ on warfarin and multiple GI bleeds who presented \nwith increased fatigue and melena, and was diagnosed to have \naplastic anemia, complicated by GI bleed.\n\nACTIVE PROBLEMS\n\n# Aplastic Anemia\nThe patient presented with symptoms of fatigue and dark stools. \nHer initial labs were concerning for pancytopenia. Initially, it \nwas thought that she had probable ITP, and she was treated with \nhigh dose steroids, IVIG, rituximab, and romiplostim. However, \nher platelets remained low despite therapy, and repeat bone \nmarrow biopsy on ___ showed markedly hypocellular bone marrow \nwith decreased megakaryocytes, which suggested a more likely \ndiagnosis of aplastic anemia. Consequently, she was treated with \nATG/TLI and cyclosporine. As a result of the treatment, she \ndeveloped dramatic serum sickness. She was treated with a course \nof high dose prednisone, and she was discharged on a taper. She \nwas also discharged on acyclovir and atovaquone for prophylaxis. \nShe was transfusion dependent while inpatient and will require \ntransfusions until she can recover her counts.\n\n# Melena / GIB: The patient presented with dark stools in the \nsetting of history of multiple GI bleeds and thrombocytopenia. \nDue to her thrombocytopenia, EGD was held until her platelets \ncame up, and it showed gastritis with nonbleeding AVMs that were \nnot intervenable for now. She had no frank bleeding while \ninpatient. She was found to be H. pylori positive and treated \nwith PPI, bismuth 525 mg qid, flagyl 250mg qid, and tetracycline \n500mg qid for 14 days.\n\n# DM: The patient had borderline elevated A1c levels for many \nyears, but in the setting of receiving high dose steroids, she \nhad worsening blood glucose control and required insulin, which \nshe will require while on predisone. She was discharged with a \ntaper for insulin along with the prednisone.\n\n# Retinal Hemorrhage: During her stay, the patient reported a \nchange in her vision that she described as a red color to \neverything that she sees. She was evaluated by ophthalmology and \nwas found to have retinal hemorrhage in right more than left eye \nsecondary to thrombocytopenia. There was no need for \nintervention, and she will follow up as an outpatient.\n\n# Ulnar Palsy: During her stay, she developed weakness and loss \nof sensation in her left ___ and ___ digit. Neurology evaluated \nand recommended MRI of the brachial plexus, which showed no \nbrachial plexopathy, mass lesion, or alternative etiology to \naccount for patient's left arm weakness, and EMG, which showed \nsevere, chronic left ulnar neuropathy with evidence for axonal \nloss. She was seen by ___. She should follow up with Neurology \nas an outpatient.\n\nCHRONIC PROBLEMS\n\n# Prior Hepatitis B Infection: For starting rituximab, her hep B \nserologies were tested, which was consistent with prior HBV \ninfection. Her viral load was negative during this \nhospitalization and lamivudine was held inpatient. She will need \nfollow up as an outpatient.\n\n# Hypertension: Her home HCTZ was held due to interaction with \ncyclosporine, and was restarted toward the end of her \nhospitalization.\n\n# PE on coumadin: \nPE ___, has hx of clots over the years with IVC filter placed \nin ___ (?). Unclear if IVC has been evaluated since placement. \nINR on admission 4.5, 0.9 at time of transfer on ___ s/p 10mg PO \nVitamin K in ED on ___. Per pt, no hx of hypercoagulable \nworkup. \n\nTRANSITIONAL ISSUES\n- GI bleeds were thought to be due to gastric AVMs that were \nunable to be intervened upon at that time.\n- Warfarin was held in the setting of thrombocytopenia. Please \nconsider resuming when appropriate.\n- Patient is Anti-K antibody positive, so she should receive \nK-antigen negative products for all red cell transfusions.\n- She is transfusion dependent currently and will need regular \nfollow up.\n- At the time of discharge, she was slightly hypertensive, and \nher hypertension regimen will need to be adjusted.\n- She was found to have an ulnar palsy of some unknown etiology. \nShe will need outpatient follow up for this problem.\n- She was found to have Hep B serologies consistent with prior \ninfection with no immunity, and she will need treatment follow \nup outpatient."}}
{'final_diagnoses': ['Aplastic Anemia', 'Upper GI bleed', 'History of PE/DVT on Coumadin', 'Hypertension'], 'procedures': ['Esophagoduodenoscopy - ___', 'Bone marrow biopsy - ___'], 'visit_summary': "Ms. ___ is a ___ lady with a history of PE s/p IVC \nfilter in ___ on warfarin and multiple GI bleeds who presented \nwith increased fatigue and melena, and was diagnosed to have \naplastic anemia, complicated by GI bleed.\n\nACTIVE PROBLEMS\n\n# Aplastic Anemia\nThe patient presented with symptoms of fatigue and dark stools. \nHer initial labs were concerning for pancytopenia. Initially, it \nwas thought that she had probable ITP, and she was treated with \nhigh dose steroids, IVIG, rituximab, and romiplostim. However, \nher platelets remained low despite therapy, and repeat bone \nmarrow biopsy on ___ showed markedly hypocellular bone marrow \nwith decreased megakaryocytes, which suggested a more likely \ndiagnosis of aplastic anemia. Consequently, she was treated with \nATG/TLI and cyclosporine. As a result of the treatment, she \ndeveloped dramatic serum sickness. She was treated with a course \nof high dose prednisone, and she was discharged on a taper. She \nwas also discharged on acyclovir and atovaquone for prophylaxis. \nShe was transfusion dependent while inpatient and will require \ntransfusions until she can recover her counts.\n\n# Melena / GIB: The patient presented with dark stools in the \nsetting of history of multiple GI bleeds and thrombocytopenia. \nDue to her thrombocytopenia, EGD was held until her platelets \ncame up, and it showed gastritis with nonbleeding AVMs that were \nnot intervenable for now. She had no frank bleeding while \ninpatient. She was found to be H. pylori positive and treated \nwith PPI, bismuth 525 mg qid, flagyl 250mg qid, and tetracycline \n500mg qid for 14 days.\n\n# DM: The patient had borderline elevated A1c levels for many \nyears, but in the setting of receiving high dose steroids, she \nhad worsening blood glucose control and required insulin, which \nshe will require while on predisone. She was discharged with a \ntaper for insulin along with the prednisone.\n\n# Retinal Hemorrhage: During her stay, the patient reported a \nchange in her vision that she described as a red color to \neverything that she sees. She was evaluated by ophthalmology and \nwas found to have retinal hemorrhage in right more than left eye \nsecondary to thrombocytopenia. There was no need for \nintervention, and she will follow up as an outpatient.\n\n# Ulnar Palsy: During her stay, she developed weakness and loss \nof sensation in her left ___ and ___ digit. Neurology evaluated \nand recommended MRI of the brachial plexus, which showed no \nbrachial plexopathy, mass lesion, or alternative etiology to \naccount for patient's left arm weakness, and EMG, which showed \nsevere, chronic left ulnar neuropathy with evidence for axonal \nloss. She was seen by ___. She should follow up with Neurology \nas an outpatient.\n\nCHRONIC PROBLEMS\n\n# Prior Hepatitis B Infection: For starting rituximab, her hep B \nserologies were tested, which was consistent with prior HBV \ninfection. Her viral load was negative during this \nhospitalization and lamivudine was held inpatient. She will need \nfollow up as an outpatient.\n\n# Hypertension: Her home HCTZ was held due to interaction with \ncyclosporine, and was restarted toward the end of her \nhospitalization.\n\n# PE on coumadin: \nPE ___, has hx of clots over the years with IVC filter placed \nin ___ (?). Unclear if IVC has been evaluated since placement. \nINR on admission 4.5, 0.9 at time of transfer on ___ s/p 10mg PO \nVitamin K in ED on ___. Per pt, no hx of hypercoagulable \nworkup. \n\nTRANSITIONAL ISSUES\n- GI bleeds were thought to be due to gastric AVMs that were \nunable to be intervened upon at that time.\n- Warfarin was held in the setting of thrombocytopenia. Please \nconsider resuming when appropriate.\n- Patient is Anti-K antibody positive, so she should receive \nK-antigen negative products for all red cell transfusions.\n- She is transfusion dependent currently and will need regular \nfollow up.\n- At the time of discharge, she was slightly hypertensive, and \nher hypertension regimen will need to be adjusted.\n- She was found to have an ulnar palsy of some unknown etiology. \nShe will need outpatient follow up for this problem.\n- She was found to have Hep B serologies consistent with prior \ninfection with no immunity, and she will need treatment follow \nup outpatient.", 'medications_prescribed': ['1. Docusate Sodium 100 mg PO BID', '2. Acyclovir 400 mg PO/NG Q8H \nRX *acyclovir 400 mg 1 tablet(s) by mouth three times a day Disp \n#*90 Tablet Refills:*1', '3. Atovaquone Suspension 1500 mg PO DAILY \nRX *atovaquone 750 mg/5 mL 10 ml by mouth daily Refills:*1', '4. Cyanocobalamin ___ mcg PO DAILY \nRX *cyanocobalamin (vitamin B-12) 2,000 mcg 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*1', '5. CycloSPORINE (Neoral) MODIFIED 150 mg PO Q12H', '6. Fluconazole 400 mg PO Q24H \nRX *fluconazole 200 mg 2 tablet(s) by mouth daily Disp #*60 \nTablet Refills:*1', '7. Vitamin D 1000 UNIT PO DAILY \nRX *ergocalciferol (vitamin D2) 2,000 unit 1 tablet(s) by mouth \nevery other day Disp #*15 Tablet Refills:*1', '8. Albuterol Inhaler ___ PUFF IH Q4H:PRN SOB', '9. Fish Oil (Omega 3) 1000 mg PO DAILY', '10. Milk of Magnesia 30 mL PO Q6H:PRN Constipation', '11. Multivitamins 1 TAB PO DAILY', '12. Simvastatin 20 mg PO QPM', '13. Pantoprazole 40 mg PO Q12H', '14. Triamterene-HCTZ (37.5/25) 1 CAP PO DAILY', '15. Lidocaine 5% Patch 2 PTCH TD DAILY \nApply only ONE to each affected knee', '16. Acetaminophen 500 mg PO ONCE:PRN Pain', '17. OxycoDONE (Immediate Release) 5 mg PO Q8H:PRN pain', "18. PredniSONE 60 mg PO DAILY Duration: 3 Days \nStart: Today - ___, First Dose: First Routine \nAdministration Time \nPlease follow your doctor's specific instructions on how to \ntake. \nTapered dose - DOWN \nRX *prednisone 10 mg 1 tablet(s) by mouth as directed Disp #*30 \nTablet Refills:*0\nRX *prednisone 5 mg 1 tablet(s) by mouth as directed Disp #*6 \nTablet Refills:*0", "19. PredniSONE 30 mg PO DAILY Duration: 3 Days \nStart: After 60 mg tapered dose \nPlease follow your doctor's specific instructions on how to \ntake. \nTapered dose - DOWN", "20. PredniSONE 15 mg PO DAILY Duration: 3 Days \nStart: After 30 mg tapered dose \nPlease follow your doctor's specific instructions on how to \ntake. \nTapered dose - DOWN", "21. PredniSONE 5 mg PO DAILY Duration: 3 Days \nStart: After 15 mg tapered dose \nPlease follow your doctor's specific instructions on how to \ntake. \nTapered dose - DOWN", '22. NPH 14 Units Breakfast\nNPH 0 Units Lunch\nNPH 0 Units Dinner\nNPH 0 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin\nRX *blood sugar diagnostic [FreeStyle Lite Strips] Disp #*100 \nStrip Refills:*0\nRX *lancets [Ultra Thin Lancets] 31 gauge Disp #*100 Each \nRefills:*0\nRX *NPH insulin human recomb [Humulin N KwikPen] 100 unit/mL (3 \nmL) 10 daily Disp #*1 Syringe Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 70, 'gender': 'F', 'symptoms': 'Gallbladder adenomyomatosis', 'medical_history': ['HTN', 'Hyperlipidemia', 'osteoporosis', 'GERD', 'D&C ___ vag bleeding: Path non-diagnostic', 'Splenectomy ___ (perforated during colonoscopy)'], 'family_history': 'Mother - DM2, galucoma, breast Ca Mother in her ___ and ___. \nSiblings- brother with prostate cancer', 'present_illness': '___ y/o female with persistent elevation of alk phos and a RUQ \nultrasound concerning for a GB mass. She underwent an MRCP which \ndemonstrated a mass in the gallbladder fundus with features \nconsistent with adenomyomatosis. Because of these findings she \nwas scheduled for an elective laproscopic cholecystectomy. Her \nprevious surgical history include an urgent exploratory \nlaparotomy and splenectomy ___ a splenic laceration during a \ncolonoscopy.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lacosamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Infusion – Comfort Care Guidelines', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Infusion – Comfort Care Guidelines', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lacosamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lacosamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fondaparinux Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lacosamide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59.4', 'valuenum': 59.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 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{'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 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'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '___', 'valuenum': 37.2, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': 'AXILLARY.'}, {'value': '/12.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 40.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. 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DOHLE BODIES PRESENT.'}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'VERY LOW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'OCCASIONAL.'}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, 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'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 37.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '___', 'valuenum': 31.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '1590', 'valuenum': 1590.0, 'valueuom': '#/uL', 'ref_range_lower': 2200.0, 'ref_range_upper': 8250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '494', 'valuenum': 494.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.50', 'valuenum': 2.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.3,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 194.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': '97 97 81 106/66 16 98RA\nNAD, comfortable\nRRR no m/r/g\nBreath sounds clear to bases b/l\nABd - moderate tenderness over RUQ, port sites c/d/i no \ndrainage. No erythema. ABd soft, non-distended, wound vac in \nplace over 6cm long by 6 cm deep midline incision, with well \ngranulating tissue\nExt: no edema or erythema\n\nOn Discharge:\nVSS, Afebrile\nGen: NAD\nCV: RRR\nLungs: Diminished bilateraly on bases\nAbd: Midline abdominal incision with VAC dressing.\nExt: Warm, no c/c/e. Right UE PICC line.', 'diagnoses': [{'icd_code': '1629', 'desc': 'Malignant neoplasm of bronchus and lung, unspecified'}, {'icd_code': '0380', 'desc': 'Streptococcal septicemia'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '4162', 'desc': 'Chronic pulmonary embolism'}, {'icd_code': '1983', 'desc': 'Secondary malignant neoplasm of brain and spinal cord'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '1961', 'desc': 'Secondary and unspecified malignant neoplasm of intrathoracic lymph nodes'}, {'icd_code': '28419', 'desc': 'Other pancytopenia'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '34830', 'desc': 'Encephalopathy, unspecified'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'E9331', 'desc': 'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'icd_code': 'V667'}, {'icd_code': '28800', 'desc': 'Neutropenia, unspecified'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '30029', 'desc': 'Other isolated or specific phobias'}, {'icd_code': 'V4987', 'desc': 'Physical restraints status'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'V153'}], 'summary': "___ WBC-10.1 Hgb-13.4 Hct-40.0 Plt-540*\n___ Lipase-36\n___ Calcium-8.6 Phos-3.1 Mg-2.1\n\nMicrobiology:\n___ 11:20 pm SWAB Site: PERITONEAL\n **FINAL REPORT ___\nGRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 2+ ___ per 1000X FIELD): GRAM NEGATIVE ROD(S). \n SMEAR REVIEWED; RESULTS CONFIRMED. \nWOUND CULTURE (Final ___: \n \n PSEUDOMONAS AERUGINOSA. RARE GROWTH. \n\n SENSITIVITIES: MIC expressed in MCG/ML\n \n_________________________________________________________\n PSEUDOMONAS AERUGINOSA\n | \nCEFEPIME-------------- 2 S\nCEFTAZIDIME----------- 4 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nPIPERACILLIN/TAZO----- 16 S\nTOBRAMYCIN------------ <=1 S\n\n ANAEROBIC CULTURE (Final ___: \n CLOSTRIDIUM PERFRINGENS. MODERATE GROWTH. \n BACTEROIDES FRAGILIS GROUP. MODERATE GROWTH. \n BETA LACTAMASE POSITIVE. \n\n___ URINE CULTURE: NO GROWTH. \n\n___ SWAB Source: Abdomen. \n **FINAL REPORT ___\nGRAM STAIN (Final ___: \n 2+ ___ per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 2+ ___ per 1000X FIELD): BUDDING YEAST. \nWOUND CULTURE (Final ___: \n \n PSEUDOMONAS AERUGINOSA. SPARSE GROWTH. \n\n SENSITIVITIES PERFORMED ON CULTURE # ___ ___. \n\nANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED\n\n___ 6:40 pm BLOOD CULTURE: No Growth\n\n___ 11:00 am ABSCESS Site: PELVIS PELVIC \nCOLLECTION. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n This is a concentrated smear made by cytospin method, \nplease refer to\n hematology for a quantitative white blood cell count.. \n\n WOUND CULTURE (Final ___: \n \n ___ ALBICANS. RARE GROWTH. \n\n___ PATHOLOGY:\n\nReport to: ___. ___\n\nSPECIMEN SUBMITTED: GALLBLADDER.\n\nDIAGNOSIS: \nGallbladder, cholecystectomy:\nChronic cholecystitis with focal pyloric metaplasia and focal \nadenomyomatous hyperplasia. \n\nClinical: Adenomyomatosis of gallbladder. \n\n___: Pathology Examination \n\nSPECIMEN SUBMITTED: Small Bowel.\n\nDIAGNOSIS: \nSmall bowel, resection (A-H):\nSegment of small intestine with perforation most consistent with \nlocalized ischemia. Margins viable. \n\nRADIOLOGY:\n___ ABD CT:\nIMPRESSION: \n1. Findings consistent with small bowel obstruction with \nprobable transition point in anterior mid abdomen adjacent to \nwhich is extensive focal stranding and locally more prominent \nfree air. \n\n2. Free fluid along the inferior tip of the liver tracking along \nthe right and mid abdomen and into the pelvis where there is \nperipheral enhancement and layering density.\n\n___ EKG:\nSinus tachycardia. Non-specific ST-T wave changes. Compared to \nthe previous tracing of ___ the rate has increased. \n\n___ ABD CT:\nIMPRESSION: \n1. Multiple intra-abdominal fluid collections, as detailed, with \na collection inferior to the liver demonstrating a hematocrit \nlevel, likely reflective of a small hematoma. Superinfection of \nthese small collections are not excluded. \n\n ___ 06:10 \nReport Comment: \nSource: Line-PICC \nCOMPLETE BLOOD COUNT \nWhite Blood Cells 18.6* 4.0 - 11.0 K/uL \n PERFORMED AT ___ LAB \nRed Blood Cells 3.01* 4.2 - 5.4 m/uL \n PERFORMED AT ___ LAB \nHemoglobin 8.9* 12.0 - 16.0 g/dL \n PERFORMED AT ___ LAB \nHematocrit 26.8* 36 - 48 % \n PERFORMED AT ___ LAB \nMCV 89 82 - 98 fL \n PERFORMED AT ___ LAB \n___ 29.5 27 - 32 pg \n PERFORMED AT ___ LAB \n___ 33.2 31 - 35 % \n PERFORMED AT ___ LAB \nRDW 14.4 10.5 - 15.5 % \n PERFORMED AT ___ LAB \nBASIC COAGULATION ___, PTT, PLT, INR) \nPlatelet Count 732* 150 - 440 K/uL\nThe patient was admitted to the General Surgical Service for \nevaluation and treatment. On ___, the patient underwent \nlaparoscopic cholecystectomy and an extensive laparoscopic lysis \nof adhesions, which went well without complication (reader \nreferred to the Operative Note for details). After a brief, \nuneventful stay in the PACU, the patient arrived on the floor on \nclear liquid diet, with a foley catheter, and Oxycodone PO for \npain control. The patient was hemodynamically stable. On POD # \n1, patient complained increased pain, abdominal discomfort; she \nwas kept in hospital for observation. Diet was increased to \nregular, but patient had very low PO intake. On POD#2, patient \ncontinue to experiencing abdominal pain/discomfort, poor PO, and \ngeneral weakness/malaise. On POD # 4, patient did not improved \nin her condition, she underwent abdominal CT, which demonstrated \nsmall bowel perforation and obstruction. Patient was taken back \nin OR, she underwent emergent exploratory laparotomy, \nsmall-bowel resection with primary anastomosis, and \nadhesiolysis. The patient was transferred to the PACU after \nsurgery and was tachycardic and had respiratory distress. \nPatient was transferred into ICU for further management. Patient \nwas NPO with NGT, started on Vanco/Aztreonam/Zosyn, she had \nFoley catheter and IV fluids for hydration. Patient's ICU course \nwas complicated by wound infection, her midline incision was \nopen. Wound dressing was changed twice a day with Dakins \nwet-to-dry dressing. Patient was started on IV Zosyn and \nAztreonam, wound cultures came back positive for Pseudomonas \nAeruginosa. For detailed ICU course please refer to ICU notes.\n.\nOn ___ (POD# ___, patient was transferred to the floor on \nfull liquids diet, she was continued on IV Abx., Foley to \ngravity and telemetry. Patient's diet was advanced to regular, \nand Foley was d/cd on ___. On ___ patient wound was started \non VAC dressing with black sponge. On ___ patient underwent \nabdominal CT scan which demonstrated multiple intra-abdominal \nfluid collections. On ___ she underwent Ultrasound guided \ndrainage of the intraabdominal fluid collection, fluid was sent \nin microbiology lab for cultures. Patient tolerated procedure \nwell, she returned on the floor in stable condition. Patient was \nevaluated by ___ and they recommended discharge in Rehab. Prior \ndischarge, patient was continued on VAC dressing and IV \nantibiotics. Patient was discharge in Rehab on ___ in \nstable condition. On discharge he VAC dressing was replaced with \nwet-to-dry for transport. \n.\nNeuro: The patient received Dilaudid PCA and Ketorolac IV for \npain control postoperatively with good effect and adequate pain \ncontrol. When tolerating oral intake, the patient was \ntransitioned to oral pain medications. After transferred on the \nfloor, and started VAC dressing, patient reported increased \nabdominal pain. Pain medication was changed from Oxycodone to \nDilaudid, she was started on Tylenol around the clock. Patient \nalso received IV Dilaudid prior VAC dressing changes, her pain \nwas adequately controlled since that.\n\nCV: Patient had episode of tachycardia post operatively, which \nwere treated with IV/PO Metoprolol. The patient remained stable \nfrom a cardiovascular standpoint; vital signs were routinely \nmonitored.\n \nPulmonary: Post operatively patient was required supplemental O2 \nvia tent mask. When stable, patient was continue to receive \nsupplemental O2 via nasal cannula. Chest xrays and CT were \nnegative for PE, patient had atelectasis s/t fluid overload. She \nwas treated with PO diuretics and extensive chest ___. Also, good \npulmonary toilet, early ambulation and incentive spirrometry \nwere encouraged throughout hospitalization. Currently patient's \nO2 sats stable on room air, her atelectasis improved on \nradiogram.\n\nGI/GU/FEN: Post-operatively, the patient was made NPO with IV \nfluids. Diet was advanced when appropriate, which was well \ntolerated. Patient's intake and output were closely monitored, \nand IV fluid was adjusted when necessary. Electrolytes were \nroutinely followed, and repleted when necessary.\n\nID: After second surgery, patient's WBC raised to 14.0. She \ndeveloped purulent discharge from her abdominal incision, and \nincision was open. Wound cultures were sent and came back \npositive with Pseudomonas Aeruginosa. Patient was started on \nantibiotics. Wound dressing was changed bid with Dakins \nsolution. Patient's WBC was continued to rise with max 21.3, on \n___ WBC finally started to decline and was 18.6. Patient \nwet-to-dry dressing was changed to VAC dressing with continuous \nsuction on ___. Patient continue on Zosyn and Aztreonam IV. \nAbscess fluid cultures came back positive for ___, \npatient was started on Micafungin 100 mg qd, switched to \nFluconazole 200 mg qd, her Aztreonam was d/cd, and Zosyn dose \nwas increased per ID recommendations. Patient's WBC continue to \nimprove and was 10.2 on ___. On time of discharge patient \ncontinue to receive IV Zosyn, PO Cipro and Fluconazole. Abx will \nbe discontinue per ID recommendations.\n\nEndocrine: The patient's blood sugar was monitored throughout \nher stay; insulin dosing was adjusted accordingly.\n\nHematology: The patient's complete blood count was examined \nroutinely; her Hct continue to decline post operatively from \n40.1 on ___ to 26.8 on ___. Patient remained asymptomatic \nwith stable vital signs, her Hct remains stable low. No blood \ntransfusion was required.\n\nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay; was encouraged to get \nup and ambulate as early as possible with assist. Physical \ntherapy evaluated the patient and recommended discharge her in \nRehab to continue ___."}}
{'final_diagnoses': ['Gallbladder mass--adenomyomatosis', 'Small bowel obstruction.', 'Perforated small bowel with peritonitis', 'Wound infection', 'Respiratory distress'], 'procedures': ['Laparoscopic cholecystectomy.', 'Laparoscopic lysis of adhesions.', 'Exploratory laparotomy after recent laparoscopy.', 'Small-bowel resection with primary anastomosis.', 'Adhesiolysis', '___ guided drainage pelvic cul de sac fluid collection'], 'visit_summary': "The patient was admitted to the General Surgical Service for \nevaluation and treatment. On ___, the patient underwent \nlaparoscopic cholecystectomy and an extensive laparoscopic lysis \nof adhesions, which went well without complication (reader \nreferred to the Operative Note for details). After a brief, \nuneventful stay in the PACU, the patient arrived on the floor on \nclear liquid diet, with a foley catheter, and Oxycodone PO for \npain control. The patient was hemodynamically stable. On POD # \n1, patient complained increased pain, abdominal discomfort; she \nwas kept in hospital for observation. Diet was increased to \nregular, but patient had very low PO intake. On POD#2, patient \ncontinue to experiencing abdominal pain/discomfort, poor PO, and \ngeneral weakness/malaise. On POD # 4, patient did not improved \nin her condition, she underwent abdominal CT, which demonstrated \nsmall bowel perforation and obstruction. Patient was taken back \nin OR, she underwent emergent exploratory laparotomy, \nsmall-bowel resection with primary anastomosis, and \nadhesiolysis. The patient was transferred to the PACU after \nsurgery and was tachycardic and had respiratory distress. \nPatient was transferred into ICU for further management. Patient \nwas NPO with NGT, started on Vanco/Aztreonam/Zosyn, she had \nFoley catheter and IV fluids for hydration. Patient's ICU course \nwas complicated by wound infection, her midline incision was \nopen. Wound dressing was changed twice a day with Dakins \nwet-to-dry dressing. Patient was started on IV Zosyn and \nAztreonam, wound cultures came back positive for Pseudomonas \nAeruginosa. For detailed ICU course please refer to ICU notes.\n.\nOn ___ (POD# ___, patient was transferred to the floor on \nfull liquids diet, she was continued on IV Abx., Foley to \ngravity and telemetry. Patient's diet was advanced to regular, \nand Foley was d/cd on ___. On ___ patient wound was started \non VAC dressing with black sponge. On ___ patient underwent \nabdominal CT scan which demonstrated multiple intra-abdominal \nfluid collections. On ___ she underwent Ultrasound guided \ndrainage of the intraabdominal fluid collection, fluid was sent \nin microbiology lab for cultures. Patient tolerated procedure \nwell, she returned on the floor in stable condition. Patient was \nevaluated by ___ and they recommended discharge in Rehab. Prior \ndischarge, patient was continued on VAC dressing and IV \nantibiotics. Patient was discharge in Rehab on ___ in \nstable condition. On discharge he VAC dressing was replaced with \nwet-to-dry for transport. \n.\nNeuro: The patient received Dilaudid PCA and Ketorolac IV for \npain control postoperatively with good effect and adequate pain \ncontrol. When tolerating oral intake, the patient was \ntransitioned to oral pain medications. After transferred on the \nfloor, and started VAC dressing, patient reported increased \nabdominal pain. Pain medication was changed from Oxycodone to \nDilaudid, she was started on Tylenol around the clock. Patient \nalso received IV Dilaudid prior VAC dressing changes, her pain \nwas adequately controlled since that.\n\nCV: Patient had episode of tachycardia post operatively, which \nwere treated with IV/PO Metoprolol. The patient remained stable \nfrom a cardiovascular standpoint; vital signs were routinely \nmonitored.\n \nPulmonary: Post operatively patient was required supplemental O2 \nvia tent mask. When stable, patient was continue to receive \nsupplemental O2 via nasal cannula. Chest xrays and CT were \nnegative for PE, patient had atelectasis s/t fluid overload. She \nwas treated with PO diuretics and extensive chest ___. Also, good \npulmonary toilet, early ambulation and incentive spirrometry \nwere encouraged throughout hospitalization. Currently patient's \nO2 sats stable on room air, her atelectasis improved on \nradiogram.\n\nGI/GU/FEN: Post-operatively, the patient was made NPO with IV \nfluids. Diet was advanced when appropriate, which was well \ntolerated. Patient's intake and output were closely monitored, \nand IV fluid was adjusted when necessary. Electrolytes were \nroutinely followed, and repleted when necessary.\n\nID: After second surgery, patient's WBC raised to 14.0. She \ndeveloped purulent discharge from her abdominal incision, and \nincision was open. Wound cultures were sent and came back \npositive with Pseudomonas Aeruginosa. Patient was started on \nantibiotics. Wound dressing was changed bid with Dakins \nsolution. Patient's WBC was continued to rise with max 21.3, on \n___ WBC finally started to decline and was 18.6. Patient \nwet-to-dry dressing was changed to VAC dressing with continuous \nsuction on ___. Patient continue on Zosyn and Aztreonam IV. \nAbscess fluid cultures came back positive for ___, \npatient was started on Micafungin 100 mg qd, switched to \nFluconazole 200 mg qd, her Aztreonam was d/cd, and Zosyn dose \nwas increased per ID recommendations. Patient's WBC continue to \nimprove and was 10.2 on ___. On time of discharge patient \ncontinue to receive IV Zosyn, PO Cipro and Fluconazole. Abx will \nbe discontinue per ID recommendations.\n\nEndocrine: The patient's blood sugar was monitored throughout \nher stay; insulin dosing was adjusted accordingly.\n\nHematology: The patient's complete blood count was examined \nroutinely; her Hct continue to decline post operatively from \n40.1 on ___ to 26.8 on ___. Patient remained asymptomatic \nwith stable vital signs, her Hct remains stable low. No blood \ntransfusion was required.\n\nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay; was encouraged to get \nup and ambulate as early as possible with assist. Physical \ntherapy evaluated the patient and recommended discharge her in \nRehab to continue ___.", 'medications_prescribed': ['Alprazolam 0.25 mg Tablet Sig: One (1) Tablet PO QHS (once a \nday (at bedtime)) as needed for anxiety.', 'Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q 8H \n(Every 8 Hours).', 'Ibuprofen 400 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.', 'Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day for \n10 days: While on narcotic pain meds.\nDisp:*20 Capsule(s)* Refills:*0*', 'Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO \nDAILY (Daily).', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily).', 'Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 \nhours) as needed for pain.', 'Piperacillin-Tazobactam-Dextrs 4.5 gram/100 mL Piggyback \nSig: One (1) Intravenous Q8H (every 8 hours) for 2 days.', 'Fluconazole 200 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours): last dose on ___.', 'Heparin Flush (10 units/ml) 2 mL IV PRN line flush \nPICC, heparin dependent: Flush with 10mL Normal Saline followed \nby Heparin as above daily and PRN per lumen.', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', 'Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H \n(every 24 hours) for 2 days.', 'HYDROmorphone (Dilaudid) 0.5-1.0 mg IV Q6H:PRN breakthrough \npain \ngive prior VAC change']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 41, 'gender': 'F', 'symptoms': 'Bilateral lower extremity claudication', 'medical_history': ['OA', 'OSA', 'hypothyroid', 'gerd', 'prostate ca s/p xrt', 'nephrolithiasis', 'dvt/pe ___', 'R knee sx ___ c/b pe/dvt', 'L knee surgery ___'], 'family_history': None, 'present_illness': 'Mr ___ is a ___ male describes his bilateral lower \nleg pain as a cramping pain in both calves and occasionally the \nbuttocks. This occurs after walking approximately half a block. \nHe will stop and rest for about 5 minutes,the pain will resolve, \nand he can continue walking. He also complains of occasional \nnumbness in the bottom of the right foot after standing for some \ntime. Arterial duplex dated ___ revealed monophasic \nwaveforms throughout the right lower extremity with a right ABI \nof 0.5. There are triphasic waveforms at the left common \nfemoral, superficial femoral, popliteal, and ___ with biphasic \nwaveforms at the DP and the left ABI is 0.9. PVRs showed normal \nwaveforms in the thigh bilaterally. There is dampening in the \nright calf and no dampening throughout the left lower extremity. \nThe patient exercised for 4 minutes on a treadmill at 1.5 miles \nper hour with 10% grade. The right ABI decreased from 0.5 to \n0.3. The left ABI decreased mildly from 0.9 to 0.8. He presents \nfor elective angiogram and potential catheter based \nintervention.', 'medications': [{'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 212.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '265', 'valuenum': 265.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '305', 'valuenum': 305.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.7', 'valuenum': 43.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '328', 'valuenum': 328.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Alert and oriented x 3 \nVS:BP124/72 HR 60 \nResp: Lungs clear\nAbd: Soft, non tender\nExt: Pulses: Left DP dop ,___ dop\n Right DP dop , ___ dop\nFeet warm, well perfused. No open areas\nLeft groin puncture site: Dressing clean dry and intact. Soft, \nno hematoma, slight ecchymosis.', 'diagnoses': [{'icd_code': 'L02412', 'desc': 'Cutaneous abscess of left axilla'}, {'icd_code': 'R7881', 'desc': 'Bacteremia'}, {'icd_code': 'B964', 'desc': 'Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere'}, {'icd_code': 'L732', 'desc': 'Hidradenitis suppurativa'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}], 'summary': '___ 05:05PM BLOOD Hct-39.5*\n___ 05:05PM BLOOD ALT-25 AST-21 LD(LDH)-128 AlkPhos-47 \nTotBili-0.3\nThe patient was brought to the operating room on ___ for an \nelective angiogram. We were unable to safely thread a catheter \ninto the artery after initial puncture so the procedure was \naborted. He was closely monitored overnight on the floor were \nthe he remained hemodynamically stable with no signs of hematoma \nand a stable HCT. His diet was advanced. He is ambulatory ad \nlib. He was discharged to home in stable condition. Follow-up \nhas been arranged for left iliofemoral ultrasound prior to \nrescheduling the procedure.'}}
{'final_diagnoses': ['Peripheral Arterial Disease'], 'procedures': ['None'], 'visit_summary': 'The patient was brought to the operating room on ___ for an \nelective angiogram. We were unable to safely thread a catheter \ninto the artery after initial puncture so the procedure was \naborted. He was closely monitored overnight on the floor were \nthe he remained hemodynamically stable with no signs of hematoma \nand a stable HCT. His diet was advanced. He is ambulatory ad \nlib. He was discharged to home in stable condition. Follow-up \nhas been arranged for left iliofemoral ultrasound prior to \nrescheduling the procedure.', 'medications_prescribed': ['1. Aspirin 325 mg PO DAILY', '2. Calcium Carbonate 500 mg PO BID', '3. Diclofenac Sodium ___ 50 mg PO BID', '4. Levothyroxine Sodium 25 mcg PO DAILY', '5. Omeprazole 20 mg PO DAILY', '6. Pravastatin 20 mg PO DAILY', '7. Multivitamins 1 TAB PO DAILY', '8. Allopurinol ___ mg PO DAILY', '9. Acetaminophen 650 mg PO Q6H:PRN pain fever']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'Mucositis', 'medical_history': ["PAST ONCOLOGIC HISTORY: \n ___- noted right breast Mass \n ___ breast imaging showed a 2.1 x 2.4 x 1.6 cm \nmass in the right axillary tail as well as a 1.4 x 0.7 cm right \naxillary node \n ___ breast mass biopsy showed invasive ductal \ncarcinoma, grade 2, measuring at least 1.2 cm, with focal DCIS \nof intermediate high nuclear grade, solid type. Perineural \ninvasion was present. There was no lymphovascular invasion. This \nwas felt to represent a primary breast carcinoma rather than a \nlymph node metastasis. The invasive carcinoma was diffusely \nstrongly positive for estrogen receptor (greater than 95%), \nprogesterone receptor positive (40%, weak variable staining), \nand HER-2/neu +1 (negative); the right breast axillary node \nshowed invasive carcinoma with both ductal and lobular features, \ngrade 2, without an in situ component. Lymphatic/vascular \ninvasion was present. The specimen showed a possible lymph node \ncapsule but no lymph node tissue. This suggested a lymph node \nthat was completely replaced by tumor however the radiologist \nrecommended correlation to exclude the possibility that this \nrepresents a second primary tumor and confirmed that this is a \nlymph node. This showed similar immunohistochemical staining. \n ___- bone scan without evidence of metastatic disease \n ___- CT C/A/P showed no evidence of disease in chest; \nfindings suspicious for bilateral hydrosalpinx were noted on \npelvic CT and dedicated pelvic ultrasound was recommended; \npelvic u/s negative- radiologist suspects they were seeing \nunopacified loops of small bowel \n ___- breast MRI showed known right UOQ cancer abutting \nchest wall, not involving skin; UIQ with 1.5 cm non mass \nenhancement; prominent right axillary nodes; UIQ of left breast \nwith 1 cm area of non mass enhancement; add'l eval recommended \nfor ipsilateral (right) UIQ lesion and contralateral (left) UIQ \nlesion; neither seen on u/s; biopsies ultimately performed \n___ of both and both were benign \n ___ - C1 D1 Doxorubicin/Cychlophosphamide \n ___ - C2 D1 Doxorubicin/Cychlophosphamide", '- s/p colposcopy cervix w/ loop conization', '- s/p appendectomy'], 'family_history': 'FAMILY HISTORY: Paternal male second cousin with breast cancer.', 'present_illness': 'Ms. ___ is a ___ female with history of stage II \nER/PR positive, HER2 negative node positive right breast cancer \non Doxorubicin/Cychlophosphamide every 2 weeks who presents with \nmucositis. \n Patient reports onset of several oral mucosal pain this \nmorning. Her last chemotherapy was on ___. She states that \nshe has been suffering from insomnia for the past 3 days. Today \nshe started to feel pain in her lips and oral mucosa and has had \ndifficulty with PO liquids due to the pain. Also lips are very \ndry and painful. \n On arrival to the ED, initial vitals were 97.8 102 123/86 14 \n100% RA. Labs were unremarkable. Patient was given viscous \nlidocaine, morphine 4mg IV, and magic mouthwash. Vitals prior to \ntransfer were 98 88 ___ 99% RA. \n On arrival to the floor, she reports severe lip pain and \ndifficulty swallowing. She denies fevers/chills, headache, \ndizziness/lightheadedness, vision changes, weakness/numbness, \nshortness of breath, cough, chest pain, palpitations, abdominal \npain, nausea/vomiting, diarrhea, and dysuria.', 'medications': [{'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.04, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.10', 'valuenum': 5.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '67.0', 'valuenum': 67.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '43.5', 'valuenum': 43.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.07, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.04', 'valuenum': 5.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.07, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n VS: Temp 98.2, BP 110/70, HR 84, RR 17, O2 sat 99% RA. \n GENERAL: Pleasant woman, in no distress, lying in bed \ncomfortably. \n HEENT: Anicteric, PERLL, EOMI. Multiple white plaques on \ntongue, buccal mucosa, and oropharynx. Dry and cracked lips. \n CARDIAC: RRR, normal s1/s2, no m/r/g. \n LUNG: Appears in no respiratory distress, clear to auscultation \n\nbilaterally, no crackles, wheezes, or rhonchi. \n ABD: Normal bowel sounds, soft, nontender, nondistended, no \nhepatomegaly, no splenomegaly. \n EXT: Warm, well perfused, no lower extremity edema, erythema or \n\ntenderness. \n NEURO: A&Ox3, CN II-XII intact, strength full throughout. \n SKIN: No significant rashes. \n\nDISCHARGE PHYSICAL EXAM\n98.1 104 / ___ \nGENERAL: Pleasant woman, in no acute distress\nHEENT: Multiple white plaques on tongue, buccal mucosa, and \noropharynx. \nCARDIAC: RRR, no murmurs \nLUNG: Clear to auscultation bilaterally \nABD: Soft, non-tender, non-distended, positive bowel sounds, no \norganomegally\nEXT: Warm, well perfused, no lower extremity edema, erythema or \n\ntenderness. \nNEURO: A&Ox3', 'diagnoses': [{'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '25070', 'desc': 'Diabetes with peripheral circulatory disorders, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': 'V8541', 'desc': 'Body Mass Index 40.0-44.9, adult'}, {'icd_code': '42820', 'desc': 'Systolic heart failure, unspecified'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '44381', 'desc': 'Peripheral angiopathy in diseases classified elsewhere'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '43810', 'desc': 'Late effects of cerebrovascular disease, speech and language deficit, unspecified'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '30501', 'desc': 'Alcohol abuse, continuous'}, {'icd_code': 'V173'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}], 'summary': '___ 12:08AM BLOOD WBC-6.2 RBC-4.04 Hgb-12.0 Hct-34.3 MCV-85 \nMCH-29.7 MCHC-35.0 RDW-12.0 RDWSD-36.4 Plt ___\n___ 12:08AM BLOOD Neuts-87* Bands-0 Lymphs-11* Monos-1* \nEos-1 Baso-0 ___ Myelos-0 AbsNeut-5.39 AbsLymp-0.68* \nAbsMono-0.06* AbsEos-0.06 AbsBaso-0.00*\n___ 12:08AM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 12:08AM BLOOD Plt Smr-NORMAL Plt ___\n___ 12:08AM BLOOD Glucose-80 UreaN-7 Creat-0.6 Na-136 K-3.8 \nCl-99 HCO3-25 AnGap-16\n___ 12:08AM BLOOD Calcium-9.6 Phos-4.5 Mg-2.2\n___ 01:02AM URINE Color-Straw Appear-Clear Sp ___\n___ 01:02AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG\n___ 01:02AM URINE UCG-NEGATIVE\nURINE CULTURE (Final ___: NO GROWTH.\nMs. ___ is a ___ female with history of stage II \nER/PR positive, HER2 negative node positive right breast cancer \non Doxorubicin/Cychlophosphamide every 2 weeks who presented \nwith mucositis. \n\n# Mucositis/Oropharyngeal Thrush: Exam and signs/symptoms were \nconsistent with mucuositis and thrush. Patient also endorsed \nodynaphagia however was able to take PO. Patient was treated \ninitially with nystatin then loaded with one dose fluconazole \n400 mg then discharged with 100 mg fluconazole daily for a total \ncourse of 14 days. Additionally, for the mucuositis, patient was \ntreated with magic mouthwash maalox/diphenhydramine/lidocaine \n___ mL PO QID:PRN mouth pain and started on low dose 5 mg \noxycodone which eased the mouth pain. \n\n# Insomnia: Additionally, prior to admission, patient stated \nthat she had not slept for four days. States she cannot fall \nasleep. No racing thoughts, states that she reads articles on \nher phone while up. She states she has multiple productive \nactivities during the day. She also notes that she previously \nhad not experienced difficulty sleeping. She has a distance \nhistory of restless leg syndrome from which she previously took \npramipexole. She slept well with the 25 mg trazadone. She was \ndischarged with prescription for trazadone to help her with \ninsomnia at home.\n\nNOTE: Patient is on fluconazole, QTc prolonging agent, QTc \nduring hospitalization was 442. LFTs ___ drawn at ___ \n___ were within normal limits.'}}
{'final_diagnoses': ['# Mucositis/Oropharyngeal Thrush', '# Hypothyroidism', '# ER/PR positive, HER2 negative breast cancer'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ female with history of stage II \nER/PR positive, HER2 negative node positive right breast cancer \non Doxorubicin/Cychlophosphamide every 2 weeks who presented \nwith mucositis. \n\n# Mucositis/Oropharyngeal Thrush: Exam and signs/symptoms were \nconsistent with mucuositis and thrush. Patient also endorsed \nodynaphagia however was able to take PO. Patient was treated \ninitially with nystatin then loaded with one dose fluconazole \n400 mg then discharged with 100 mg fluconazole daily for a total \ncourse of 14 days. Additionally, for the mucuositis, patient was \ntreated with magic mouthwash maalox/diphenhydramine/lidocaine \n___ mL PO QID:PRN mouth pain and started on low dose 5 mg \noxycodone which eased the mouth pain. \n\n# Insomnia: Additionally, prior to admission, patient stated \nthat she had not slept for four days. States she cannot fall \nasleep. No racing thoughts, states that she reads articles on \nher phone while up. She states she has multiple productive \nactivities during the day. She also notes that she previously \nhad not experienced difficulty sleeping. She has a distance \nhistory of restless leg syndrome from which she previously took \npramipexole. She slept well with the 25 mg trazadone. She was \ndischarged with prescription for trazadone to help her with \ninsomnia at home.\n\nNOTE: Patient is on fluconazole, QTc prolonging agent, QTc \nduring hospitalization was 442. LFTs ___ drawn at ___ \n___ were within normal limits.', 'medications_prescribed': ['Fluconazole 200 mg PO Q24H \nRX *fluconazole 100 mg 1 tablet(s) by mouth daily Disp #*14 \nTablet Refills:*0', 'OxyCODONE (Immediate Release) 5 mg PO Q6H:PRN Pain - \nModerate \ncauses drowsiness, do not drive afterwards \nRX *oxycodone 5 mg 1 tablet(s) by mouth twice daily Disp #*14 \nTablet Refills:*0', 'TraZODone 25 mg PO QHS:PRN insomnia \nRX *trazodone 50 mg 0.5 (One half) tablet(s) by mouth night as \nneeded Disp #*14 Tablet Refills:*0', 'Dexamethasone 4 mg PO BID \nOnly take as prescribed by your oncologist', 'Ibuprofen 400 mg PO Q8H:PRN Pain - Moderate', 'Levothyroxine Sodium 175 mcg PO DAILY', 'Lidocaine Viscous 2% 15 mL PO QID:PRN mouth pain', 'LORazepam 1 mg PO Q6H:PRN nausea/anxiety', 'Maalox/Diphenhydramine/Lidocaine ___ mL PO QID:PRN mouth \npain', 'Multivitamins 1 TAB PO DAILY', 'Ondansetron 8 mg PO Q8H:PRN nausea/vomiting', 'Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 50, 'gender': 'F', 'symptoms': 'Fall from ladder', 'medical_history': ['ETOH abuse', 'HTN', 'GERD', 'Gout', 'Ezcema', 'Left tibia fracture ___'], 'family_history': 'NC', 'present_illness': '___ patient was reportedly at work up on a ladder when he\nfell 5 feet. The patient was able to walk and went home after\nfalling. He then had several drinks due to the severe pain that\nhe was in. Subsequently he was sent to the ER at ___. \n\nHere he was found to have the following injuries:\n1. Lat, Med, Inf orbital wall fractures\n2. Left corneal abrasion, subconjuntival hemorrhage, Upper \neyelid laceration\n3. Nasal laceration and nasal bone fracture\n4. C5 comminuted spinous process fracture that extends to canal\n5. T11 compression fx - duration unknown', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': 'Upon Discharge:\nVS: 97.6, 83, 126/58, 17, 96% on RA\nGen: NAD, confused at times, but oriented to person and place.\nHEENT: C-collar in place in good position. The left eye is \nmarkedly swollen and ecchymottic with a suture in place s/p \ntarsorraphy. There is marked generalized facial swelling with \nseveral abrasions througout.\nCV: RRR, S1S2\nLungs: CTAB\nAbd: Soft, NTND\nExt: LLE - moderate ecchymossis in popliteal fossa. wound near \nleft fibular head is c/d/i with minimal erythema.', 'diagnoses': [{'icd_code': '7210', 'desc': 'Cervical spondylosis without myelopathy'}, {'icd_code': '7220', 'desc': 'Displacement of cervical intervertebral disc without myelopathy'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '7224', 'desc': 'Degeneration of cervical intervertebral disc'}, {'icd_code': '30520', 'desc': 'Cannabis abuse, unspecified'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': 'V1551', 'desc': 'Personal history of traumatic fracture'}, {'icd_code': 'V4577', 'desc': 'Acquired absence of organ, genital organs'}], 'summary': '___ 09:10PM BLOOD WBC-14.4* RBC-3.96* Hgb-12.2* Hct-36.9* \nMCV-93 MCH-30.8 MCHC-33.1 RDW-14.7 Plt ___\n___ 04:00AM BLOOD WBC-12.9* RBC-3.65* Hgb-11.7* Hct-34.3* \nMCV-94 MCH-32.1* MCHC-34.1 RDW-14.8 Plt ___\n___ 05:01AM BLOOD WBC-7.3 RBC-3.04* Hgb-9.9* Hct-29.0* \nMCV-95 MCH-32.4* MCHC-34.0 RDW-15.0 Plt ___\n___ 01:17AM BLOOD WBC-8.7 RBC-2.91* Hgb-9.1* Hct-27.8* \nMCV-95 MCH-31.3 MCHC-32.8 RDW-15.1 Plt ___\n___ 04:44AM BLOOD WBC-10.4 RBC-2.94* Hgb-9.6* Hct-28.0* \nMCV-95 MCH-32.6* MCHC-34.1 RDW-15.4 Plt ___\n___ 09:10PM BLOOD ___ PTT-25.7 ___\n___ 04:00AM BLOOD ___ PTT-26.6 ___\n___ 04:00AM BLOOD Glucose-103 UreaN-10 Creat-1.0 Na-136 \nK-3.1* Cl-105 HCO3-18* AnGap-16\n___ 05:01AM BLOOD Glucose-78 UreaN-9 Creat-0.9 Na-139 \nK-3.0* Cl-107 HCO3-25 AnGap-10\n___ 12:55PM BLOOD K-3.3\n___ 09:14PM BLOOD K-3.2*\n___ 03:14AM BLOOD Glucose-87 UreaN-8 Creat-0.9 Na-140 K-4.1 \nCl-108 HCO3-22 AnGap-14\n___ 04:44AM BLOOD Glucose-85 UreaN-9 Creat-0.9 Na-139 K-3.7 \nCl-106 HCO3-25 AnGap-12\n___ 04:00AM BLOOD Calcium-7.1* Phos-3.2 Mg-1.5*\n___ 05:01AM BLOOD Calcium-6.9* Phos-2.0* Mg-1.3*\n___ 09:14PM BLOOD Mg-1.8\n___ 01:17AM BLOOD Calcium-6.6* Phos-1.2* Mg-2.4\n___ 03:14AM BLOOD Calcium-7.0* Phos-1.3* Mg-2.4\n___ 04:44AM BLOOD Calcium-7.3* Phos-2.1* Mg-1.7\n___ 09:10PM BLOOD ASA-NEG ___ Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-POS\n\nCT Face ___:\nIMPRESSION: \n1. Left orbital blowout fractures involving the superior, \ninferior, medial, and lateral walls. Fracture of the left \nzygomatic process and bilateral nasal fractures. \n2. Inferior rectus muscle swelling and displacement inferiorly \nwithout \novert evidence of muscle entrapment. \n3. Left periorbital and left frontal subgaleal hematomas.\n\nCT C-spine ___:\nIMPRESSION: Comminuted fracture of the C5 spinous process \nextending into the left lamina and associated central canal \nhematoma. The hematoma appears to impinge on the adjacent spinal \ncord. MRI is recommended for further evaluation of the cord and \nthe adjacent ligaments. Grade 1 retrolisthesis of C5 on C6 is \nalso identified.\n\nCT Torso ___:\nIMPRESSION: \n1. No definite intra-abdominal, intrapelvic or intrathoracic \ninjury. \n2. Bilateral old rib fractures and old pelvic fractures. \n3. T11 compression fracture, chronicity unknown. \n\nMRI C-spine ___:\n1. Possible small spinal canal epidural hematoma without \nevidence of change in spinal cord signal. Also seen are the \npreviously detailed spinous process fracture and degenerative \nchanges in the cervical spine.\n\nLeft Tib/Fib xrays ___:\nIMPRESSION: S/p ORIF with advanced healing of tibial and fibular \nfractures.\nNo hardware loosenig or conclusive evidence for osteomyelitis.\n\nCT head ___:\nIMPRESSION: \n1. Interval development of prominent frontal extra-axial space \nfilled with \nsimple fluid, concerning for acute subdural hygromas. These \nmeasure \napproximately 7 mm in greatest diameter. No evidence of shift of \nnormally \nmidline structures. \n2. Unchanged appearance of left-sided facial fractures, left \nperiorbital \nswelling, and left frontal subgaleal hematoma. \n3. Left maxillary opacification, stable. \n4. No evidence of acute hemorrhage within the brain parenchyma. \n\nCXR ___:\nFINDINGS: In comparison with study of ___, the right subclavian \ncatheter has been extended at least to the right atrium. No \nchange in the appearance of the heart and lungs. There is a \nvague suggestion of some increased opacification at the left \nbase, which could reflect atelectasis or even pneumonia in the \nregion of multiple lower left rib fractures. \n\nCT head ___:\nIMPRESSION: \nStable acute subdural hygromas.\nMr. ___ was admitted to the Trauma Surgery service on ___. \nHe was placed in the trauma SICU for close monitoring. He was \nstabilized in the ICU and transferred to the floor on ___. \nHowever, he was having signs and symptoms of ETOH withdrawal and \nwas transferred back to the ICU for closer monitoring. He was \nagain stabilized in the ICU, tolerating a regular diet with well \ncontrolled pain. He was again transferred to the floor.\n\nOn the floor he was seen and evaluate by plastic surgery, \northopaedic surgery, neurosurgery, and ophthalmology for his \nmyriad injuries.\n\nOrtho: WBAT, continue dicloxacillin. Will follow up in 1 month.\nPlastics: performed left lateral tarsorraphy ___. Placed a \nsingle stitch with xeroform dressing. Will have patient come to \nclinic on ___. Will likely treat facial fractures \noperatively\nOphtho: Recommended erythromycin to eye q2hrs. Patching eye at \nnight, and taping eyelid at night if not closing properly. Will \nf/u in ___ weeks for further eval.\nNeurosurgery: Hard collar at all times x 3 months. Will follow \nup in 3 months for c-spine fracture, and 4 weeks for hygromas.\n\nUTI: The patient was found to have a UTI on ___ and was started \non a 5day course of cipro, which he completed prior to \ndischarge. He was asymptomatic at that time.\n\nHe was tolerating a regular diet throughout his hospital course. \nHis pain was well controlled with IV and then PO pain \nmedications.\n\nHe was discharged to rehab on ___ in stable condition.\n\nETOH withdrawal: He was placed on a CIWA scale with valium for \nDT prophylaxis'}}
{'final_diagnoses': ['Lat, Med, Inf orbital wall fractures', 'Left corneal abrasion, subconjuntival hemorrhage, Upper eyelid laceration', 'Nasal laceration and nasal bone fracture', 'C5 comminuted spinous process fracture that extends to canal', 'T11 compression fx - duration unknown', 'ETOH abuse', 'Left tibia/fibula fracture c/b infection and removal of hardware'], 'procedures': ['Left eye partial tarsorrhaphy'], 'visit_summary': 'Mr. ___ was admitted to the Trauma Surgery service on ___. \nHe was placed in the trauma SICU for close monitoring. He was \nstabilized in the ICU and transferred to the floor on ___. \nHowever, he was having signs and symptoms of ETOH withdrawal and \nwas transferred back to the ICU for closer monitoring. He was \nagain stabilized in the ICU, tolerating a regular diet with well \ncontrolled pain. He was again transferred to the floor.\n\nOn the floor he was seen and evaluate by plastic surgery, \northopaedic surgery, neurosurgery, and ophthalmology for his \nmyriad injuries.\n\nOrtho: WBAT, continue dicloxacillin. Will follow up in 1 month.\nPlastics: performed left lateral tarsorraphy ___. Placed a \nsingle stitch with xeroform dressing. Will have patient come to \nclinic on ___. Will likely treat facial fractures \noperatively\nOphtho: Recommended erythromycin to eye q2hrs. Patching eye at \nnight, and taping eyelid at night if not closing properly. Will \nf/u in ___ weeks for further eval.\nNeurosurgery: Hard collar at all times x 3 months. Will follow \nup in 3 months for c-spine fracture, and 4 weeks for hygromas.\n\nUTI: The patient was found to have a UTI on ___ and was started \non a 5day course of cipro, which he completed prior to \ndischarge. He was asymptomatic at that time.\n\nHe was tolerating a regular diet throughout his hospital course. \nHis pain was well controlled with IV and then PO pain \nmedications.\n\nHe was discharged to rehab on ___ in stable condition.\n\nETOH withdrawal: He was placed on a CIWA scale with valium for \nDT prophylaxis', 'medications_prescribed': ['Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO Q4H (every 4 hours) as needed for pain.', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 times a day).', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).', 'Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for constipation.', 'Insulin Regular Human 100 unit/mL Solution Sig: One (1) inj Injection ASDIR (AS DIRECTED): see printed sliding scale.', 'Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 hours) as needed for pain, HA.', 'Erythromycin 5 mg/g Ointment Sig: One (1) app Ophthalmic Q2H (every 2 hours).', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO QID (4 times a day).', 'Doxepin 25 mg Capsule Sig: Eight (8) Capsule PO HS (at bedtime).', 'Allopurinol ___ mg Tablet Sig: One (1) Tablet PO HS (at bedtime).', 'Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Diazepam ___ mg IV Q2H:PRN per CIWA>10', 'Campral 333 mg Tablet, Delayed Release (E.C.) Sig: Two (2) Tablet, Delayed Release (E.C.) PO three times a day.', 'Dicloxacillin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every 6 hours).']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 53, 'gender': 'M', 'symptoms': 'Shortness of breath', 'medical_history': ['Chronic pericardial effusion', 'Hyperlipidemia', 'Osteoarthritis', 'Osteoporosis', 'GERD', 'Irritable bowel syndrome', 'Peripheral neuropathy', 'Anxiety disorder', 'Cataracts'], 'family_history': 'There is no family history of premature coronary artery disease \nor sudden death.', 'present_illness': "___ year old female patient was admitted to ___ for \nshortness of breath on ___. Patient had a negative d-dimer \nand CTA. She had a stress echo on ___ which showed a small \npericardial effusion. She went 3 minutes of ___ protocol and \ndeveloped shortness of breath. The test was negative for \nischemia with no wall motion abnormalities. She was then \ntransferred for cardiac catheterization. She was started on \naspirin and loaded with plavix 300 mg on ___ and has been \nreceiving 75 mg daily.\n\nShe is currently post-catheterization and is complaining of some \nright foot pain on the plantar surface. She currently complains \nof no shortness of breath, no chest pain, no N/V, no abdominal \npain, no leg pain. She is set to go home tomorrow. She's \ncurrently hungry and wondering if she can eat.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Ferric Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ascorbic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '65', 'valuenum': 65.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '519', 'valuenum': 519.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '604', 'valuenum': 604.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 8.1, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 186.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.4,. Estimated GFR = 29 if non African-American (mL/min/1.73 m2). Estimated GFR = 35 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 316.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '___', 'valuenum': 0.05, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1000', 'valuenum': 1000.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.029', 'valuenum': 1.029, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6-10', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.06, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.04, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO MONOCLONAL IMMUNOGLOBULIN SEEN. NEGATIVE FOR BENCE-JONES PROTEIN. INTERPRETED BY ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MULTIPLE PROTEIN BANDS SEEN, WITH ALBUMIN PREDOMINATING. BASED ON IFE (SEE SEPARATE REPORT),. NO MONOCLONAL IMMUNOGLOBULIN SEEN. NEGATIVE FOR BENCE-JONES PROTEIN. INTERPRETED BY ___.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'Ratio', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO SPECIFIC ABNORMALITIES SEEN. INTERPRETED BY ___.'}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 256.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 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'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.0,. Estimated GFR = 22 if non African-American (mL/min/1.73 m2). Estimated GFR = 27 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 210.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen: WDWN female in NAD. Oriented x3. Mood, affect appropriate. \n\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva are \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNeck: No LAD. No JVD noted \nCV: PMI located in ___ intercostal space, midclavicular line. \nRR, normal S1, S2. ___ systolic murmur loudest at left sternal \nborder. No thrills, lifts. No S3 or S4. \nChest: No chest wall deformities, scoliosis or kyphosis. \nRespirations are unlabored, no accessory muscle use. CTAB, no \ncrackles, wheezes or rhonchi. \nAbd: Soft, NTND. No HSM or tenderness. Abd aorta not enlarged by \npalpation. No abdominial bruits. \nExt: No c/c/e. No tenderness on palpation of foot. WWP. \nSkin: No stasis dermatitis, ulcers, scars, or xanthomas. \n.\nPulses: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': '42831', 'desc': 'Acute diastolic heart failure'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '58181', 'desc': 'Nephrotic syndrome in diseases classified elsewhere'}, {'icd_code': '25040', 'desc': 'Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '25050', 'desc': 'Diabetes with ophthalmic manifestations, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '7910', 'desc': 'Proteinuria'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '28529', 'desc': 'Anemia of other chronic disease'}, {'icd_code': '60886', 'desc': 'Edema of male genital organs'}, {'icd_code': '59971', 'desc': 'Gross hematuria'}, {'icd_code': '36201', 'desc': 'Background diabetic retinopathy'}], 'summary': 'After cath:\n\n___ 07:45AM BLOOD WBC-8.5 RBC-3.76* Hgb-11.2* Hct-33.9* \nMCV-90 MCH-29.9 MCHC-33.1 RDW-13.2 Plt ___\n\n___ 07:45AM BLOOD Glucose-84 UreaN-12 Creat-0.6 Na-141 \nK-4.2 Cl-110* HCO3-24 AnGap-11\n\n___ 07:45AM BLOOD ___ PTT-21.3* ___\n\nCardiac catheterization ___:\n \nCOMMENTS: \n1. Selective angiography in this right dominant system reveals \nno \nangiographically apparent flow limiting disease. \n2. Invasive hemodynamic measurements demonstrate a normal \ncardiac index \nof 2.69 L/min/m2, and low biventricular filling pressures. \n \nFINAL DIAGNOSIS: \n1. Coronary arteries have no flow limiting disease. \n2. Filling pressures of both the right and left ventricle are \nlow\n#.Shortness of breath: patient initially presented to ___ \nfor shortness of breath. Patient had a negative d-dimer and \nCTA. She had a stress echo on ___ which showed a small \npericardial effusion. She went 3 minutes of ___ protocol and \ndeveloped shortness of breath. The test was negative for \nischemia with no wall motion abnormalities. She was then \ntransferred to ___ for cardiac catheterization. She was \nstarted on aspirin and loaded with plavix 300 mg on ___ and \nhas been receiving 75 mg daily. Catheterization showed no flow \nlimiting disease and low filling pressures. Patient was checked \nafter catheterization for palpable pulses, lack of pain, and \nfemoral bruits. Patient was counseled to follow up with a new \npulmonologist, Dr. ___ discharge to further work-up of \nher dyspnea. She was also counseled to avoid heavy lifting and \ndriving in the short term.\n.\n#.Hyperlipidemia: patient was continued on home dose of \natorvastatin.\n.\n#.Dispostion: patient was counseled to follow up with her \nprimary care provider upon discharge, for which she was arranged \nan appointment.'}}
{'final_diagnoses': ['Shortness of breath'], 'procedures': ['Cardiac catheterization'], 'visit_summary': '#.Shortness of breath: patient initially presented to ___ \nfor shortness of breath. Patient had a negative d-dimer and \nCTA. She had a stress echo on ___ which showed a small \npericardial effusion. She went 3 minutes of ___ protocol and \ndeveloped shortness of breath. The test was negative for \nischemia with no wall motion abnormalities. She was then \ntransferred to ___ for cardiac catheterization. She was \nstarted on aspirin and loaded with plavix 300 mg on ___ and \nhas been receiving 75 mg daily. Catheterization showed no flow \nlimiting disease and low filling pressures. Patient was checked \nafter catheterization for palpable pulses, lack of pain, and \nfemoral bruits. Patient was counseled to follow up with a new \npulmonologist, Dr. ___ discharge to further work-up of \nher dyspnea. She was also counseled to avoid heavy lifting and \ndriving in the short term.\n.\n#.Hyperlipidemia: patient was continued on home dose of \natorvastatin.\n.\n#.Dispostion: patient was counseled to follow up with her \nprimary care provider upon discharge, for which she was arranged \nan appointment.', 'medications_prescribed': ['Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Atorvastatin Oral', 'Loperamide Oral', 'Citracal + D Oral']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 65, 'gender': 'M', 'symptoms': 'upper back pain and SSCP', 'medical_history': ['1. CARDIAC RISK FACTORS: (+)Diabetes, (+)Dyslipidemia, \n(+)Hypertension', '2. CARDIAC HISTORY: \n-CABG: \n-PERCUTANEOUS CORONARY INTERVENTIONS: \n-PACING/ICD:', '3. OTHER PAST MEDICAL HISTORY: \nCOPD on home O2\nDiverticulitis\nMorbid Obesity\nHypothyroidism\nChronic LBP\nChronic Headaches\nGlaucoma \nPERICARDIAL EFFUSION'], 'family_history': 'No family history of early MI, otherwise non-contributory.', 'present_illness': ' ___ yo female with h/o COPD on home O2, HTN, HLP, DM, \nosteoporosis, morbid obesity who was recently discharged from \n___ s/p drainage of 820 cc of pericardial fluid, NOW presents \nwith similar symptoms. In the days preceding her previous \nadmission, pt noted severe back pain between her shoulders and \nsevere epigastric pain exacerbated by swallowing. These symptoms \nbegan to recur 3 days prior to this admission but with less \nintensity. Notably, the patient had increased SOB and increased \n___ edema preceding the last admission which she is not \nexperiencing now. \n. \nEcho did not show evidence of tamponade during previous \nadmission, but cath revealed elevated right sided pressures and \nequalization of of RA, PCW and pericardial pressures consistent \nwith tamponade. 820cc of bloody fluid was removed and sent for \ncytology and culture. It revealed only hemosiderin-laden \nmacrophages and mesothelial cells; no malignant cells. \n. \nBedside US done in the ED did reveal a fluid collection, but pt \nrefused to have a full echocardiogram done at the time. Given \nher complaint of back pain, ED staff pursued CTA to r/o \ndissection in addition to quantifying pericardial fluid. This \nrevealed flattening of the right ventricle--a non-specific \nfinding on CT. \n. \nPt\'s epigastric and chest pain seem to have resolved with IV \npepcid at OSH prior to transfer. On the floor, she states that \nher SOB is at baseline. Typically she uses 2L O2 for 5hrs at \nnight to sleep. She denies CP. Denies dizzyness or \nlightheadedness. Pt states that all of her routine oncologic \nscreening is up to date: yearly PAPs until ___ years ago, \ncolonoscopy with polyp removal recently, yearly mammograms. She \nhas never had cancer. She has never had any serious infections. \nShe states that she had some strictures dilated a few years ago \nin her corkscrew esophagus at another institution and that even \nat her baseline, she has difficulty swallowing because food gets \n"stuck in her chest."\n. \nOn review of systems, she denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, bleeding at the \n \ntime of surgery, myalgias, joint pains, cough, hemoptysis, black \n \nstools or red stools. She denies recent fevers, chills or \nrigors. She denies exertional buttock or calf pain. All of the \nother review of systems were negative. \n. \nCardiac review of systems is notable for paroxysmal nocturnal \ndyspnea, orthopnea, palpitations, syncope or presyncope.', 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.2', 'valuenum': 43.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.92', 'valuenum': 4.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.68', 'valuenum': 4.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: Afebrile BP=142/64 with pulsus of 6, HR=72 RR=16 O2 \nsat=95%2L \nGENERAL: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. PERRL, EOMI. Neck veins not distended. \nNECK: Supple with JVP of 8-10 cm. \nCARDIAC: RRR, normal S1, S2. No m/r/g. No S3 or S4. \nLUNGS: Resp were unlabored, no accessory muscle use. few \nbibasilar crackles with a scattered expiratory wheezes \nthroughout lung fields, limited air movement. \nABDOMEN: Soft, NTND. No abdominial bruits. \nEXTREMITIES: No c/c/e. \nSKIN: some venous stasis changes in distal ___ B/L \nPULSES: \nRight: Carotid 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ DP 2+ ___ 2+ \n=================================\nPHYSICAL EXAM NOT CHANGED AT THE TIME OF DISCHARGE', 'diagnoses': [{'icd_code': '8439', 'desc': 'Sprains and strains of unspecified site of hip and thigh'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}], 'summary': '___ 03:23PM BLOOD WBC-8.0 RBC-4.22 Hgb-11.6* Hct-33.8* \nMCV-80* MCH-27.5 MCHC-34.3 RDW-14.4 Plt ___\n___ 06:40AM BLOOD WBC-6.0 RBC-3.65* Hgb-10.0* Hct-29.4* \nMCV-81* MCH-27.4 MCHC-34.0 RDW-14.2 Plt ___\n___ 03:23PM BLOOD Neuts-63.7 ___ Monos-7.5 Eos-2.3 \nBaso-0.1\n___ 03:23PM BLOOD ___ PTT-27.3 ___\n___ 06:40AM BLOOD UreaN-12 Creat-0.6 Na-136 K-4.0 Cl-100 \nHCO3-27 AnGap-13\n___ 03:23PM BLOOD CK(CPK)-49\n___ 06:35AM BLOOD CK(CPK)-50\n___ 03:23PM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 06:35AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 06:40AM BLOOD Mg-1.9\n=================================\nCXR:\nSimilar to the prior exam, this evaluation is limited by body \nhabitus and AP portable technique. Massive cardiomegaly is again \nidentified but stable. No signs of failure are noted. There is \nno definite focal consolidation. There is blunting of the \nbilateral costophrenic angles, possibly due to underlying \neffusions. No definite pneumothorax is seen. The aorta is mildly \ntortuous. \nIMPRESSION: Limited study as above. If clinically feasible, \nconsider PA and lateral views in the radiology suite for more \nsensitive evaluation. As is, no gross acute pulmonary process \nidentified. Stable cardiomegaly. \n===============================\nCTA:\n1. No evidence of pulmonary embolus or aortic dissection. \n2. Large pericardial effusion. Echocardiography is recommended \nto evaluate \nfor tamponade physiology. \n3. Small right and trace left pleural effusions. \n===============================\nECHO\nThe estimated right atrial pressure is ___. Overall left \nventricular systolic function is normal (LVEF>55%). Right \nventricular chamber size and free wall motion are normal. There \nis abnormal septal motion/position. The aortic valve leaflets \n(3) are mildly thickened but aortic stenosis is not present. No \naortic regurgitation is seen. The mitral valve appears \nstructurally normal with trivial mitral regurgitation. There is \na small pericardial effusion. There are no echocardiographic \nsigns of tamponade. \nCompared with the prior study (images reviewed) of ___, \nno major change.\n___ yo F with COPD, DM, HTN, hyperlipidemia, who was recently \ndischarged from ___ s/p drainage of 820cc of pericardial fluid \nwith tamponade physiology found on cath, but not seen on echo, \nNOW PRESENTS with similar symptoms and found to have large \neffusion on CTA of the chest but with stable BP, pulsus of 6, \nand JVP of 8-10cm suggesting that there is no tamponade \nphysiology currently. Moreover, ECHO showed no change in the \nECHO since pt was last dischared s/p pericardiocentesis.\n.\n# PUMP / PERICARDIAL EFFUSION: \n- Epigastric and back pain were the pt\'s original presenting \nsymptoms for previous admission for pericardial effusion. It is \nunclear why these symptoms recurred when her effusion had not \nchanged in size since she was last discharged s/p \npericardiocentesis. Pain not c/w pericarditis. \n- Cytology and cultures from last admission have not revealed \nsource of pericardial effusion thus far, AFB cultures still \npending at time of d/c.\n- She will f/u with Dr. ___, if effusion returns, \nshe may be a candidate for pericardial window.\n. \n# CORONARIES: The patient has no known history of coronary \nartery disease. Continue Statin. Continue ASA for primary \nprevention given diabetes. \n- ruled out for MI by enzymes. \n. \n# RHYTHM: telemetry: no events durnig this admission\n. \n# Dysphagia: reccommend that pt receive an endoscopy as outpt as \nshe seems to be quite symptomatic post-prandially from food \ngetting "caught in chest."\n. \n# COPD: Continue home advair and albuterol nebs. Pt at baseline \n02 requirement at the time of d/c. \n. \n# DM: The patient takes avandamet as an outpatient\n. \n# Hypothyroidism: continued synthroid'}}
{'final_diagnoses': ['Pericardial Effusion', 'Type 2 Diabetes', 'COPD'], 'procedures': ['none'], 'visit_summary': '___ yo F with COPD, DM, HTN, hyperlipidemia, who was recently \ndischarged from ___ s/p drainage of 820cc of pericardial fluid \nwith tamponade physiology found on cath, but not seen on echo, \nNOW PRESENTS with similar symptoms and found to have large \neffusion on CTA of the chest but with stable BP, pulsus of 6, \nand JVP of 8-10cm suggesting that there is no tamponade \nphysiology currently. Moreover, ECHO showed no change in the \nECHO since pt was last dischared s/p pericardiocentesis.\n.\n# PUMP / PERICARDIAL EFFUSION: \n- Epigastric and back pain were the pt\'s original presenting \nsymptoms for previous admission for pericardial effusion. It is \nunclear why these symptoms recurred when her effusion had not \nchanged in size since she was last discharged s/p \npericardiocentesis. Pain not c/w pericarditis. \n- Cytology and cultures from last admission have not revealed \nsource of pericardial effusion thus far, AFB cultures still \npending at time of d/c.\n- She will f/u with Dr. ___, if effusion returns, \nshe may be a candidate for pericardial window.\n. \n# CORONARIES: The patient has no known history of coronary \nartery disease. Continue Statin. Continue ASA for primary \nprevention given diabetes. \n- ruled out for MI by enzymes. \n. \n# RHYTHM: telemetry: no events durnig this admission\n. \n# Dysphagia: reccommend that pt receive an endoscopy as outpt as \nshe seems to be quite symptomatic post-prandially from food \ngetting "caught in chest."\n. \n# COPD: Continue home advair and albuterol nebs. Pt at baseline \n02 requirement at the time of d/c. \n. \n# DM: The patient takes avandamet as an outpatient\n. \n# Hypothyroidism: continued synthroid', 'medications_prescribed': ['1. Atorvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. Meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO TID (3 times \na day).', '3. Psyllium Packet Sig: One (1) Packet PO DAILY (Daily).', '4. Claritin 10 mg Tablet Sig: One (1) Tablet PO once a day.', '5. Levothyroxine 125 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '6. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.', '7. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '8. Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at \nbedtime).', '9. Advair Diskus 500-50 mcg/Dose Disk with Device Sig: One (1) \nInhalation twice a day.', '10. Fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1) \nNasal twice a day.', '11. AVANDAMET Oral', '12. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) neb Inhalation twice a day.', '13. Fosamax Oral', '14. Aspirin EC 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO once a day.', '15. home oxygen\npt requires home oxygen for COPD and ambulatory sat of 88%; dose \nby pulse for duration']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['-Vitamin D deficiency', '-Left renal mass found on OSH CT', '-h/o cervical dysplasia', '-enlarged thyroid'], 'family_history': 'Mother - healthy, living \nFather - died from ___ malignancy in ___ (?prostate, family \nkept details of this from the pt) \nMGM - breast CA at 62', 'present_illness': '___ with obesity and recently discovered L renal mass who \npresents with worsening abd pain. Pain started last ___, \nshe was previously free of abd pain before last week. She \ninitially presented to the ___ ED and had a CT abd/pelvis which \nnoted a mass in her left kidney as well as a liver lesion. She \nwas discharged home with recommendation for outpatient MRI \nabdomen. Pain is located in the LUQ and noted to be sharp and \nvery intermittent, ___ and then ___ just a few minutes later. \nShe has not taken anything for the pain at home. She also \nendorses severe heartburn in the few days preceeding this pain, \nwith reflux and sour taste in her mouth when she lies down. Pain \nin her abdomen inproves when she eats and becomes worse when she \nis fasting. She also endordes alternating constipation and \ndiarrhea over the past few weeks. \nShe also reports weight loss over the past 6 months. Pant size \nwent from 14 to 9, but she does not know how many pounds she \nlost. She was trying to lose weight, but states that she was \nusing methods that were previously unsuccessful. She became \ntearful when discussing the weight loss. She reports \nintermittent night sweats and chills over the past few weeks. \nDenies fevers. \n\nIn the ED, initial VS were: 98.0 93 135/87 18 100%. No imaging \nwas obtained. She received morphine 4mg IV x2 and zofran IV x1. \nShe was noted to be guaiac positive. Labs including LFTs were \nnormal aside fro mild leukocytosis to 12.6. \n\nOn arrival to the floor, she reports no pain after receiving \nmorphine in the ED. Denies nausea.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PrednisoLONE Acetate 0.12% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'MoviPrep', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.99', 'valuenum': 2.99, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61.3', 'valuenum': 61.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '363', 'valuenum': 363.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.17', 'valuenum': 0.17, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.62', 'valuenum': 0.62, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.19', 'valuenum': 6.19, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.4', 'valuenum': 46.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '345', 'valuenum': 345.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.05', 'valuenum': 3.05, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '374', 'valuenum': 374.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.7', 'valuenum': 47.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '376', 'valuenum': 376.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '398', 'valuenum': 398.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.6', 'valuenum': 47.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '401', 'valuenum': 401.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.4', 'valuenum': 48.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '416', 'valuenum': 416.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.12', 'valuenum': 3.12, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVS - BP 135/84 HR 69 RR 20 SpO2 98/RA \nGENERAL - well-appearing woman in NAD, comfortable, appropriate \n\nHEENT - NC/AT, PERRLA, MMM \nNECK - supple, no JVD \nLUNGS - CTA bilat, no r/rh/wh, good air movement \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft/ND, mild TTP in the epigastrium and LUQ, no \nmasses palpated \nBACK - mild CVA tenderness bilaterally \nEXTREMITIES - WWP, no c/c/e \nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout, no focal \ndeficits, gait normal\n\nDISCHARGE EXAM:\nVS 98.2 96/63, 55, 18, 99RA\nGEN Alert, oriented, no acute distress \nHEENT NCAT MMM EOMI sclera anicteric, OP clear \nNECK supple, no JVD, no LAD \nPULM Good aeration, CTAB no wheezes, rales, ronchi \nCV RRR normal S1/S2, no mrg\nABD soft TTP in epigastric area, RUQ and LUQ w/o r/g. ND, \nnormoactive bowel sounds. negative ___ sign. No CVA \ntenderness.\nEXT WWP 2+ pulses palpable bilaterally, no c/c/e\nNEURO CNs2-12 intact, motor function grossly normal \nSKIN no ulcers or lesions', 'diagnoses': [{'icd_code': '5781', 'desc': 'Blood in stool'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}, {'icd_code': 'V4572', 'desc': 'Acquired absence of intestine (large) (small)'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': 'ADMISSION LABS:\n\n___ 02:33PM BLOOD WBC-12.6* RBC-4.28 Hgb-13.8 Hct-39.9 \nMCV-93 MCH-32.3* MCHC-34.6 RDW-12.7 Plt ___\n___ 02:33PM BLOOD Glucose-149* UreaN-8 Creat-0.6 Na-140 \nK-3.7 Cl-102 HCO3-23 AnGap-19\n___ 02:33PM BLOOD ALT-24 AST-19 AlkPhos-49 TotBili-0.2\n___ 06:20AM BLOOD Calcium-8.6 Phos-4.3 Mg-2.0\n\nDISCHARGE LABS:\n\n___ 06:20AM BLOOD WBC-8.1 RBC-4.04* Hgb-13.0 Hct-37.8 \nMCV-94 MCH-32.1* MCHC-34.3 RDW-12.6 Plt ___\n___ 06:20AM BLOOD Glucose-91 UreaN-8 Creat-0.6 Na-139 K-3.9 \nCl-104 HCO3-27 AnGap-12\n\nPERTINENT MICRO: NONE\n\nPERTINENT IMAGING:\n\n___ RENAL US:\nThe right kidney measures 13.7 cm. The left kidney measures \n13.7\ncm. In the mid to upper pole of the left kidney, there is a 5.9 \nx 4.8 x 5.5\ncm cystic mass with a thick, irregular wall and increased \nvascularity. There\nis a fluid-fluid level within the mass, indicating possible \ninternal\nhemorrhage. In addition, there is a 6 mm non-obstructing stone \nin the left\nkidney. There is no hydronephrosis bilaterally and the \ncorticomedullary\narchitecture is normal. The bladder is normal.\nIMPRESSION:\n1. 5.9 cm cystic and possibly hemorrhagic mass in the left \nkidney, with\nconcerning features for renal cell carcinoma including a \nthickened wall and\nincreased vascularity. Further characterization with MRI is \nrecommended.\n2. 6 mm non-obstucting stone in the left kidney.\n \n___ ABDOMINAL MR:\n1. 4.1 x 3.9 x 3.6 cm complex cystic lesion within the upper \npole of the\nright kidney which contains internal hemorrhagic/proteinaceous \ndebris and\nslightly thick wall and enhancing septations. Follow-up MRI in \n6 months is\nrecommended to ensure stability.\n2. Cavernous hemangiomas within the liver. \n3. Cholelithiasis.\n___ with recently discovered left renal/liver lesions who \npresents with worsening abd pain and GERD symptoms. \n\n#ABDOMINAL MASSES: \nThe patient had gone to ___ ED with abnormal renal and liver \nmasses seen on CT A/P. Further workup was recommended with \noutpatient MRI. Due to insurance issues, the pt was unable to \nhave her MRI performed. She instead presented to ___ ED with \nabdominal pain - a sharp left upper quadrant pain worse on deep \ninspiration and with certain position changes. She also \ncomplained of a separate epigastric pain that felt better after \neating. Of note, she had been taking frequent doses of motrin to \ncombat the LUQ sharp pain. She was started on PPI and maalox \novernight and her epigastric discomfort improved. A an \nultrasound of her L kidney was performed to further characterize \nthe mass, showing a complex cystic mass with hemorrhagic \nfeatures. She had an abdominal MRI just prior to transfer. We \nsuspect that the hemorrhagic component of the mass was causing \nperitoneal irritation on deep inspiration and that her \nepigastric pain may be due to gastritis. She was discharged on a \nPPI. Just prior to transfer, she received an abdominal MRI. She \nwill need to follow up with her outpatient physician, who was \ncontacted, in regards to further workup of the masses. It is \npossible that due to its complex, hemorrhagic features, that \nthis could be malignancy. Especially given her recent weight \nloss, night sweats.'}}
{'final_diagnoses': ['Left kidney mass'], 'procedures': ['none'], 'visit_summary': '___ with recently discovered left renal/liver lesions who \npresents with worsening abd pain and GERD symptoms. \n\n#ABDOMINAL MASSES: \nThe patient had gone to ___ ED with abnormal renal and liver \nmasses seen on CT A/P. Further workup was recommended with \noutpatient MRI. Due to insurance issues, the pt was unable to \nhave her MRI performed. She instead presented to ___ ED with \nabdominal pain - a sharp left upper quadrant pain worse on deep \ninspiration and with certain position changes. She also \ncomplained of a separate epigastric pain that felt better after \neating. Of note, she had been taking frequent doses of motrin to \ncombat the LUQ sharp pain. She was started on PPI and maalox \novernight and her epigastric discomfort improved. A an \nultrasound of her L kidney was performed to further characterize \nthe mass, showing a complex cystic mass with hemorrhagic \nfeatures. She had an abdominal MRI just prior to transfer. We \nsuspect that the hemorrhagic component of the mass was causing \nperitoneal irritation on deep inspiration and that her \nepigastric pain may be due to gastritis. She was discharged on a \nPPI. Just prior to transfer, she received an abdominal MRI. She \nwill need to follow up with her outpatient physician, who was \ncontacted, in regards to further workup of the masses. It is \npossible that due to its complex, hemorrhagic features, that \nthis could be malignancy. Especially given her recent weight \nloss, night sweats.', 'medications_prescribed': ['Vitamin D 1000 UNIT PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Acetaminophen ___ mg PO Q6H:PRN pain \ndo not exceed 3g in one day']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 82, 'gender': 'M', 'symptoms': 'Abdominal Pain', 'medical_history': ['- DM2', '- HTN', '- COPD on home O2', '- CAD - Prior NSTEMI in ___ and ___, medically managed w/o \ncatheterization. NSTEMI ___ at ___, cardiac cath showed \nmoderate CAD: 50% ___ LAD lesion, 40% mid RCA lesion.', '- HFpEF, recovered', '- HIT in ___ though per report has been on heparin products\nsubsequently', '- Legally blind', '- Hard of hearing'], 'family_history': 'Family History: Father with CAD.', 'present_illness': "Ms. ___ is a ___ year old woman ___ speaking), with a \nhistory of CAD, HFrEF, DM2, HTN, COPD on home O2, legally blind, \nmultiple abdominal surgeries with large ventral hernia, \npresenting with several hours of epigastric pain, nausea, emesis \nwith CT abd/pelvis showing c/f SBO with transition point within\nventral wall hernia. \n\nPatient history obtained with assistance of patient's daughter. \nPatient has had constipation for ___ days, and had a large BM \nthis afternoon. Shortly after she had dinner and had crampy \nabdominal pain associated with nausea and small volume emesis. \nShe presented to the ED for evaluation of these symptoms. She \nhas\nnot had fevers/chills, diarrhea, melena/hematochezia. Patient \nreports mild nausea currently improved with antiemetics. She \ndoes endorse passing flatus. \n\nIn the ED, patient was found to be afebrile, mildly tachycardic \nto ___, with WBC 13.3, lactate 2.5, troponin 0.25 ___bd/pelvis showing SBO with possible transition point in large \nventral wall hernia. She was given 1L bolus IVF, had EKG without \nST changes. Surgery was consulted given her symptoms and CT scan \nfindings. Patient reports her pain is improved since she arrived \nto the ED.", 'medications': [{'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROcodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.0', 'valuenum': 43.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.7', 'valuenum': 21.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '208', 'valuenum': 208.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM ON ADMISSION:\nVitals - T 98.2; BP 133/79; HR 93; RR 24; 99% 3L NC\nGEN - Well appearing, no acute distress\nHEENT - NCAT, EOMI, sclera anicteric\nCV - HDS\nPULM - No signs of respiratory distress. \nABD - soft, minimally tender LUQ, no rebound, no guarding\n\nPHYSICAL EXAM ON DISCHARGE:\nVS: 97.9 PO 101 / 64 89 20 97 3 \nGEN: Awake, alert, cooperative.\nHEENT: PERRL, EOMI, nares patent. \nCV: RRR\nPULM: Bilateral rhonchi, breath sounds diminished in the bases.\nABD: Soft, mildly distended, palpable hernia, mild tenderness to \npalp over hernia, Active bowel sounds. \nEXT: Warm and dry.', 'diagnoses': [{'icd_code': 'T8453XA', 'desc': 'Infection and inflammatory reaction due to internal right knee prosthesis, initial encounter'}, {'icd_code': 'F05', 'desc': 'Delirium due to known physiological condition'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'B957', 'desc': 'Other staphylococcus as the cause of diseases classified elsewhere'}, {'icd_code': 'Y834', 'desc': 'Other reconstructive surgery as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'Z96653', 'desc': 'Presence of artificial knee joint, bilateral'}, {'icd_code': 'Z85038', 'desc': 'Personal history of other malignant neoplasm of large intestine'}, {'icd_code': 'Z8551', 'desc': 'Personal history of malignant neoplasm of bladder'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}], 'summary': "CT ABD & PELVIS WITH CONTRASTStudy Date of ___\n1. Small-bowel obstruction with a possible transition point in \nthe large ventral wall hernia.\n2. No free air, portal venous gas, or pneumatosis intestinalis.\n3. Diverticulosis without evidence of diverticulitis.\n4. There is fluid within the esophagus, suggestive of \ndysmotility versus reflux.\n\nCTA HEAD AND CTA NECKStudy Date of ___\n1. No acute intracranial abnormality.\n2. Patent circle of ___ without evidence of stenosis, \nocclusionor aneurysm.\n3. Patent bilateral cervical carotid and vertebral arteries \nwithout evidence of occlusion or dissection.\n4. Small pleural effusions bilaterally.\n5. There is a 1 cm pleural placed lobulated hyperdensity in the \nright upper lobe, new in comparison study ___, that may \nrepresent small loculated fluid collection in the setting of \npleural effusions or a lung nodule. In the correct clinical \nsetting, follow-up chest imaging may be considered.\n\nTRANSTHORACIC ECHOCARDIOGRAM: ___\nMild symmetric left ventricular hypertrophy with normal cavity \nsize and regional/ global biventricular systolic function. MIld \naortic regurgitation. Elevated LVEDP.\n\n___ CXR: \n1. There is a progression in the right lower lobe consolidation \nconcerning for evolving pneumonia or aspiration. Recommend \nrepeat chest radiograph to follow until resolution. \n2. Bilateral pleural effusions and mild pulmonary edema. \n\n___ CXR: \nCompared to chest radiographs ___ through ___. \nModerate cardiomegaly is chronic. Moderate right and small left \npleural \neffusions are new. Heterogeneous opacification left lung base \ncould be \naspiration or pneumonia. Pulmonary vessels are engorged but \nthere is no \npulmonary edema. No pneumothorax. \n\nLABRATORY RESULTS:\n\n___ 09:25AM BLOOD WBC-8.6 RBC-3.99 Hgb-8.8* Hct-30.5* \nMCV-76* MCH-22.1* MCHC-28.9* RDW-23.5* RDWSD-64.4* Plt ___\n___ 06:18AM BLOOD WBC-8.1 RBC-4.61 Hgb-10.1* Hct-35.2 \nMCV-76* MCH-21.9* MCHC-28.7* RDW-23.2* RDWSD-64.0* Plt ___\n___ 06:30AM BLOOD WBC-8.3 RBC-4.71 Hgb-10.3* Hct-36.0 \nMCV-76* MCH-21.9* MCHC-28.6* RDW-23.5* RDWSD-63.9* Plt ___\n___ 01:30AM BLOOD WBC-13.3* RBC-5.46* Hgb-11.8 Hct-42.3 \nMCV-78* MCH-21.6* MCHC-27.9* RDW-24.1* RDWSD-65.7* Plt ___\n___:25AM BLOOD Glucose-158* UreaN-15 Creat-0.8 Na-139 \nK-4.1 Cl-107 HCO3-24 AnGap-8*\n___ 06:18AM BLOOD Glucose-125* UreaN-16 Creat-0.7 Na-142 \nK-3.7 Cl-106 HCO3-26 AnGap-10\n___ 06:30AM BLOOD Glucose-117* UreaN-20 Creat-0.8 Na-142 \nK-3.8 Cl-101 HCO3-26 AnGap-15\n___ 01:30AM BLOOD Glucose-189* UreaN-16 Creat-0.7 Na-138 \nK-3.7 Cl-96 HCO3-25 AnGap-17\n___ 09:25AM BLOOD Glucose-158* UreaN-15 Creat-0.8 Na-139 \nK-4.1 Cl-107 HCO3-24 AnGap-8*\n___ 06:18AM BLOOD Glucose-125* UreaN-16 Creat-0.7 Na-142 \nK-3.7 Cl-106 HCO3-26 AnGap-10\n___ 06:18AM BLOOD CK-MB-8 cTropnT-0.38*\n___ 03:20PM BLOOD CK-MB-8 cTropnT-0.39*\n___ 01:31PM BLOOD CK-MB-7 cTropnT-0.38*\n___ 06:30AM BLOOD cTropnT-0.37*\n___ 09:30PM BLOOD CK-MB-8 cTropnT-0.38*\n___ 03:00PM BLOOD CK-MB-9 cTropnT-0.32*\n___ 04:29AM BLOOD CK-MB-12* cTropnT-0.24*\n___ 01:30AM BLOOD CK-MB-13* cTropnT-0.25*\n___ 09:25AM BLOOD Calcium-8.0* Phos-3.2 Mg-2.0\n___ 06:18AM BLOOD Calcium-8.4 Phos-3.4 Mg-2.3\n___ 06:30AM BLOOD Calcium-8.4 Phos-3.9 Mg-1.9\n___ 03:00PM BLOOD %HbA1c-5.9 eAG-123\n___ 03:00PM BLOOD LDLmeas-103\n___ 01:41AM BLOOD Lactate-2.5*\n___ 06:41AM BLOOD Lactate-3.8*\n___ 05:35PM BLOOD Lactate-1.7\n___ 11:03AM URINE Color-Straw Appear-Hazy* Sp ___\n___ 07:00AM URINE Color-Straw Appear-Hazy* Sp ___\n___ 11:03AM URINE Blood-SM* Nitrite-POS* Protein-TR* \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG*\n___ 07:00AM URINE Blood-SM* Nitrite-NEG Protein-TR* \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-LG*\n___ 11:03AM URINE RBC-2 WBC-105* Bacteri-FEW* Yeast-NONE \nEpi-0 TransE-<1\n___ 07:00AM URINE RBC-41* WBC->182* Bacteri-FEW* Yeast-NONE \nEpi-2\n\nMICROBIOLOGY:\n\n___ 7:00 am URINE\n **FINAL REPORT ___\n URINE CULTURE (Final ___: \n MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT \nWITH SKIN\n AND/OR GENITAL CONTAMINATION. \n \n___ 11:03 am URINE Source: Catheter. \n **FINAL REPORT ___\n REFLEX URINE CULTURE (Final ___: \n MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT \nWITH FECAL\n CONTAMINATION.\nMs. ___ is a ___ yo F with a history of CAD, HFrEF, DM2, HTN, \nCOPD on home O2, legally blind, multiple abdominal surgeries \nwith large ventral hernia, presenting with several hours of \nepigastric pain, nausea, emesis. CT abd/pelvis showing concern \nfor small bowel obstruction SBO with transition point within \nventral wall hernia. In the emergency department she was \nhemodynamically stable with mild tachycardia with heart rates \n___, afebrile, WBC 13.3, lactate 2.5, troponin 0.25. She \nwas given 1L bolus IVF and EKG showed no ST changes. Surgery was \nconsulted given her symptoms and CT scan findings. The patient \nwas made NPO, given IV fluids, and admitted to the surgical \nfloor for hemodynamic monitoring and ongoing treatment of her \nbowel obstruction. \n\nOn HD1, troponins were trended and increased to 0.38, EKG was \nstable. Cardiology was consulted. In the afternoon, she was \nnoted to have a right sided facial droop and dysarthria. A code \nstroke was called and the patient was seen and evaluated by \nneurology. The symptoms were transient and only lasted several \nminutes. She underwent CT and CTA which were unremarkable. After \na through discussion of risks and benefits, no further work up \nwas pursued. Cardiology evaluated the patient for troponin \nelevation given her significant cardiac history. Her troponin \nelevation in setting of no chest pain and no EKG changes was \nthought to be demand ischemia. Given her age and functional \nstatus, no further work up was recommended and the patient and \ndaughter were in agreement with plan. On HD2 her abdominal pain \ncontinued to improve and therefore diet was advanced to clears \nwith good tolerability. On HD3 diet was advanced to regular with \ncontinued good tolerability. On HD4 foley catheter was removed \nand she voided spontaneously but continued to have high post \nvoid residuals in the 400's. A urine sample was sent for \nurinalysis and culture. She was initially put on a course of \ncefpidoxime until culture resulted negative and therefore \nantibiotics were discontinued. The daughter was made aware of \nthe risks and benefits of discharge with a foley catheter vs. \nrisks of urinary retention and elected to not have a foley \ncatheter replaced. \n\nDuring this hospitalization, the patient ambulated early and \nfrequently, was adherent with respiratory toilet, and actively \nparticipated in the plan of care. The patient received \nsubcutaneous fondaparinux given heparin allergy and venodyne \nboots were used during this stay.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, incontinent of urine, and pain was well controlled. The \npatient was discharged home with services including 24 hour \ncare. The patient received discharge teaching and follow-up \ninstructions with understanding verbalized and agreement with \nthe discharge plan."}}
{'final_diagnoses': ['Small-bowel obstruction with a possible transition point in \nthe large ventral wall hernia', 'Urinary retention', 'demand NSTEMI'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is a ___ yo F with a history of CAD, HFrEF, DM2, HTN, \nCOPD on home O2, legally blind, multiple abdominal surgeries \nwith large ventral hernia, presenting with several hours of \nepigastric pain, nausea, emesis. CT abd/pelvis showing concern \nfor small bowel obstruction SBO with transition point within \nventral wall hernia. In the emergency department she was \nhemodynamically stable with mild tachycardia with heart rates \n___, afebrile, WBC 13.3, lactate 2.5, troponin 0.25. She \nwas given 1L bolus IVF and EKG showed no ST changes. Surgery was \nconsulted given her symptoms and CT scan findings. The patient \nwas made NPO, given IV fluids, and admitted to the surgical \nfloor for hemodynamic monitoring and ongoing treatment of her \nbowel obstruction. \n\nOn HD1, troponins were trended and increased to 0.38, EKG was \nstable. Cardiology was consulted. In the afternoon, she was \nnoted to have a right sided facial droop and dysarthria. A code \nstroke was called and the patient was seen and evaluated by \nneurology. The symptoms were transient and only lasted several \nminutes. She underwent CT and CTA which were unremarkable. After \na through discussion of risks and benefits, no further work up \nwas pursued. Cardiology evaluated the patient for troponin \nelevation given her significant cardiac history. Her troponin \nelevation in setting of no chest pain and no EKG changes was \nthought to be demand ischemia. Given her age and functional \nstatus, no further work up was recommended and the patient and \ndaughter were in agreement with plan. On HD2 her abdominal pain \ncontinued to improve and therefore diet was advanced to clears \nwith good tolerability. On HD3 diet was advanced to regular with \ncontinued good tolerability. On HD4 foley catheter was removed \nand she voided spontaneously but continued to have high post \nvoid residuals in the 400's. A urine sample was sent for \nurinalysis and culture. She was initially put on a course of \ncefpidoxime until culture resulted negative and therefore \nantibiotics were discontinued. The daughter was made aware of \nthe risks and benefits of discharge with a foley catheter vs. \nrisks of urinary retention and elected to not have a foley \ncatheter replaced. \n\nDuring this hospitalization, the patient ambulated early and \nfrequently, was adherent with respiratory toilet, and actively \nparticipated in the plan of care. The patient received \nsubcutaneous fondaparinux given heparin allergy and venodyne \nboots were used during this stay.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, incontinent of urine, and pain was well controlled. The \npatient was discharged home with services including 24 hour \ncare. The patient received discharge teaching and follow-up \ninstructions with understanding verbalized and agreement with \nthe discharge plan.", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Docusate Sodium 100 mg PO DAILY', 'GlipiZIDE XL 10 mg PO DAILY', 'MetFORMIN (Glucophage) 500 mg PO BID', 'Metoprolol Succinate XL 25 mg PO DAILY', 'Torsemide 80 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 45, 'gender': 'M', 'symptoms': 'Pleurtitc chest pain', 'medical_history': ['Mitral valve prolapse with severe mitral regurgitation', 'Hypertension', 'Dyslipidemia', 'BPH/Prostatism', 'Urethral stricture disease, occasional UTI.', 'GERD', 'Sciolosis, Kyphosis and cervical spondylosis', '___ cystoscopy at a young age, followed by bladder surgery\nwith internal ureterotomy at the age of ___.', '___ Right Knee Arthroscopy'], 'family_history': 'Mother and brother(___) underwent CABG operations', 'present_illness': 'This is a ___ yo M with ___ significant for MVP with severe MR \n___ repair in ___, HTN, and HLD that came to ___ because of \n___ L-sided chest pain x48 hours. Pain started on ___ \nevening, and began as dull ache. Worse with inspiration, but no \nassociated shortness of breath. Pt took ibuprofen with partial \nresolution of symptoms, but the pain kept him up both ___ \n___ and ___ evening. Does not describe a positional \ncomponent to symptoms. No associated N/V, diaphoresis, \ndizziness, or lightheadedness. Pain is at rest, constant, and \ndoes not worsen with activity. He has had pleurisy in the past, \nbut this seems to be worse. No history of angina in the past, \nand he does not take SL nitro at home. Pt stays active at home \nand uses a bowflex for exercise, but does not recall any recent \noverexertion. \n\nOf note, he did suffer from recent chills and full body myalgias \nlast week that resolved on their own.\n \nIn the ED, initial vitals were ___ pain 97 83 139/77 14 99% \nLabs and imaging significant for D-dimer of 1315, Trop <.01, Cr \n1.1 \nPatient given ASA 325mg, MS 4mg IV x2, and started on heparin \ngtt. Pain was not relieved by IV morphine. Vitals on transfer \nwere 8 /10 pain 98.6 74 117/95 18 98% \n\nOn arrival to the floor, patient 128/89 70 18 96% RA. He relates \nthe left sided pain to a "toothache". Partially reproducible \nwith palpation, and he believes "the muscle\'s involved". No \nradiation to jaw or neck.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Stavudine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Epoetin Alfa', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QMOWEFR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LaMIVudine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'MWF', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Tenofovir Disoproxil (Viread)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Cinacalcet', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '582', 'valuenum': 582.0, 'valueuom': '#/uL', 'ref_range_lower': 578.0, 'ref_range_upper': 1850.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': '#/uL', 'ref_range_lower': 350.0, 'ref_range_upper': 1100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '333', 'valuenum': 333.0, 'valueuom': '#/uL', 'ref_range_lower': 193.0, 'ref_range_upper': 685.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'Ratio', 'ref_range_lower': 0.84, 'ref_range_upper': 3.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '748', 'valuenum': 748.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71.1', 'valuenum': 71.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.2, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '612', 'valuenum': 612.0, 'valueuom': '#/uL', 'ref_range_lower': 578.0, 'ref_range_upper': 1850.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': '#/uL', 'ref_range_lower': 350.0, 'ref_range_upper': 1100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '328', 'valuenum': 328.0, 'valueuom': '#/uL', 'ref_range_lower': 193.0, 'ref_range_upper': 685.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'Ratio', 'ref_range_lower': 0.84, 'ref_range_upper': 3.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '780', 'valuenum': 780.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.5, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68.3', 'valuenum': 68.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Exam;\nVS- 128/89 70 18 96% RA\nGENERAL- NAD. Well nourished. Well developed. Conversive with \ngood mood/affect. \nHEENT- NCAT. EOMI. PERRL. MMM. \nNECK- Supple with JVP of 5 cm. \nCARDIAC- PMI located in ___ intercostal space, midclavicular \nline. RRR, normal S1, S2. Soft rub heard best at ___. No \nthrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN- Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES- No c/c/e. No femoral bruits. \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES- \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \n .\nDischarge Exam:\nVitals: 97 139/91 63 18 97%RA\nGENERAL- NAD. Well nourished. Well developed. Conversive with \ngood mood/affect. \nHEENT- NCAT. EOMI. PERRL. MMM. \nNECK- Supple with JVP of 5 cm. \nCARDIAC- PMI located in ___ intercostal space, midclavicular \nline. RRR, normal S1, S2. Soft rub heard best at ___. No \nthrills, lifts. No S3 or S4. \nLUNGS- No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN- Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES- No c/c/e. No femoral bruits. \nSKIN- No stasis dermatitis, ulcers, scars, or xanthomas.', 'diagnoses': [{'icd_code': '042', 'desc': 'Human immunodeficiency virus [HIV] disease'}, {'icd_code': '40391', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease'}, {'icd_code': '5856', 'desc': 'End stage renal disease'}, {'icd_code': '07030', 'desc': 'Viral hepatitis B without mention of hepatic coma, acute or unspecified, without mention of hepatitis delta'}, {'icd_code': '4539', 'desc': 'Other venous embolism and thrombosis of unspecified site'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '28850', 'desc': 'Leukocytopenia, unspecified'}, {'icd_code': '78065', 'desc': 'Hypothermia not associated with low environmental temperature'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '07070', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': '4589', 'desc': 'Hypotension, unspecified'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}, {'icd_code': 'V1201', 'desc': 'Personal history of tuberculosis'}, {'icd_code': '5932', 'desc': 'Cyst of kidney, acquired'}], 'summary': 'Admission Labs:\n___ 05:04AM BLOOD WBC-7.8 RBC-5.10 Hgb-14.7 Hct-42.3 MCV-83 \nMCH-28.8 MCHC-34.8 RDW-14.4 Plt ___\n___ 05:04AM BLOOD ___ PTT-36.7* ___\n___ 05:04AM BLOOD Glucose-128* UreaN-28* Creat-1.1 Na-141 \nK-4.1 Cl-105 HCO3-23 AnGap-17\n___ 01:17PM BLOOD Calcium-8.4 Phos-3.0 Mg-2.0\n.\nDischarge Labs:\n___ 05:46AM BLOOD WBC-6.4 RBC-5.10 Hgb-14.3 Hct-42.7 MCV-84 \nMCH-28.1 MCHC-33.6 RDW-14.3 Plt ___\n___ 05:46AM BLOOD Glucose-89 UreaN-26* Creat-1.1 Na-139 \nK-4.1 Cl-103 HCO3-28 AnGap-12\n___ 05:46AM BLOOD Calcium-8.8 Phos-3.4 Mg-2.1\n.\nPertinent Labs:\n___ 05:04AM BLOOD cTropnT-<0.01\n___ 01:17PM BLOOD CK-MB-4 cTropnT-<0.01\n___ 07:15AM BLOOD D-Dimer-1315*\n___ 01:17PM BLOOD CRP-63.1*\n___ 01:17PM BLOOD ESR-26*\n.\nStudies:\n___ CTA\nNo lower cervical adenopathy. Normal appearance of the thyroid \ngland. There is a three-vessel aortic arch. No mediastinal \nadenopathy. Atherosclerotic coronary artery calcifications are \nnoted. Patient is status post mitral valve replacement. Heart \nsize is mildly enlarged. Normal appearance of the \ngastroesophageal junction. Limited evaluation of the upper \nabdomen is unremarkable. \nLungs demonstrate normal overall parenchymal pattern without \nsuspicious nodule or mass. There is bilateral dependent \natelectasis with a small left pleural effusion. \n \nPulmonary arteries are patent without evidence of filling \ndefect. \n \nOsseous structures demonstrate patient is status post median \nthoracotomy. No acute osseous abnormality is evident. \nDegenerative changes of the thoracic spine are noted. \n \nIMPRESSION: \n1. No evidence of pulmonary embolism. \n2. Post-surgical and chronic changes as above. \n.\n___ CXR: \nNo acute cardiopulmonary process.\n.\n___ EKG:\nEctopic atrial rhythm. Minor J point elevation in the precordial \nleads. \nCompared to the previous tracing of ___ rate is faster, Q-T \ninterval is shorter. \nRate PR QRS QT/QTc P QRS T \n78 168 80\n___ yo M with PMH significant for MVP and severe MR ___ repair in \n___ presenting to hospital with 48 hour h/o pleuritic chest \npain following recent illness. EKG changes non-specific for \npericarditis, but elevated ESR and CRP consistent with \ninlammatory process. D-dimer elevated in ED, but CTA negative \nfor PE. Pain improved with PO ibuprofen and colchicine. Pt \ndischarged home with instructions to follow-up with \ncardiologist. \n .\nActive Issues\n# Chest Pain: Patient presented with L. sided, pleuritic pain at \nrest and during activity. Differential included pericarditis vs. \nmusculoskeletal vs. PE vs. ACS. Ruled out for ACS with negative \nenzymes, non-specific EKG changes, and atypical nature of pain. \nD-dimer elevated, and came to the floor on heparin gtt. Ruled \nout for PE with negative CTA, so heparin stopped. Pericarditis \nseemed most likely given history, elevated inflammatory markers, \nrecent viral illness, and good response to anti-inflammatories. \nEKG changes non-specifiic for pericarditis and no friction rub \non exam, so no definitive diagnosis. No concern for pericardial \neffusion. Discharged on PO ibuprofen 800mg TID PRN. Also given \ncolchicine 0.6mg BID to complete a 3 month course in order to \nprevent future recurrence. Will follow-up with cardiologist and \nobtain TTE, if pain persists and concern for effusion.\n.\nChronic Issues\n#CAD: Pt with 1 vessel coronary artery disease. Symptoms likely \nnot ___ ACS (see above). Cardiac enzymes wer negative x2. \nContinued home meds.\n.\n# MR ___ Mitral valve repair: Recent mitral valve repair in \n___. No new murmur, or CHF symptoms. No thought that current \nsymptoms related to surgery.\n.\n#BPH: Continues flomax \n.\n#HTN: Continued on home meds, and remained normotensive\n.\nTransitional:\n#Pt scheduled to see cardiologist and PCP, but will follow-up \nsooner if pain not entirely resolved after ___ weeks. ___ need \nTTE to evaluate for effusion'}}
{'final_diagnoses': ['Atypical chest pain', 'history of mitral valve prolapse with mitral valve repair', 'GERD', 'Urethral stricture'], 'procedures': ['None'], 'visit_summary': '___ yo M with PMH significant for MVP and severe MR ___ repair in \n___ presenting to hospital with 48 hour h/o pleuritic chest \npain following recent illness. EKG changes non-specific for \npericarditis, but elevated ESR and CRP consistent with \ninlammatory process. D-dimer elevated in ED, but CTA negative \nfor PE. Pain improved with PO ibuprofen and colchicine. Pt \ndischarged home with instructions to follow-up with \ncardiologist. \n .\nActive Issues\n# Chest Pain: Patient presented with L. sided, pleuritic pain at \nrest and during activity. Differential included pericarditis vs. \nmusculoskeletal vs. PE vs. ACS. Ruled out for ACS with negative \nenzymes, non-specific EKG changes, and atypical nature of pain. \nD-dimer elevated, and came to the floor on heparin gtt. Ruled \nout for PE with negative CTA, so heparin stopped. Pericarditis \nseemed most likely given history, elevated inflammatory markers, \nrecent viral illness, and good response to anti-inflammatories. \nEKG changes non-specifiic for pericarditis and no friction rub \non exam, so no definitive diagnosis. No concern for pericardial \neffusion. Discharged on PO ibuprofen 800mg TID PRN. Also given \ncolchicine 0.6mg BID to complete a 3 month course in order to \nprevent future recurrence. Will follow-up with cardiologist and \nobtain TTE, if pain persists and concern for effusion.\n.\nChronic Issues\n#CAD: Pt with 1 vessel coronary artery disease. Symptoms likely \nnot ___ ACS (see above). Cardiac enzymes wer negative x2. \nContinued home meds.\n.\n# MR ___ Mitral valve repair: Recent mitral valve repair in \n___. No new murmur, or CHF symptoms. No thought that current \nsymptoms related to surgery.\n.\n#BPH: Continues flomax \n.\n#HTN: Continued on home meds, and remained normotensive\n.\nTransitional:\n#Pt scheduled to see cardiologist and PCP, but will follow-up \nsooner if pain not entirely resolved after ___ weeks. ___ need \nTTE to evaluate for effusion', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Colchicine 0.6 mg PO DAILY Duration: 3 Months \nRX *colchicine [Colcrys] 0.6 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', 'Ibuprofen 800 mg PO Q8H:PRN chest pain', 'Losartan Potassium 100 mg PO DAILY', 'Metoprolol Succinate XL 50 mg PO DAILY', 'Mirtazapine 7.5 mg PO HS', 'Ranitidine 150 mg PO BID', 'Simvastatin 20 mg PO DAILY', 'Tamsulosin 0.4 mg PO HS', 'Amlodipine 5 mg PO DAILY', 'Chlorthalidone 25 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Left ankle pain', 'medical_history': ['None'], 'family_history': 'NC', 'present_illness': '___ w/ no significant PMHx tx from OSH w/ L ankle dislocation & \nmedial malleolus fracture s/p closed reduction & splinting. He \nwas working today at a ___ site when ___ fell onto \nhis L ankle, causing inversion injury. He presented to OSH w/ \nobvious deformity. X-rays showed dislocation w/ medial mal \nfracture. It was reduced w/ conscious sedation & splinted. He \ncurrently has minimal pain. Denies numbness, paresthesias. No \nother injuries.', 'medications': [{'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'PB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Viokase-8', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Viokase-8', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Cosyntropin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Viokase-8', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Pancrelipase 5000', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Viokase-8', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '595', 'valuenum': 595.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '400', 'valuenum': 400.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '16/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'POS', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.3, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': 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'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81.8', 'valuenum': 81.8, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '262', 'valuenum': 262.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'In general, the patient is a well appearing man in NAD\nVitals stable.\n\nRight lower extremity:\nSkin intact\nSoft, non-tender thigh and leg\nFull, painless AROM/PROM of hip, knee, and ankle\n___ fire\n+SILT SPN/DPN/TN/saphenous/sural distributions\n___ pulses, foot warm and well-perfused\n\nLeft lower extremity:\nFiberglass splint in place, visible skin intact\nSoft, non-tender thigh\nFull, painless AROM/PROM of hip\n___ fire\n+SILT distally\n___ pulses, foot warm and well-perfused', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '5185', 'desc': 'Pulmonary insufficiency following trauma and surgery'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'V551'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '3332', 'desc': 'Myoclonus'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}], 'summary': "___ 11:21PM URINE COLOR-Yellow APPEAR-Hazy SP ___\n___ 11:21PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-LG\n___ 11:21PM URINE RBC-0 WBC-32* BACTERIA-FEW YEAST-NONE \nEPI-3 TRANS EPI-<1\n___ 11:21PM URINE MUCOUS-RARE\n___ 06:55PM GLUCOSE-89 UREA N-8 CREAT-0.8 SODIUM-141 \nPOTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-25 ANION GAP-13\n___ 06:55PM estGFR-Using this\n___ 06:55PM WBC-12.5* RBC-5.20 HGB-15.7 HCT-47.1 MCV-91 \nMCH-30.2 MCHC-33.4 RDW-12.8\n___ 06:55PM NEUTS-77.4* LYMPHS-16.0* MONOS-5.2 EOS-0.7 \nBASOS-0.6\n___ 06:55PM PLT COUNT-198\n___ 06:55PM ___ PTT-28.5 ___\nThe patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have a left ankle fracture and was admitted to the orthopedic \nsurgery service. The patient was taken to the operating room on \n___ for ORIF left ankle, which the patient tolerated well \n(for full details please see the separately dictated operative \nreport). The patient was taken from the OR to the PACU in stable \ncondition and after recovery from anesthesia was transferred to \nthe floor. \n\nMusculoskeletal: Prior to operation, patient was NWB LLE. \nAfter procedure, patient's weight-bearing status was \ntransitioned to TDWB LLE. Throughout the hospitalization, \npatient worked with physical therapy who determined that \ndischarge home was appropriate.\n\nNeuro: Post-operatively, patient's pain was controlled by IV \npain medication and was subsequently transitioned to oxycodone \nwith good effect and adequate pain control.\n\nCV: The patient was stable from a cardiovascular standpoint; \nvital signs were routinely monitored.\n\nHematology: The patient did not require transfusion of blood \nproducts during this hospitalization.\n\nPulmonary: The patient was stable from a pulmonary standpoint; \nvital signs were routinely monitored.\n\nGI/GU: A po diet was tolerated well. Patient was also started \non a bowel regimen to encourage bowel movement. Intake and \noutput were closely monitored.\n\nID: The patient received perioperative antibiotics. The \npatient's temperature was closely watched for signs of \ninfection.\n\nProphylaxis: The patient received enoxaparin during this stay, \nand was encouraged to get up and ambulate as early as possible.\n\nAt the time of discharge on ___, POD #1, the patient was \ndoing well, afebrile with stable vital signs, tolerating a \nregular diet, ambulating, voiding without assistance, and pain \nwas well controlled. The incision was clean, dry, and intact \nwithout evidence of erythema or drainage; the extremity was NVI \ndistally throughout. The patient was given written instructions \nconcerning precautionary instructions and the appropriate \nfollow-up care. The patient will be continued on chemical DVT \nprophylaxis for 2 weeks post-operatively. All questions were \nanswered prior to discharge and the patient expressed readiness \nfor discharge."}}
{'final_diagnoses': ['Left ankle fracture'], 'procedures': ['ORIF left ankle fracture ___'], 'visit_summary': "The patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have a left ankle fracture and was admitted to the orthopedic \nsurgery service. The patient was taken to the operating room on \n___ for ORIF left ankle, which the patient tolerated well \n(for full details please see the separately dictated operative \nreport). The patient was taken from the OR to the PACU in stable \ncondition and after recovery from anesthesia was transferred to \nthe floor. \n\nMusculoskeletal: Prior to operation, patient was NWB LLE. \nAfter procedure, patient's weight-bearing status was \ntransitioned to TDWB LLE. Throughout the hospitalization, \npatient worked with physical therapy who determined that \ndischarge home was appropriate.\n\nNeuro: Post-operatively, patient's pain was controlled by IV \npain medication and was subsequently transitioned to oxycodone \nwith good effect and adequate pain control.\n\nCV: The patient was stable from a cardiovascular standpoint; \nvital signs were routinely monitored.\n\nHematology: The patient did not require transfusion of blood \nproducts during this hospitalization.\n\nPulmonary: The patient was stable from a pulmonary standpoint; \nvital signs were routinely monitored.\n\nGI/GU: A po diet was tolerated well. Patient was also started \non a bowel regimen to encourage bowel movement. Intake and \noutput were closely monitored.\n\nID: The patient received perioperative antibiotics. The \npatient's temperature was closely watched for signs of \ninfection.\n\nProphylaxis: The patient received enoxaparin during this stay, \nand was encouraged to get up and ambulate as early as possible.\n\nAt the time of discharge on ___, POD #1, the patient was \ndoing well, afebrile with stable vital signs, tolerating a \nregular diet, ambulating, voiding without assistance, and pain \nwas well controlled. The incision was clean, dry, and intact \nwithout evidence of erythema or drainage; the extremity was NVI \ndistally throughout. The patient was given written instructions \nconcerning precautionary instructions and the appropriate \nfollow-up care. The patient will be continued on chemical DVT \nprophylaxis for 2 weeks post-operatively. All questions were \nanswered prior to discharge and the patient expressed readiness \nfor discharge.", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN pain/fever ', '2. Enoxaparin Sodium 40 mg SC QPM Duration: 2 Weeks \nStart: Today - ___, First Dose: Next Routine Administration \nTime \nRX *enoxaparin 40 mg/0.4 mL 1 syringe SC QPM Disp #*14 Syringe \nRefills:*0', '3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*80 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 68, 'gender': 'F', 'symptoms': 'Abdominal pain', 'medical_history': ['-HIV since ___, CD4 count 399 on ___', '-Oral squamous cell cancer', '-Basal Cell Carcinoma', '-Rectal Dysplasia'], 'family_history': 'Father died of cancer, mother of old age. No hx of diabetes, \nCAD.', 'present_illness': '___ with PMH HIV on HAART (last CD4 count 399 on ___, who \npresented to the ED with RUQ abdominal pain. Reported 4 days of \ngradually increasing pain. Pain was originally in the back and \nmigrated to the right upper quadrant. Pain was constant and \nassociated with nausea and anorexia. denies vomiting. Reports \nchills but no fevers. Denies constipation, diarrhea or blood in \nthe stool. \n\nPatient has history of elevated bilirubin from 1.1-3.6, thought \nto be secondary to HAART.', 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'GEN: AAOX3, NAD\nHEENT: Mucous membranes moist. PERRL. EOMI.\nCV: RRR\nPULM: Clear to auscultation b/l\nABD: Soft, nondistended, mildly tender to palpation in the right \nupper quadrant. no rebound/rigidity, no palpable masses, \numbilical incision\nExt: No ___ edema, ___ warm and well perfused', 'diagnoses': [{'icd_code': 'S82851B', 'desc': 'Displaced trimalleolar fracture of right lower leg, initial encounter for open fracture type I or II'}, {'icd_code': 'Z6843', 'desc': 'Body mass index [BMI] 50.0-59.9, adult'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'W010XXA', 'desc': 'Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter'}, {'icd_code': 'Y92002', 'desc': 'Bathroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}], 'summary': '___ 03:25PM ___ PTT-30.6 ___\n___ 10:05AM CREAT-1.3* SODIUM-138 POTASSIUM-3.5 \nCHLORIDE-100 TOTAL CO2-24 ANION GAP-18\n___ 10:05AM estGFR-Using this\n___ 10:05AM ALT(SGPT)-20 AST(SGOT)-23 ALK PHOS-73 TOT \nBILI-6.2* DIR BILI-0.4* INDIR BIL-5.8\n___ 10:05AM WBC-15.9*# RBC-4.29* HGB-15.0 HCT-42.9 \nMCV-100* MCH-34.9* MCHC-35.0 RDW-14.1\n___ 10:05AM NEUTS-83.6* LYMPHS-8.4* MONOS-7.6 EOS-0.2 \nBASOS-0.2\n___ 10:05AM PLT COUNT-113*\nPatient was taken to the Operating Room on postoperative day 0. \nA laparoscopic cholecystectomy was performed and the patient \ntolerated the procedure well. The patient was monitored \npostoperatively and his diet was slowly advanced. The patients \npain improved. By the time of discharge, the patient was \ntolerating a PO diet and his pain was controlled on PO \nmedications. The patients vitals remained stable and the patient \nwas discharged with recommendations for follow up with his PCP \nand with the Acute Care Surgery Clinic.'}}
{'final_diagnoses': ['Cholecystitis'], 'procedures': ['Laparoscopic Cholecystectomy'], 'visit_summary': 'Patient was taken to the Operating Room on postoperative day 0. \nA laparoscopic cholecystectomy was performed and the patient \ntolerated the procedure well. The patient was monitored \npostoperatively and his diet was slowly advanced. The patients \npain improved. By the time of discharge, the patient was \ntolerating a PO diet and his pain was controlled on PO \nmedications. The patients vitals remained stable and the patient \nwas discharged with recommendations for follow up with his PCP \nand with the Acute Care Surgery Clinic.', 'medications_prescribed': ['1. Acetaminophen ___ mg PO Q6H:PRN pain ', '2. Atazanavir 300 mg PO DAILY ', '3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY ', '4. RiTONAvir 100 mg PO DAILY ', '5. HYDROmorphone (Dilaudid) 2 mg PO Q6H:PRN pain Duration: 3 \nDays \nRX *hydromorphone 2 mg 1 tablet(s) by mouth every six (6) hours \nDisp #*18 Tablet Refills:*0', '6. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*30 Capsule Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 64, 'gender': 'M', 'symptoms': 'Nausea, vomiting, abdominal pain', 'medical_history': ['# Idiopathic chronic pancreatitis dx ___, followed by GI Dr ___ \n___ in ___', '# Hypertension', '# s/p Splenectomy due to splenic vein thrombosis ___', '# s/p Knee surgery', '-pylorus-preserving radical pancreaticoduodenectomy on ___'], 'family_history': 'Mother with breast cancer.\nFather with valvular heart disease.', 'present_illness': 'Mr. ___ is a ___ year old man s/p pylorus-preserving\nradical pancreaticoduodenectomy on ___ for groove\npancreatitis. Biopsy of the pancreas and duodenum at the\ntime of the procedure showed evidence of chronic pancreatitis,\npancreatic intraepithelial neoplasia (PanIN-1B), and no\nmalignancy identified. Following his procedure he was discharged\non ___ with two JPs in place, as his JP amylase was high on\nPOD 3 & 5. At the time of discharge he was doing well, afebrile\nwith stable vital signs. He was tolerating a regular low fat\ndiet, ambulating, voiding without assistance and with pain well\ncontrolled. \n\nMr. ___ presented to clinic today and reported ___\nepigastric pain radiating to his back. The pain persists\ndespite taking dilaudid (2 mg x 2 Q4H), a fentanyl patch, and\ngabapentin. He also had a fever of 100.9 on ___ with chills\nand sweats. The fever has since abated but he is still\nexperiencing sweats and chills today. At the time of the fever \nhe\nalso developed nausea and vomited three times. He took Zofran to\ncontrol the nausea and has not vomited since but continues to\nfeel intermittent nausea. He denied any weakness or dizziness on\nstanding. He has been drinking fluids and tolerating ___ small\nmeals of chicken/pasta/sandwiches. He states that the more\nmedially placed of his JP drains (draining anterior to the\npancreatic and biliary anastomoses) was producing ___ cc of\nmilky grey fluid suggestive of pancreatic fluid per day and\nunfortunately fell out this morning.', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'GlipiZIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65.1', 'valuenum': 65.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '360', 'valuenum': 360.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.06', 'valuenum': 5.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.3, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '337', 'valuenum': 337.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.85', 'valuenum': 4.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS 98.6 84 130/78 18 98 RA\n\nGen: NAD, A&O x3\nCV: RRR\nPulm: CTAB\nGI: Soft, NTND\nExt: WWP', 'diagnoses': [{'icd_code': '6824', 'desc': 'Cellulitis and abscess of hand, except fingers and thumb'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}], 'summary': 'CT ___\n\n___ 06:23AM BLOOD WBC-16.7* RBC-4.11* Hgb-12.6* Hct-39.8* \nMCV-97 MCH-30.7 MCHC-31.7* RDW-14.5 RDWSD-51.0* Plt ___\n___ 10:30AM BLOOD WBC-16.3* RBC-4.97# Hgb-15.5 Hct-48.4# \nMCV-97 MCH-31.2 MCHC-32.0 RDW-14.5 RDWSD-52.0* Plt ___\n___ 10:30AM BLOOD Neuts-72.3* Lymphs-17.6* Monos-6.7 \nEos-2.5 Baso-0.6 Im ___ AbsNeut-11.78*# AbsLymp-2.87 \nAbsMono-1.09* AbsEos-0.41 AbsBaso-0.10*\n___ 06:23AM BLOOD Plt ___\n___ 10:30AM BLOOD Plt ___\n___ 06:23AM BLOOD Glucose-130* UreaN-7 Creat-0.6 Na-135 \nK-4.7 Cl-99 HCO3-28 AnGap-13\n___ 10:30AM BLOOD Glucose-144*\n___ 10:30AM BLOOD UreaN-6 Creat-0.7 Na-135 K-5.1 Cl-94* \nHCO3-29 AnGap-17\n___ 10:30AM BLOOD ALT-14 AST-18 AlkPhos-132* TotBili-0.2\n___ 10:30AM BLOOD Lipase-8\nMr. ___ presented from clinic on POD#15 from his pylorus \npreserving Whipple with epigastric pain, nausea and vomiting. He \nunderwent a CT scan which showed expected postsurgical changes \nand no evidence of a drainable fluid collection. He was admitted \nfor pain management and a chronic pain consult was obtained. \nThey recommended an increased PO dilaudid regimen which was \nimplemented and was helpful with controlling his pain better. \nTheir thought was that this pain was neuropathic and so his \ngabapentin was also increased. \nHis diet was advanced as tolerated, his pain was controlled with \nPo pain meds, he was voiding and ambulating. He was thus deemed \nstable for discharge home with followup instructions with Dr. \n___ in clinic.'}}
{'final_diagnoses': ['Dehydration/Chronic Pain'], 'procedures': ['None'], 'visit_summary': 'Mr. ___ presented from clinic on POD#15 from his pylorus \npreserving Whipple with epigastric pain, nausea and vomiting. He \nunderwent a CT scan which showed expected postsurgical changes \nand no evidence of a drainable fluid collection. He was admitted \nfor pain management and a chronic pain consult was obtained. \nThey recommended an increased PO dilaudid regimen which was \nimplemented and was helpful with controlling his pain better. \nTheir thought was that this pain was neuropathic and so his \ngabapentin was also increased. \nHis diet was advanced as tolerated, his pain was controlled with \nPo pain meds, he was voiding and ambulating. He was thus deemed \nstable for discharge home with followup instructions with Dr. \n___ in clinic.', 'medications_prescribed': ['1. ALPRAZolam 0.5 mg PO QHS:PRN insomnia', '2. Creon 12 2 CAP PO TID W/MEALS', '3. Docusate Sodium 100 mg PO BID', '4. DULoxetine 60 mg PO DAILY', '5. Fentanyl Patch 12 mcg/h TD Q72H', '6. Gabapentin 900 mg PO TID', '7. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nRX *hydromorphone 2 mg ___ tablet(s) by mouth q4 Disp #*168 \nTablet Refills:*0', '8. Nicotine Patch 21 mg TD DAILY', '9. Omeprazole 20 mg PO DAILY', '10. Ondansetron 4 mg PO Q8H:PRN nausea', '11. Senna 8.6 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 84, 'gender': 'M', 'symptoms': 'abdominal pain', 'medical_history': ['Chronic abdominal with a history of internal hemorrhoids', '___ Body dementia', 'Anemia', 'Anxiety', 'Chronic back pain', 'Osteoarthritis', 'Slow transit constipation', 'Coronary artery disease', 'MI', 'Hyperlipidemia', 'GERD'], 'family_history': 'Non-contributory', 'present_illness': '___ with PMH signficant for ___ Body Dementia, CAD, MI who \ncomes into the ED for abdominal pain with imaging c/f colonic \npseudo-obstruction. He was in his usual state of health until 4 \ndays ago when his abdomen became increasingly distended. At this \ntime, he developed ___ transient, diffuse crampy abdominal pain \nthat was worse with eating and with BMs. He was having hard, \nnon-liquidy BMs daily w/ increased straining. Although he was \ntolerating PO w/ no nausea or vomiting, he notes decreased \nappetite. On ROS, he endorses increased urination and \nintermittent dysuria but otherwise, denies f, c, chest pain, \nSOB, and mental status changes.\n\nBecause of continued pain and growing abdominal distention, ___ \nperformed an xray that showed mild gaseous distenion of the \ncolon w/ c/f distal colonic obstruction, so he was BIBA to the \nED.\n\nIn the ED, initial vitals:6 98.2 76 136/81 20 99% RA \n- Labs notable for: Chem 7 WNL. CBC with H&H 13.3/36.8 WBC 5.5 \nwith abnormal lactate (1.6). UA clean.\n- Imaging: showed extensive colonic distention without evidence \nof obstruction. Mild wall thickening with distal sigmoid colon \nand rectum suggests mild proctitis/colitis. \n- Consultants: ACS was initially consulted, but patient had a \nlarge BM while in the ED. GI was then consulted for ?colonsocopy \ndecompression. As per the ED dash, GI recommended avoiding \nopiates and CCB, repleting electolytes, KUB in am and consult if \nneeded by floor team. \n- Patient was given: morphine and 500 cc of NS.\n- Vitals prior to transfer:78 184/92 18 98% RA \n\nOn arrival to the floor, pt reports continued abdominal pain and \ndistention. He continues to deny f, c, n, v, and is tolerating \nPO. \n\nROS: Please refer to HPI for pertinent positives and negatives. \n10 point ROS is otherwise negative.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'GuaiFENesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Montelukast', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cepacol (Sore Throat Lozenge)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clobetasol Propionate 0.05% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MoviPrep', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'Q2H PER MOVIPREP PROTOCOL', 'doses_per_24_hrs': 2.0}, {'medication': 'Verapamil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Verapamil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.75', 'valuenum': 1.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.9', 'valuenum': 44.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.46', 'valuenum': 2.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.8', 'valuenum': 47.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.03', 'valuenum': 1.03, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.6', 'valuenum': 45.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.73', 'valuenum': 2.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.8', 'valuenum': 46.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '32', 'valuenum': 32.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.86', 'valuenum': 2.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MOD*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '39', 'valuenum': 39.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.027', 'valuenum': 1.027, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MOD*.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.3', 'valuenum': 24.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.73', 'valuenum': 2.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.66', 'valuenum': 2.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "PHYSICAL EXAM ON ADMISSION:\nVitals: T 98.9 BP 133/84 HR 76 RR 16 SaO2 99%RA \nGeneral: AAOx2 (name, location), mildly uncomfortable appearing, \nin NAD\nMSE: Unable to spell world backwards, repeated ___ words and \nrecalled ___ @ 5 minutes. Further exam was delayed due to pt's \ndiscomfort.\nHEENT: PERRL. Sclera anicteric, conjunctiva pink. MMM. OP clear.\nNeck: supple, no LAD, no JVP elevation\nLungs: CTAB, no w/r/r\nCV: irregular heart rate, normal S1 and S2, no m/g/r\nAbdomen: Tympany to percussion, significantly distended, \nnontender to palpation. No HSM.\nGU: foley\nExt: WWP. 2+ peripheral pulses. No edema.\nNeuro: CNs II-XII intact. Grossly normal strength and sensation.\n.\nPHYSICAL EXAM ON DISCHARGE: ___\nPHYSICAL EXAM: \nVitals: Tm/Tc 97.9 BP 162/96 HR 78 RR 18 SaO2 97% RA \nI/O: +700\nGeneral: AOx2 (name, location ___, said date was \n___, no acute distress \nMSE: Able to spell WORLD backwards, unable to recall ___ words \nHEENT: sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: clear to auscultation bilaterally, no wheezes, rales, \nronchi \nCV: irregular rhythm w/ regular rate, normal S1 + S2, no \nmurmurs, rubs, gallops \nAbdomen: moderate distention w/ tympany to percussion \nthroughout, TTP in RLQ +LLQ, bowel sounds decreased, no rebound \ntenderness or guarding, no organomegaly. \nRectal: No rectal tube \nGU: no foley \nExt: Lower extremity rigidity b/l, no rigidity in upper \nextremities, warm, well perfused, 2+ pulses, no clubbing, \ncyanosis or edema. Neuro: CNs grossly intact, motor function and \nsensation grossly normal ", 'diagnoses': [{'icd_code': 'K3182', 'desc': 'Dieulafoy lesion (hemorrhagic) of stomach and duodenum'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I480', 'desc': 'Paroxysmal atrial fibrillation'}, {'icd_code': 'E222', 'desc': 'Syndrome of inappropriate secretion of antidiuretic hormone'}, {'icd_code': 'I422', 'desc': 'Other hypertrophic cardiomyopathy'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'K209', 'desc': 'Esophagitis, unspecified'}, {'icd_code': 'L409', 'desc': 'Psoriasis, unspecified'}, {'icd_code': 'R339', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}], 'summary': "Labs on Admission:\n___ 03:50PM URINE COLOR-Yellow APPEAR-Clear SP \n___\n___ 03:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 03:50PM URINE RBC-2 WBC-3 BACTERIA-NONE YEAST-NONE \nEPI-<1\n___ 05:21AM LACTATE-1.6\n___ 05:15AM GLUCOSE-100 UREA N-37* CREAT-1.1 SODIUM-144 \nPOTASSIUM-4.0 CHLORIDE-105 TOTAL CO2-28 ANION GAP-15\n___ 05:15AM WBC-5.5 RBC-4.04*# HGB-13.3*# HCT-36.8*# \nMCV-91 MCH-32.9* MCHC-36.1* RDW-13.8\n___ 05:15AM NEUTS-60.5 ___ MONOS-4.7 EOS-0.9 \nBASOS-0.5\n___ 05:15AM PLT COUNT-200\n\nIMAGING:\nCT abdomen/pelvis (___):\n1. Extensive colonic distention without evidence of bowel \nobstruction or ischemia. Appearance is most consistent with \nsevere ileus or ___. \n2. Mild wall thickening of the distal sigmoid colon and rectum \nsuggests mild proctitis/colitis.\n3. Additional incidental findings as detailed in report. \n\nKUB (___):\nImpression:\nGaseous distention of the large bowel is grossly unchanged in \ncomparison to ___. \n\nKUB (___):\nIMPRESSION: \nGaseous distention of the large bowel is minimally improved from \n___.\nMr. ___ is a ___ with PMH ___ Body Dementia and CAD who \ncame to the ED for several days of worsening abdominal pain and \ndistention, who was found to have colonic pseudo-obstruction.\n\nACTIVE ISSUES:\n=============\n\n#Colonic pseudo-obstruction: \nCT of the abdomen and pelvis showed no evidence of colonic \nobstruction but did show a distended colon c/w severe ileus vs. \nOlgilive's syndrome. Of note, the CT also showed mild wall \nthickening of the distal sigmoid colon and rectum that suggests \nmild proctitis/colitis. ED consulted GI who thought a \ncolonoscopy for decompression was unnecessary given he had a BM \nwhile in the ED. Surgery was consulted who placed a rectal tube \n(___) for decompression, after which his abdominal \ndistention signficantly improved and patient removed rectal tube \n___. His quetiapine, donepezil, and lactulose were all \nheld. Quetiapine was restarted on ___ as a PRN instead of \nstanding as he was never agitated. His electrolytes were \nrepleted as needed. His pain was well-controlled on tylenol. \nSerial KUBs showed improved colonic distention, with the most \nrecent showing significantly less distended colon (5cm vs. 9cm). \nHe was tolerating a house diet with no nausea, vomiting, and his \nlast BM was ___. \n\nCHRONIC ISSUES:\n==============\n# ___ body dementia:Continued home carbidopa/levodopa. \nDischarged him off of donepezil given concern of its negative \neffects on bowels. PCP should address restarting this.\n\n# CAD/HLD:Continued ASA 81mg\n\n#Anxiety\n-Held home quetiapine given anticholingergic and restarted as \nPRN only prior to discharge\n\nTRANSITIONAL ISSUES:\n===================="}}
{'final_diagnoses': ['-Colonic Pseudobstruction', '___ Body Dementia'], 'procedures': ['Rectal tube ___, removed ___'], 'visit_summary': "Mr. ___ is a ___ with PMH ___ Body Dementia and CAD who \ncame to the ED for several days of worsening abdominal pain and \ndistention, who was found to have colonic pseudo-obstruction.\n\nACTIVE ISSUES:\n=============\n\n#Colonic pseudo-obstruction: \nCT of the abdomen and pelvis showed no evidence of colonic \nobstruction but did show a distended colon c/w severe ileus vs. \nOlgilive's syndrome. Of note, the CT also showed mild wall \nthickening of the distal sigmoid colon and rectum that suggests \nmild proctitis/colitis. ED consulted GI who thought a \ncolonoscopy for decompression was unnecessary given he had a BM \nwhile in the ED. Surgery was consulted who placed a rectal tube \n(___) for decompression, after which his abdominal \ndistention signficantly improved and patient removed rectal tube \n___. His quetiapine, donepezil, and lactulose were all \nheld. Quetiapine was restarted on ___ as a PRN instead of \nstanding as he was never agitated. His electrolytes were \nrepleted as needed. His pain was well-controlled on tylenol. \nSerial KUBs showed improved colonic distention, with the most \nrecent showing significantly less distended colon (5cm vs. 9cm). \nHe was tolerating a house diet with no nausea, vomiting, and his \nlast BM was ___. \n\nCHRONIC ISSUES:\n==============\n# ___ body dementia:Continued home carbidopa/levodopa. \nDischarged him off of donepezil given concern of its negative \neffects on bowels. PCP should address restarting this.\n\n# CAD/HLD:Continued ASA 81mg\n\n#Anxiety\n-Held home quetiapine given anticholingergic and restarted as \nPRN only prior to discharge\n\nTRANSITIONAL ISSUES:\n====================", 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H', '2. Aspirin 81 mg PO DAILY', '3. Calcium Carbonate 1250 mg PO QHS', '4. Carbidopa-Levodopa (___) 1 TAB PO QHS', '5. Carbidopa-Levodopa (___) 2 TAB PO TID', '6. Senna 17.2 mg PO QHS', '7. Bisacodyl 10 mg PR QHS:PRN constipation', '8. Docusate Sodium 100 mg PO BID', '9. Bisacodyl 10 mg PO DAILY:PRN constipation', '10. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '11. QUEtiapine Fumarate 12.5 mg PO QHS:PRN agitation']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 81, 'gender': 'F', 'symptoms': 'exertional dyspnea and chest discomfort', 'medical_history': ['Colon polyps', 'GERD', 'Hypertension', 'Angina Pectoris-CCS class III', 'Borderline dyslipidemia', 'RBBB', 'BPH', 'h/o Vertigo'], 'family_history': 'no family history of CAD', 'present_illness': '___ year old male with complaints of\nseveral months of exertional dyspnea that has now developed in\ninto chest discomfort. He now experiences chest discomfort\nwithin a minute of starting walking and due to his worsening\nsymptoms he was referred for a cardiac catheterization by Dr.\n___. Upon catheterization he was found to have left main\ndisease and is now being referred to cardiac surgery for \nsurgical\nrevascularization.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tolterodine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '307', 'valuenum': 307.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.4, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse:82 Resp:13 O2 sat:97/RA\nB/P Right:141/69 Left:137/72\nHeight:5\'7" Weight:71.7 kg\n\nGeneral:\nSkin: Dry [x] intact [x]\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [x] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur [] grade ______\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds\n+[x]\nExtremities: Warm [x], well-perfused [x] Edema: None [x]\nVaricosities: None [x]\nNeuro: Grossly intact []\nPulses:\nFemoral Right: palp Left: palp\nDP Right: palp Left: palp\n___ Right: palp Left: palp\nRadial Right: palp Left: palp\n\nCarotid Bruit Right: None Left: None', 'diagnoses': [{'icd_code': '43491', 'desc': 'Cerebral artery occlusion, unspecified with cerebral infarction'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '7140', 'desc': 'Rheumatoid arthritis'}, {'icd_code': '4370', 'desc': 'Cerebral atherosclerosis'}], 'summary': '___ 06:54AM BLOOD WBC-11.7* RBC-3.54* Hgb-9.2* Hct-29.8*\nMCV-84 MCH-26.0 MCHC-30.9* RDW-16.3* RDWSD-50.4* Plt ___\n___ 06:54AM BLOOD Glucose-86 UreaN-17 Creat-1.0 Na-137 \nK-4.2 Cl-102 HCO3-23 AnGap-16\n___ 06:54AM BLOOD Calcium-8.5 Phos-2.9 Mg-2.3\n___ 05:05PM BLOOD %HbA1c-5.5 eAG-111\n___ 09:30AM BLOOD WBC-6.6 RBC-3.27* Hgb-8.2* Hct-26.5*\nMCV-81* MCH-25.1* MCHC-30.9* RDW-15.8* RDWSD-46.5* Plt ___\n___ 05:05PM BLOOD ___ PTT-28.8 ___\n___ 05:05PM BLOOD Glucose-120* UreaN-14 Creat-1.0 Na-137 \nK-3.9 Cl-104 HCO3-23 AnGap-14\n___ 05:05PM BLOOD ALT-15 AST-18 LD(LDH)-156 AlkPhos-62 \nTotBili-0.4\n___ 01:50AM BLOOD Calcium-8.4 Phos-3.0 Mg-2.5\n\n___\nReferred to cardiac catheterization and found to have left main \ndisease. Was admitted to the hospital, cardiac surgery was \nconsulted and underwent preoperative workup. On ___ he was \ntaken to the operating room for coronary artery bypass graft \nsurgery. See operative report for further details. Post \noperatively he was taken to the intensive care unit for \nmanagement. That evening he was weaned from sedation, awoke \nneurologically intact and was extubated without complications. \nPost operative day one he was started on betablocker and \ndiuretic. He continued to progress and was transferred to the \nfloor. Chest tubes and epicardial wires were removed per \nprotocol. He was noted on post operative day two for epitaxis \nwhich was treated with pressure and afrin which resolved. He \nwas placed on ocean spray for moisture with good response. His \nblood levels remained stable. Physical therapy worked with him \non strength and mobility with recommendation for home. He \ncontinued to progress and was discharged home with services on \npost operative day four.'}}
{'final_diagnoses': ['Coronary artery disease s/p revascularization', 'Colon polyps', 'Gastroesophageal reflux disease', 'Hypertension', 'Angina Pectoris-CCS class III', 'Borderline dyslipidemia', 'RBBB', 'Benign Prostatic Hypertrophy', 'Vertigo'], 'procedures': ['Coronary artery bypass graft surgery x2 (left internal \nmammary artery > left anterior descending, Saphenous vein graft \n> obtuse marginal)', 'cardiac catheterization'], 'visit_summary': 'Referred to cardiac catheterization and found to have left main \ndisease. Was admitted to the hospital, cardiac surgery was \nconsulted and underwent preoperative workup. On ___ he was \ntaken to the operating room for coronary artery bypass graft \nsurgery. See operative report for further details. Post \noperatively he was taken to the intensive care unit for \nmanagement. That evening he was weaned from sedation, awoke \nneurologically intact and was extubated without complications. \nPost operative day one he was started on betablocker and \ndiuretic. He continued to progress and was transferred to the \nfloor. Chest tubes and epicardial wires were removed per \nprotocol. He was noted on post operative day two for epitaxis \nwhich was treated with pressure and afrin which resolved. He \nwas placed on ocean spray for moisture with good response. His \nblood levels remained stable. Physical therapy worked with him \non strength and mobility with recommendation for home. He \ncontinued to progress and was discharged home with services on \npost operative day four.', 'medications_prescribed': ['Acetaminophen ___ mg PO Q6H:PRN pain/fever', 'Aspirin EC 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Docusate Sodium 100 mg PO BID', 'Furosemide 20 mg PO DAILY Duration: 1 Week', 'Metoprolol Tartrate 75 mg PO Q8H', 'Omeprazole 20 mg PO DAILY', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN Pain: \nmoderate/severe', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Potassium Chloride 10 mEq PO DAILY Duration: 1 Week', 'Sodium Chloride Nasal ___ SPRY NU Q1H', 'Tamsulosin 0.4 mg PO QHS']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 47, 'gender': 'M', 'symptoms': 'asymptomatic-- previously chest pain', 'medical_history': ['Aortic Stenosis', 'Ascending Aortic Aneurysm', 'Benign Prostatic Hyperplasia', 'Bicuspid Aortic Valve', 'Colon Polyps', 'Gout', 'Hyperlipidemia', 'Meniscus Tear', 'Morbid Obesity', 'Osteoarthritis', 'Renal Colic'], 'family_history': 'Father - died at age ___ of old age, history of ___. \nMother - died at age ___ of natural causes, history of diabetes.\n\nSiblings - He has four brothers and one sister. One of his\nbrothers died of complications from lupus. One brother died at\nage ___ of emphysema. There is no family history notable for\nstroke, hypertension, hyperlipidemia, early coronary artery\ndisease or sudden cardiac death.', 'present_illness': '___ year old male well known to\nservice see previous note from ___ that has aortic\nstenosis, ascending aortic aneurysm, bicuspid aortic valve,\nhyperlipidemia, and morbid obesity. Was seen in clinical for\nsurgical evaluation and underwent cardiac catheterization and CT\nchest today in preparation for surgery. Of note CT with noted\nlesions and surgery deferred until thoracic evaluation. He\ndenies having symptoms but has limited activity related to\narthritis per his report He has been followed with\nserial echocardiograms.', 'medications': [{'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '337', 'valuenum': 337.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 74.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '317', 'valuenum': 317.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'BP: 108/62 HR: 60 RR: 18 O2 sat 98%\nHeight: 65" Weight: 242# \n\nGeneral: No acute distress obese \nSkin: Warm, dry, intact\nHEENT: PERRLA, EOMI, \nNeck: Supple, full ROM, no JVD\nChest: Lungs clear bilaterally\nHeart: Regular rate and rhythm, III/VI systolic \nAbdomen: Obese normal BS, non-tender, no masses \nExtremities: Warm, well-perfused, trace bilateral edema\nVaricosities: None\nNeuro: Alert and oriented x3 no focal deficits \nPulses:\nFemoral Right: 1+ Left: 1+\nDP Right: 1+ Left: 1+\n___ Right: 1+ Left: 1+\nRadial Right: 1+ Left: 1+\n\nCarotid Bruit: murmur vs bruit', 'diagnoses': [{'icd_code': '5770', 'desc': 'Acute pancreatitis'}, {'icd_code': '2731', 'desc': 'Monoclonal paraproteinemia'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '56409', 'desc': 'Other constipation'}, {'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}], 'summary': 'TEE report unavailable at the time of discharge.\n\n___ 05:35AM BLOOD WBC-6.3 RBC-3.31* Hgb-9.8* Hct-30.5* \nMCV-92 MCH-29.6 MCHC-32.1 RDW-13.1 RDWSD-44.3 Plt ___\n___ 05:10AM BLOOD WBC-5.3 RBC-3.16* Hgb-9.9* Hct-28.4* \nMCV-90 MCH-31.3 MCHC-34.9 RDW-12.8 RDWSD-42.1 Plt ___\n___ 04:56AM BLOOD WBC-12.3* RBC-3.78* Hgb-11.6* Hct-34.1* \nMCV-90 MCH-30.7 MCHC-34.0 RDW-13.0 RDWSD-42.2 Plt ___\n___ 05:35AM BLOOD ___ PTT-38.4* ___\n___ 04:38PM BLOOD ___\n___ 05:10AM BLOOD ___\n___ 04:25AM BLOOD ___ PTT-35.7 ___\n___ 04:56AM BLOOD ___ PTT-29.5 ___\n___ 02:46AM BLOOD ___ PTT-30.0 ___\n___ 03:00PM BLOOD ___ PTT-30.1 ___\n___ 01:49PM BLOOD ___ PTT-29.1 ___\n___ 05:35AM BLOOD Glucose-119* UreaN-16 Creat-0.7 Na-136 \nK-4.0 Cl-98 HCO3-30 AnGap-12\n___ 05:35AM BLOOD Mg-2.5\nThe patient was brought to the Operating Room on ___ where \nthe patient underwent AVR (___. Overall the \npatient tolerated the procedure well and post-operatively was \ntransferred to the CVICU in stable condition for recovery and \ninvasive monitoring. \n POD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable. Beta blocker was initiated and the \npatient was gently diuresed toward the preoperative weight. \nPrevena vac was applied in the OR to assist in wound healing. \nThere were issues with the quality of suction and the vac was \ndiscontinued. \nThe patient was transferred to the telemetry floor for further \nrecovery. Chest tubes and pacing wires were discontinued \nwithout complication. Anti-coagulation was initiated with \nWarfarin. The patient was evaluated by the physical therapy \nservice for assistance with strength and mobility. INR became \nsupratherapeutic at 5.6 and Vitamin K and FFP were administered \nwith good effect. \n By the time of discharge on POD 5 the patient was ambulating \nfreely, the wound was healing and pain was controlled with oral \nanalgesics. The patient was discharged to ___ and \nRehab in good condition with appropriate follow up instructions.'}}
{'final_diagnoses': ['aortic stenosis'], 'procedures': ['Aortic valve replacement (21mm ___ mechanical) ___'], 'visit_summary': 'The patient was brought to the Operating Room on ___ where \nthe patient underwent AVR (___. Overall the \npatient tolerated the procedure well and post-operatively was \ntransferred to the CVICU in stable condition for recovery and \ninvasive monitoring. \n POD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable. Beta blocker was initiated and the \npatient was gently diuresed toward the preoperative weight. \nPrevena vac was applied in the OR to assist in wound healing. \nThere were issues with the quality of suction and the vac was \ndiscontinued. \nThe patient was transferred to the telemetry floor for further \nrecovery. Chest tubes and pacing wires were discontinued \nwithout complication. Anti-coagulation was initiated with \nWarfarin. The patient was evaluated by the physical therapy \nservice for assistance with strength and mobility. INR became \nsupratherapeutic at 5.6 and Vitamin K and FFP were administered \nwith good effect. \n By the time of discharge on POD 5 the patient was ambulating \nfreely, the wound was healing and pain was controlled with oral \nanalgesics. The patient was discharged to ___ and \nRehab in good condition with appropriate follow up instructions.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild', 'Docusate Sodium 100 mg PO BID', 'Furosemide 40 mg PO DAILY Duration: 7 Days', 'Metoprolol Tartrate 37.5 mg PO TID', 'Milk of Magnesia 30 mL PO DAILY \nhold for loose stool', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain: \nmoderate/severe \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*40 Tablet Refills:*0', 'Senna 17.2 mg PO QHS', '___ MD to order daily dose PO DAILY \ndose to change daily for goal INR ___, dx: ___ AVR', 'Aspirin EC 81 mg PO DAILY', 'Potassium Chloride 20 mEq PO DAILY Duration: 7 Days', 'Allopurinol ___ mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Colchicine 1.2 mg PO ONCE prn gout Duration: 1 Dose', 'Tamsulosin 0.4 mg PO QHS']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 61, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['UC, thalasemmia minor', '___ proctocolectomy with ileoanal pouch and diverting \nileostomy'], 'family_history': 'unremarkable', 'present_illness': '___ with ulcerative colitis s/p panproctocolectomy/ileoanal\nJ-pouch/loop ileostomy ___. Had almost weaned off post-op \npain meds but on ___ developed intense, crampy, lower abd \npain. Poor appetite. Ostomy with good output. At the advice of \nDr. ___ had an outpatient CT scan which showed a \n4.5cm pelvic collection c/w either ovarian cyst or pelvic \nabscess, at ___ they attempted CT guided \ndrainage of the collection with bloody return. Abd u/s looked \nc/w ovarian cyst. Pt requested transfer here. \nPt still has significant pain. The pain has changed since \ndrainage. Ant and burning rather than crampy. LPM ___.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tamoxifen Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1,. Estimated GFR = 50 if non African-American (mL/min/1.73 m2). Estimated GFR = 61 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 319.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 226.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.7', 'valuenum': 22.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1018', 'valuenum': 1018.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 500.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.8', 'valuenum': 45.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.7', 'valuenum': 47.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}], 'exams': 'on discharge: \nVS: Tm 98.2, Tc 96.9, HR 75, BP 98/62, RR 16, O2 sat 98 RA \ngen: WA/ WD, NAD \nCV: RRR\npulm: CTA b/l \nabd: soft, ND/NT, +BS, ostomy pink with stool output, incision \nc/d/i, staples removed \nextremities: no edema', 'diagnoses': [{'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '1749', 'desc': 'Malignant neoplasm of breast (female), unspecified'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '71941', 'desc': 'Pain in joint, shoulder region'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': "admission: \n___ 09:10PM ___ PTT-27.5 ___\n___ 01:57PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-0.2 PH-6.0 \nLEUK-NEG\n___ 01:08PM LACTATE-1.3\n___ 01:00PM GLUCOSE-104* UREA N-7 CREAT-0.6 SODIUM-136 \nPOTASSIUM-3.3 CHLORIDE-98 TOTAL CO2-29 ANION GAP-12\n___ 01:00PM ALT(SGPT)-43* AST(SGOT)-16 ALK PHOS-115* TOT \nBILI-1.4\n___ 01:00PM WBC-12.6* RBC-4.85 HGB-9.0* HCT-28.5* MCV-59* \nMCH-18.6* MCHC-31.6 RDW-14.7\n\ndischarge: \n\n___ 07:15AM BLOOD Hct-23.2*\n___ 06:30AM BLOOD Neuts-62.3 ___ Monos-9.1 Eos-1.0 \nBaso-0.2\n___ 09:10AM BLOOD PTT-32.3\n___ 06:30AM BLOOD Glucose-74 UreaN-3* Creat-0.5 Na-137 \nK-3.9 Cl-101 HCO3-30 AnGap-10\n___ 06:30AM BLOOD ALT-27 AST-13 AlkPhos-92 Amylase-24 \nTotBili-0.5\n___ 06:30AM BLOOD Albumin-3.2* Calcium-8.5 Phos-2.3* Mg-1.6\n\nimaging: \nCT abd/pelvis ___\nIMPRESSION: \n1. Hypoenhencing lesion in segment VIII, incompletely \ncharacterized. While \nunlikely an infectious origin with developing intrahepatic \nabscess cannot be excluded. Recommend clinical correlatios. MRI \nmay be performed to further evaluate with the use of Eovist \nrecommended. \n2. Multiple small thrombi in the distal peripheral branches of \nportal veins bilaterally. \n3. Inferior IMV not opacified and appears enlarged. Suspicious \nfor distal \nIMV thrombosis. \n4. Wall thickening of superior aspect of the pouch and adjacent \nsmall-bowel, could be post-surgical but perianastamotic ischemia \nor infection/inflammation not excluded. Fluid in small bowel \nproximal to pouch with mild dilation and fluid within the pouch, \nwhich is distended. Rectal exam to ensure no pouch-anal \nanastamotic stricture is recommended. \n5. Loculated simple fluid in the deep pelvis, without thickened \nwall to \nsuggest abscess, likely post-surgical. \n6. Right adnexal cystic lesion, likely a hemorrhagic ovarian \ncyst. Recommend pelvic ultrasound for further evaluation. \n7. Splenomegaly. \n8. An isolated tiny pocket of extraluminal air beneath the \nanterior pelvic \nwall. A tiny layer of benign-appearing subcutaneous gas in the \nabdominal \nfascia. Likely from recent procedure. Recommend clinical \ncorrelations. \n\nabdominal US ___\nIMPRESSION: \n1. Normal uterus, endometrium and left ovary. \n2. 4-cm right hemorrhagic ovarian cyst. Recommend followup in \nsix weeks to \nensure resolution. \n3. Small-to-moderate amount of free fluid, and fluid-filled \nJ-pouch, better seen in the prior CT study.\nThe patient was admitted to the General Surgical Service for \nevaluation and treatment of her abdominal pain which was \noriginally worked up with a CT scan, showing 4.5 cm pelvic fluid \ncollection. The attempt to aspirate the collection was \nunsuccessful at the outside hospital and patient was \nsubsequently transferred here. During the aspiration attempt, \nblood was extracted and the concern was for aspiration of the \novarian cyst. Pelvic US done here showed 4cm hemorrhagic ovarian \ncyst on the right side. Upon transfer the patient was \nhemodynamically stable with baseline stool ostomy output. \n\nNeuro: The patient received dilaudid and oxycodone with good \neffect and adequate pain control. \n\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\n\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirrometry were \nencouraged throughout hospitalization.\n\nGI/GU/FEN: Patient was admitted with lower abdominal pain which \nimproved over time. On the CT scan, she was found to have portal \nvein thrombosis in the peripheral branches bilaterally. She was \nanticoagulated with heparin drip. Following the administration \nof the heparin drip, patient's hematocrit dropped from 28 to 22 \nin less than 24 hours. The heparin drip was stopped. Serial \nabdominal exams were performed. Patient remained hemodynamically \nstable and did not require a blood transfusion. Diet was \nadvanced as tolerated. Patient's intake and output were closely \nmonitored, and IV fluid was adjusted when necessary. \nElectrolytes were routinely followed, and repleted when \nnecessary.\n\nID: The patient's white blood count and fever curves were \nclosely watched for signs of infection. \n\nEndocrine: Patient was started on prednisone 20 mg daily. She \nwill be discharged on a taper regiment as described in her \ndischarge instructions. \n\nHematology: The patient's complete blood count was monitored. It \ninitially decreased from 28 to 22 and subsequently increased to \n24 and 23 and was 25.3 prior to discharge. No transfusions were \nrequired. There was need for any anticoagulation. \n\nProphylaxis: The patient received heparin drip for less than 24 \nhours. This was discontinued and she recieved subcutaneous \nheparin and venodyne boots for the rest of her stay. She was \nencouraged to get up and ambulate.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan."}}
{'final_diagnoses': ['abdominal pain'], 'procedures': ['none this admission'], 'visit_summary': "The patient was admitted to the General Surgical Service for \nevaluation and treatment of her abdominal pain which was \noriginally worked up with a CT scan, showing 4.5 cm pelvic fluid \ncollection. The attempt to aspirate the collection was \nunsuccessful at the outside hospital and patient was \nsubsequently transferred here. During the aspiration attempt, \nblood was extracted and the concern was for aspiration of the \novarian cyst. Pelvic US done here showed 4cm hemorrhagic ovarian \ncyst on the right side. Upon transfer the patient was \nhemodynamically stable with baseline stool ostomy output. \n\nNeuro: The patient received dilaudid and oxycodone with good \neffect and adequate pain control. \n\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\n\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirrometry were \nencouraged throughout hospitalization.\n\nGI/GU/FEN: Patient was admitted with lower abdominal pain which \nimproved over time. On the CT scan, she was found to have portal \nvein thrombosis in the peripheral branches bilaterally. She was \nanticoagulated with heparin drip. Following the administration \nof the heparin drip, patient's hematocrit dropped from 28 to 22 \nin less than 24 hours. The heparin drip was stopped. Serial \nabdominal exams were performed. Patient remained hemodynamically \nstable and did not require a blood transfusion. Diet was \nadvanced as tolerated. Patient's intake and output were closely \nmonitored, and IV fluid was adjusted when necessary. \nElectrolytes were routinely followed, and repleted when \nnecessary.\n\nID: The patient's white blood count and fever curves were \nclosely watched for signs of infection. \n\nEndocrine: Patient was started on prednisone 20 mg daily. She \nwill be discharged on a taper regiment as described in her \ndischarge instructions. \n\nHematology: The patient's complete blood count was monitored. It \ninitially decreased from 28 to 22 and subsequently increased to \n24 and 23 and was 25.3 prior to discharge. No transfusions were \nrequired. There was need for any anticoagulation. \n\nProphylaxis: The patient received heparin drip for less than 24 \nhours. This was discontinued and she recieved subcutaneous \nheparin and venodyne boots for the rest of her stay. She was \nencouraged to get up and ambulate.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan.", 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q8H PRN \nas needed for pain.', 'Dilaudid 2 mg Tablet Sig: One (1) Tablet PO q3h PRN as \nneeded for pain.\nDisp:*30 Tablet(s)* Refills:*0*', 'Oxycodone 5 mg Capsule Sig: One (1) Capsule PO every ___ hrs \nPRN as needed for pain.\nDisp:*30 Capsule(s)* Refills:*0*', 'Tylenol 8 Hour 650 mg Tablet Sustained Release Sig: One (1) \nTablet Sustained Release PO every eight (8) hours for 1 weeks.\nDisp:*30 Tablet Sustained Release(s)* Refills:*1*', 'Prednisone 2.5 mg Tablet Sig: Four (4) Tablet PO once a day: \ntaper: ___ - ___ - ___ - \n___.Disp:*22 Tablet(s)* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 63, 'gender': 'F', 'symptoms': '___', 'medical_history': ['* Autosomal recessive polycystic kidney disease with ESRD ', "* ___'s disease s/p combined liver/kidney transplant in ___, \ndid not take immunosuppression after kidney failed ", '* peptic ulcer disease with life-threatening bleed in ___ ', '* anxiety/depression ', '* gout with joint deformities ', '* secondary hyperparathyroidism ', '* s/p cholecystectomy & appendectomy'], 'family_history': 'Reports no other family members with medical problems. ', 'present_illness': "Ms. ___ is a ___ year old female with PKD and Caroli's \ndisease s/p liver and kidney tranplant, known esophageal varices \nwho developed melena two days ago. She had approximately 10 \nblack tarry bowel movements. No CP, SOB, lightheadedness. She \ndenies nausea, vomiting, hematemasis, BRBPR. She denied \nabdominal pain, diarrhea, dysuria, fevers, chills, or any other \nsymptoms.", 'medications': [{'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam - CIWA protocol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.46', 'valuenum': 1.46, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66.8', 'valuenum': 66.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.47', 'valuenum': 0.47, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.33', 'valuenum': 4.33, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '60.7', 'valuenum': 60.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58.6', 'valuenum': 58.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.84', 'valuenum': 2.84, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '57.0', 'valuenum': 57.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59.2', 'valuenum': 59.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'VS: HR 72, BP 143/93, RR 16, 100% RA \nGen: Small female appearing much older than stated age, NAD \nHEENT: EOMI, o/p clear, MMM \nCV: RRR, ___ systolic murmur \nPulm: clear to auscultation bilaterally \nAbd: soft, NT, ND, bowel sounds present \nExt: no peripheral edema, multiple joint deformities especially \ninvolving the hands. \nNeuro: AxOx3', 'diagnoses': [{'icd_code': 'S065X9A', 'desc': 'Traumatic subdural hemorrhage with loss of consciousness of unspecified duration, initial encounter'}, {'icd_code': 'F10239', 'desc': 'Alcohol dependence with withdrawal, unspecified'}, {'icd_code': 'S066X9A', 'desc': 'Traumatic subarachnoid hemorrhage with loss of consciousness of unspecified duration, initial encounter'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'S0101XA', 'desc': 'Laceration without foreign body of scalp, initial encounter'}, {'icd_code': 'S40812A', 'desc': 'Abrasion of left upper arm, initial encounter'}, {'icd_code': 'L089', 'desc': 'Local infection of the skin and subcutaneous tissue, unspecified'}, {'icd_code': 'W06XXXA', 'desc': 'Fall from bed, initial encounter'}, {'icd_code': 'W01198A', 'desc': 'Fall on same level from slipping, tripping and stumbling with subsequent striking against other object, initial encounter'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'Y92003', 'desc': 'Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'F10229', 'desc': 'Alcohol dependence with intoxication, unspecified'}, {'icd_code': 'Z86711', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'R9431', 'desc': 'Abnormal electrocardiogram [ECG] [EKG]'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}], 'summary': "___ ECG\nSinus rhythm \nPoor R wave progression \nSince previous tracing of ___, no significant change \n \nCT abd/pelv ___. No evidence of acute bleeding source or significant \ndiverticulosis. No \nacute abdominal or pelvic process. \n2. Liver transplant with nodular contour likely due to \ncirrhosis. Aneurysmal \ndilatation of the intrahepatic portal vein. \n3. Splenomegaly is suggestive of underlying portal hypertension. \n\n4. Status post right lower quadrant renal transplants. \n5. Two cystic pancreatic tail lesions. No associated ductal \ndilatation. \nCorrelation with prior imaging would be helpful. If no prior \nimaging is \navailable, a CT is recommended in ___ months to document \nstability. \n\n___\nEGD\nVarices at the lower third of the esophagus\nGranularity, erythema and friability in the fundus and stomach \nbody compatible with atrophic gastritis Erythema and granularity \nin the duodenal bulb compatible with duodenitis Polyps in the \nantrum\nOtherwise normal EGD to third part of the duodenum\n=\n=\n=\n=\n=\n=\n=\n=\n=\n=\n==============================================================\n\n___ 06:00PM BLOOD WBC-1.4* RBC-2.65* Hgb-8.6* Hct-25.3* \nMCV-96 MCH-32.4* MCHC-33.9 RDW-18.3* Plt Ct-61*\n___ 06:10AM BLOOD WBC-4.3 RBC-3.18* Hgb-10.0* Hct-29.2* \nMCV-92 MCH-31.3 MCHC-34.1 RDW-19.2* Plt Ct-81*\n___ 06:00PM BLOOD Neuts-62 Bands-0 ___ Monos-1* Eos-0 \nBaso-0 ___ Myelos-0\n___ 09:30AM BLOOD Neuts-53.5 ___ Monos-3.9 Eos-2.3 \nBaso-0.5\n___ 06:00PM BLOOD Hypochr-OCCASIONAL Anisocy-1+ \nPoiklo-NORMAL Macrocy-1+ Microcy-NORMAL Polychr-NORMAL\n___ 06:00PM BLOOD ___ PTT-22.9 ___\n___ 06:10AM BLOOD ___ PTT-26.3 ___\n___ 06:00PM BLOOD Glucose-103 UreaN-75* Creat-8.1* Na-142 \nK-4.7 Cl-101 HCO3-28 AnGap-18\n___ 06:10AM BLOOD Glucose-90 UreaN-104* Creat-10.1*# Na-138 \nK-4.8 Cl-97 HCO3-25 AnGap-21*\n___ 06:00PM BLOOD ALT-60* AST-65* CK(CPK)-29 AlkPhos-432* \nTotBili-0.5\n___ 05:25AM BLOOD ALT-58* AST-67* LD(LDH)-190 AlkPhos-410* \nTotBili-1.0\n___ 06:00PM BLOOD cTropnT-<0.01\n___ 09:30AM BLOOD CK-MB-NotDone cTropnT-<0.01\n___ 06:00PM BLOOD Lipase-61*\n___ 09:30AM BLOOD Calcium-9.4 Phos-8.2*# Mg-2.1\n___ 06:10AM BLOOD Calcium-10.2 Phos-8.5*# Mg-2.0\nMs. ___ is a ___ year old female with PCKD, Caroli's disease, \ns/p liver & kidney transplant (failed) now on HD, gout, known \nesophageal varices, admitted for melena. \n. \n1. Melena. Patient has history of GI bleed last month, hct now \ndown 6 points from last. EGD last month showed esophageal \nvarices and showed gastritis. Patient is taking PPI BID and \ndenied NSAID use. Melena resolved, and her Hct stabilized \nwithout intervention. She had a repeat EGD as well as well as a \ncapsule study. Results of capsule study were pending at time of \nd/c. CT abdomen demonstrated 2 pancreatic head cystic lesions \nwhich need follow up in ___ months.\n. \n2. ESRD on HD. Has left AVF. Prefers to get dialysis at \n___ and had bad experience w/ dialysis at ___. She was \nable to be convinced to recieve dialysis at ___. continued \ncalcitriol, nephrocaps, phos binders \n. \n3. Pancytopenia. Likely related to hepatosplenomegaly. Stable, \nthough did require PRBC transfusions with melena. "}}
{'final_diagnoses': ['GIB requiring transfusion, source still unknown but hct stable', 'ESRD on HD', 'liver failure s/p transplant', 'Gout', 'anxiety/depression'], 'procedures': ['Hemodialysis', 'upper endoscopy', 'capsule endoscopy', 'RBC transfusion'], 'visit_summary': "Ms. ___ is a ___ year old female with PCKD, Caroli's disease, \ns/p liver & kidney transplant (failed) now on HD, gout, known \nesophageal varices, admitted for melena. \n. \n1. Melena. Patient has history of GI bleed last month, hct now \ndown 6 points from last. EGD last month showed esophageal \nvarices and showed gastritis. Patient is taking PPI BID and \ndenied NSAID use. Melena resolved, and her Hct stabilized \nwithout intervention. She had a repeat EGD as well as well as a \ncapsule study. Results of capsule study were pending at time of \nd/c. CT abdomen demonstrated 2 pancreatic head cystic lesions \nwhich need follow up in ___ months.\n. \n2. ESRD on HD. Has left AVF. Prefers to get dialysis at \n___ and had bad experience w/ dialysis at ___. She was \nable to be convinced to recieve dialysis at ___. continued \ncalcitriol, nephrocaps, phos binders \n. \n3. Pancytopenia. Likely related to hepatosplenomegaly. Stable, \nthough did require PRBC transfusions with melena. ", 'medications_prescribed': ['1. Allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '2. B Complex-Vitamin C-Folic Acid 1 mg Capsule Sig: One (1) Cap \nPO DAILY (Daily). ', '3. Calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO DAILY \n(Daily). ', '4. Nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '5. Venlafaxine 75 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO DAILY (Daily). ', '6. Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO Q48H (every \n48 hours). ', '7. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO every twelve (12) hours. ', '8. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed. ', '9. Trazodone 50 mg Tablet Sig: Three (3) Tablet PO HS (at \nbedtime) as needed. ', '10. Calcium Acetate 667 mg Capsule Sig: Seven (7) Capsule PO TID \nW/MEALS (3 TIMES A DAY WITH MEALS). ', '11. Simethicone 80 mg Tablet, Chewable Sig: Two (2) Tablet, \nChewable PO QID (4 times a day) as needed. ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 20, 'gender': 'F', 'symptoms': 'Shortness of breath', 'medical_history': ['Type 2 diabetes mellitus', 'Hyperlipidemia', 'Hypertension', 'Peripheral vascular disease', 'Stroke', 'H/O DEEP VENOUS THROMBOPHLEBITIS', 'Hypertensive heart disease with heart failure', 'Peripheral vascular disease', 'Chronic kidney disease stage III'], 'family_history': '- mother: COPD\n- father: lung cancer, tobacco use', 'present_illness': '___ year old male with hx of HFpEF ((EF 66% ___, STEMI s/p \nPCI (___) on ASA, PVD s/p L femoral-tibial (___) and R \nfem-pop bypass (___), CVA (___), CKD3, HTN, T2DM and BPH who \npresents for evaluation of acute dyspnea, left lower extremity \npain and swelling. On ___ his visiting nurse noted increased \nswelling and weeping of legs, and on ___ family noted redness, \nincreased pain, hypoxia to ___ on his home 2L and altered mental \nstatus. Family called EMS due to his respiratory distress. He \nwas tachypneic to the ___, febrile, tachycardic, normal blood \npressure. Patient denied any headache or dizziness, chest pain,\nno abdominal pain, nausea, vomiting, diarrhea. He was admitted \nfor sepsis secondary to probable cellulitis; further hospital \ncourse below.\n \nROS: Positives as per HPI; otherwise 10 pt review of systems \nreviewed and negative.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Naproxen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'FLUoxetine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FLUoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'BusPIRone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAMINATION:\n===============================\nGENERAL: Alert, confused, pulling at gown \nHEENT: NCAT. PERRL, EOMI. Sclera anicteric and without \ninjection.\npoor dentition \nNECK: No JVD. \nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No\nmurmurs/rubs/gallops. \nLUNGS: decreased aeration of lungs b/l, Mild increased work of\nbreathing. \nABDOMEN: Normal bowels sounds, non distended, non-tender to deep\npalpation in all four quadrants. \nEXTREMITIES: 2+ edema. left leg with erythema and prior venous\ngraft scar, Pulses DP/Radial 2+ bilaterally. \nSKIN: Warm. \nNEUROLOGIC: CN2-12 intact. ___ strength throughout. Normal\nsensation. Gait is normal. AOx1.\n\nDISCHARGE PHYSICAL EXAMINATION:\n===============================\nGENERAL: Lying in bed, comfortable in NAD \nHEENT: MMM. \nNECK: JVP not appreciably elevated \nCARDIAC: Regular rhythm, normal rate. Audible S1 and S2. No\nmurmurs/rubs/gallops.\nLUNGS: CTA b/l, no wheezes, rales or rhonchi\nABDOMEN: Obese, soft, non-tender to deep palpation in all four\nquadrants.\nEXTREMITIES: Trace pre-tibial edema on the RLE (baseline). 1+\npitting pretibial edema on the LLE with diffuse, warm,\nerythematous patch with sparse pustules centrally within\npreviously demarcated borders. \nPulses DP/Radial 2+ bilaterally.\nNEUROLOGIC: AOx3. No focal deficits', 'diagnoses': [{'icd_code': 'F332', 'desc': 'Major depressive disorder, recurrent severe without psychotic features'}, {'icd_code': 'E878', 'desc': 'Other disorders of electrolyte and fluid balance, not elsewhere classified'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'E343', 'desc': 'Short stature due to endocrine disorder'}, {'icd_code': 'F633', 'desc': 'Trichotillomania'}, {'icd_code': 'Z818', 'desc': 'Family history of other mental and behavioral disorders'}, {'icd_code': 'G2571', 'desc': 'Drug induced akathisia'}, {'icd_code': 'T43225A', 'desc': 'Adverse effect of selective serotonin reuptake inhibitors, initial encounter'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}, {'icd_code': 'Z915', 'desc': 'Personal history of self-harm'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': 'ADMISSION LABS: remarkable for elevated WBC count to 13.9 with \n89% PMNS, Cr 1.9, Glucose 305, K 5.4, trop 0.2, proBNP673, VBG \n7.29 / 68 / ___, lactate 2.4\n\nIMAGING:\n========\nCHEST PORTABLE (___\nBibasilar opacities thought to reflect atelectasis, difficult to \nentirely\nexclude a component of aspiration though overall appearance of \nthe chest is\nnot significantly changed from prior.\n\nTTE ___\nIMPRESSION: Suboptimal image quality. Normal left ventricular \nwall thickness and cavity size with\nmild regional systolic function with overall normal ejection \nfraction. Restrictive LV filling pattern.\nRV not seen well in apical ___ut appears to have \nnormal function in other views.No\npathologic valvular flow (tricuspid valve not well seen). \nIndeterminate pulmonary artery systolic\npressure, though mild pulmonary artery diastolic hypertension \ndetected.\n\nUNILAT LOWER EXT VEINS ___\nPopliteal and upper calf veins not well visualized. Allowing \nfor these\nlimitations, no DVT seen.\n\nCXR ___: Lungs are low volume with small bilateral effusions \nleft greater than right. There is moderate pulmonary vascular \ncongestion. Cardiomediastinal silhouette is unchanged. No \npneumothorax\n\nCXR ___: No significant interval change since the radiograph \nperformed ___. Moderate pulmonary edema. \n\nTransesophageal Echocardiogram ___:\nThere is no spontaneous echo contrast or thrombus in the body of \nthe left atrium/left atrial appendage. The left atrial appendage \nejection velocity is normal. The left atrial appendage ejection \nvelocity phenotype is sinus. No spontaneous echo contrast or \nthrombus is seen in the body of the right atrium/ right atrial \nappendage. The right atrial appendage ejection velocity is \nnormal. The right atrial appendage ejection velocity phenotype \nis sinus. No thrombus/vegetation is seen on the catheter/wire. \nThe interatrial septum is dynamic, but not frankly aneurysmal. \nThere is no evidence for an atrial septal defect by 2D/ color \nDoppler. Overall left ventricular systolic function is normal. \nThere are no aortic arch atheroma\nwith simple atheroma in the descending aorta to 40 cm from the \nincisors. The aortic valve leaflets (3) are mildly thickened. No \nmasses or vegetations are seen on the aortic valve. No abscess \nis seen. There is no\naortic regurgitation. The mitral valve leaflets appear \nstructurally normal with no mitral valve prolapse. No masses or \nvegetations are seen on the mitral valve. No abscess is seen. \nThere is physiologic mitral regurgitation. The pulmonic valve \nleaflets are normal. No masses/vegetations are seen on the \npulmonic valve. The tricuspid valve leaflets appear structurally \nnormal. No mass/vegetation are seen on the\ntricuspid valve. No abscess is seen. There is physiologic \ntricuspid regurgitation. There is moderate pulmonary artery \nsystolic hypertension. There is no pericardial effusion.\n\nIMPRESSION: Mild aortic valve sclerosis without discrete \nvegetation or pathologic regurgitation. Normal mitral and \ntricuspid valve morphology. Moderate pulmonary artery systolic \nhypertension\n \nMICROBIOLOGY\n=============\n___ 8:28 pm BLOOD CULTURE x2 positive for group C strep\n___ Blood culture: GPC in pairs and chains; GPC in chains\n___ Blood Culture: No growth x 3\n___ Blood Culture: No growth x 2\n___ Blood Culture: No growth \n\nBlood Culture, Routine (Final ___: \n BETA STREPTOCOCCUS GROUP C. \nSENSITIVITIES: MIC expressed in MCG/ML\n \n_________________________________________________________\n BETA STREPTOCOCCUS GROUP C\n | \nCEFTRIAXONE-----------<=0.12 S\nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.12 S\nPENICILLIN G----------<=0.06 S\nVANCOMYCIN------------<=0.12 S\n\nKEY INTERVAL LABS: \n====================\n___ 04:22AM BLOOD Glucose-181* UreaN-76* Creat-2.0* Na-138 \nK-4.5 Cl-89* HCO3-38* AnGap-11\n___ 06:53AM BLOOD ALT-10 AST-18 LD(LDH)-205 AlkPhos-33* \nTotBili-0.2\n___ 06:53AM BLOOD CRP-40.5*\n\nDISCHARGE LABS: \n================\n___ 06:00AM BLOOD WBC-12.1* RBC-3.44* Hgb-9.1* Hct-29.5* \nMCV-86 MCH-26.5 MCHC-30.8* RDW-15.7* RDWSD-49.3* Plt ___\n___ 06:00AM BLOOD Plt ___\n___ 06:00AM BLOOD Glucose-205* UreaN-71* Creat-1.7* Na-138 \nK-4.4 Cl-93* HCO3-36* AnGap-9*\n___ 06:00AM BLOOD Calcium-8.7 Phos-4.0 Mg-2.___\nyear old male with hx of HFpEF (EF 66% ___, STEMI s/p PCI \n(___) on ASA, PVD s/p L femoral-tibial (___) and R fem-pop \nbypass (___), CVA (___), CKD3, HTN, T2DM and BPH who \npresented with acute dyspnea, LLE pain and swelling, admitted to \nthe ICU on ___ for sepsis secondary to LLE cellulitis. He was \nfound to have group C strep bacteremia sensitive to ceftriaxone. \nCourse also notable for hypoxemia from acute on chronic \ndiastolic heart failure requiring IV diuresis. He was \nsuccessfully diuresed and transitioned back to his home diuretic \nregimen; was seen by sleep medicine, who recommended outpatient \nsleep study. \n\nTRANSITIONAL ISSUES\n======================\n[ ] Repeat PFTs (last completed in ___\n[ ] Sleep study ordered to see whether patient will need CPAP in \nfuture\n[ ] To complete CTX through ___ with remaining duration to be \ndetermined by ID follow-up\n[ ] Discharged on Amlodipine 5mg (home 10mg). Uptitrate as \nneeded\n[ ] Patient not on home inhalers for COPD; he was sent home with \nprescription for inhalers. \n[ ] Recheck BMP in 1 week. Discharge Cr 1.7\n[ ] Check weekly LFTs, CRP (next check ___\n[ ] Discharged off home daily potassium repletion given stable \npotassium throughout admission. Consider restarting if necessary \nbased on repeat BMP\n\nACUTE ISSUES \n======================= \n# Sepsis (fever, leukocytosis, LLE cellulitis) \n# Group C Strep bacteremia \n# Left lower leg cellulitis\nPatient presented with cellulitis on admission which was the \nmost likely source for bacteremia. Started on vanc/cefepime then \nnarrowed to CTX based on sensitivities. TTE and TEE negative for \nvegetations. ID was consulted and ultimately recommended course \nof IV ceftriaxone for 3 weeks through ___. \n\n# Acute Hypoxemic Respiratory Failure \n# Dyspnea \n# HFpEF \nPatient presented with shortness of breath, tachypnea, and O2 \nrequirement increased from prior (on 2L at home). Left lower \nextremity infection likely precipitant. TTE unchanged from prior \nwith EF 55-60% and restrictive LV filling pattern. Suspect \ndyspnea is multifactorial from COPD, heart failure, and possibly \nOSH. He was diuresed with IV Lasix before being transitioned \nback to home Torsemide 20mg po. Spirinolactone was initially \nheld in the setting ___ but was restarted prior to discharge. \nDischarge Cr 1.7\n\n# Acute toxic metabolic encephalopathy \nLikely in the setting of infection, resolved shortly after \nadmission. \n\n___ on CKD\nCreatinine baseline around 1.2-1.4, peaked at 2.0. Initially \npresumed ___ cardiorenal etiology, though likely precipitated by \ndiuresis given FeUrea consistent with pre-renal etiology. \nImproved with transition to po diuretics. Downtrending to 1.7 on \ndischarge. \n\n#History of DVT\nPatient with history of DVT of left femoral vein diagnosed \n___. Also has a history of prior DVT/PE, both appear to be \nunprovoked, and patient recommended for indefinite AC after last \nadmission. Continued apixaban BID. \n\n# COPD \nPFTs in ___ that showed mild obstructive ventilatory defect \nwith likely restrictive component, likely in setting of OSH. Has \n> 50 pack year history. Last admission was recommended for PFTs, \nsleep study. Duonebs were scheduled every 6 hours. Transitioned \nto albuterol/Spiriva on discharge. \n\n#Urinary retention \n#BPH \nHe also has a history of hesitancy, dribbling, and overflow \nincontinence. Continued tamsulosin and finasteride. Given \nongoing urinary retention and difficulty with straight \ncatheterization, urology was consulted and had Foley placed, to \ncontinue on discharge. He will be seen by urology as an \noutpatient to determine whether he will require chronic Foley. \n\n#?OSA\nPatient reportedly started on CPAP at outside facility prior to \npresentation before getting sleep study. Briefly required \nCPAP/BIPAP while inpatient, but also in setting of acute \nhypoxemic respiratory failure ___ CHF exacerbation as above. \nFollowing diuresis, did not require CPAP/BIPAP. Sleep medicine \nwas consulted and patient is planned for outpatient sleep study \nto consider whether he needs CPAP in the future. \n\n#Metabolic Alkalosis\nLikely precipitated by overiduresis as above. Improving on \ndischarge.\n\nCHRONIC/STABLE ISSUES \n======================= \n# Hypertension \nHome amdlodipine 10 mg was initially held but was restarted at \nlower dose 5mg daily prior to discharge.\n\n# Intertriginous Rash \nContinued miconazole powder BID while inpatient. \n\n# Depression \nContinued home sertraline 50 mg daily.\n\n# Hyperlipidemia \n# History of MI s/p PCI \nContinue home ASA 81mg, atorvastatin 80mg, fenofibrate. Resumed \nhome carvedilol 25 BID on ___. \n\n# Type 2 diabetes mellitus \nInsulin-dependent, followed at ___. Home regimen is Novolog \n70/30 40U AM and 30U ___, with SSI. Ordered for Glargine 45 units \nqHS and Humalog ___ with meals, and SSI. Discharged back on \nhome regimen\n\n#CODE STATUS: full (confirmed)\n#EMERGENCY CONTACT: ___ (wife) - ___ (cell) \n\nWe anticipate that patient will require <30 days stay at acute \nrehabilitation facility.'}}
{'final_diagnoses': ['Acute on chronic congestive heart failure exacerbation', 'Cellulitis', 'Sepsis', 'Urinary retention', 'Acute on Chronic Kidney Disease', 'Metabolic Alkalosis', 'Toxic Metabolic Encephalopathy', 'COPD'], 'procedures': ['TEE'], 'visit_summary': 'year old male with hx of HFpEF (EF 66% ___, STEMI s/p PCI \n(___) on ASA, PVD s/p L femoral-tibial (___) and R fem-pop \nbypass (___), CVA (___), CKD3, HTN, T2DM and BPH who \npresented with acute dyspnea, LLE pain and swelling, admitted to \nthe ICU on ___ for sepsis secondary to LLE cellulitis. He was \nfound to have group C strep bacteremia sensitive to ceftriaxone. \nCourse also notable for hypoxemia from acute on chronic \ndiastolic heart failure requiring IV diuresis. He was \nsuccessfully diuresed and transitioned back to his home diuretic \nregimen; was seen by sleep medicine, who recommended outpatient \nsleep study. \n\nTRANSITIONAL ISSUES\n======================\n[ ] Repeat PFTs (last completed in ___\n[ ] Sleep study ordered to see whether patient will need CPAP in \nfuture\n[ ] To complete CTX through ___ with remaining duration to be \ndetermined by ID follow-up\n[ ] Discharged on Amlodipine 5mg (home 10mg). Uptitrate as \nneeded\n[ ] Patient not on home inhalers for COPD; he was sent home with \nprescription for inhalers. \n[ ] Recheck BMP in 1 week. Discharge Cr 1.7\n[ ] Check weekly LFTs, CRP (next check ___\n[ ] Discharged off home daily potassium repletion given stable \npotassium throughout admission. Consider restarting if necessary \nbased on repeat BMP\n\nACUTE ISSUES \n======================= \n# Sepsis (fever, leukocytosis, LLE cellulitis) \n# Group C Strep bacteremia \n# Left lower leg cellulitis\nPatient presented with cellulitis on admission which was the \nmost likely source for bacteremia. Started on vanc/cefepime then \nnarrowed to CTX based on sensitivities. TTE and TEE negative for \nvegetations. ID was consulted and ultimately recommended course \nof IV ceftriaxone for 3 weeks through ___. \n\n# Acute Hypoxemic Respiratory Failure \n# Dyspnea \n# HFpEF \nPatient presented with shortness of breath, tachypnea, and O2 \nrequirement increased from prior (on 2L at home). Left lower \nextremity infection likely precipitant. TTE unchanged from prior \nwith EF 55-60% and restrictive LV filling pattern. Suspect \ndyspnea is multifactorial from COPD, heart failure, and possibly \nOSH. He was diuresed with IV Lasix before being transitioned \nback to home Torsemide 20mg po. Spirinolactone was initially \nheld in the setting ___ but was restarted prior to discharge. \nDischarge Cr 1.7\n\n# Acute toxic metabolic encephalopathy \nLikely in the setting of infection, resolved shortly after \nadmission. \n\n___ on CKD\nCreatinine baseline around 1.2-1.4, peaked at 2.0. Initially \npresumed ___ cardiorenal etiology, though likely precipitated by \ndiuresis given FeUrea consistent with pre-renal etiology. \nImproved with transition to po diuretics. Downtrending to 1.7 on \ndischarge. \n\n#History of DVT\nPatient with history of DVT of left femoral vein diagnosed \n___. Also has a history of prior DVT/PE, both appear to be \nunprovoked, and patient recommended for indefinite AC after last \nadmission. Continued apixaban BID. \n\n# COPD \nPFTs in ___ that showed mild obstructive ventilatory defect \nwith likely restrictive component, likely in setting of OSH. Has \n> 50 pack year history. Last admission was recommended for PFTs, \nsleep study. Duonebs were scheduled every 6 hours. Transitioned \nto albuterol/Spiriva on discharge. \n\n#Urinary retention \n#BPH \nHe also has a history of hesitancy, dribbling, and overflow \nincontinence. Continued tamsulosin and finasteride. Given \nongoing urinary retention and difficulty with straight \ncatheterization, urology was consulted and had Foley placed, to \ncontinue on discharge. He will be seen by urology as an \noutpatient to determine whether he will require chronic Foley. \n\n#?OSA\nPatient reportedly started on CPAP at outside facility prior to \npresentation before getting sleep study. Briefly required \nCPAP/BIPAP while inpatient, but also in setting of acute \nhypoxemic respiratory failure ___ CHF exacerbation as above. \nFollowing diuresis, did not require CPAP/BIPAP. Sleep medicine \nwas consulted and patient is planned for outpatient sleep study \nto consider whether he needs CPAP in the future. \n\n#Metabolic Alkalosis\nLikely precipitated by overiduresis as above. Improving on \ndischarge.\n\nCHRONIC/STABLE ISSUES \n======================= \n# Hypertension \nHome amdlodipine 10 mg was initially held but was restarted at \nlower dose 5mg daily prior to discharge.\n\n# Intertriginous Rash \nContinued miconazole powder BID while inpatient. \n\n# Depression \nContinued home sertraline 50 mg daily.\n\n# Hyperlipidemia \n# History of MI s/p PCI \nContinue home ASA 81mg, atorvastatin 80mg, fenofibrate. Resumed \nhome carvedilol 25 BID on ___. \n\n# Type 2 diabetes mellitus \nInsulin-dependent, followed at ___. Home regimen is Novolog \n70/30 40U AM and 30U ___, with SSI. Ordered for Glargine 45 units \nqHS and Humalog ___ with meals, and SSI. Discharged back on \nhome regimen\n\n#CODE STATUS: full (confirmed)\n#EMERGENCY CONTACT: ___ (wife) - ___ (cell) \n\nWe anticipate that patient will require <30 days stay at acute \nrehabilitation facility.', 'medications_prescribed': ['Albuterol Inhaler 2 PUFF IH Q6H:PRN dspnea', 'CefTRIAXone 2 gm IV Q24H', 'Tiotropium Bromide 1 CAP IH DAILY', 'amLODIPine 5 mg PO DAILY', '70/30 40 Units Breakfast', '70/30 30 Units Dinner', 'Apixaban 5 mg PO BID', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Bisacodyl 10 mg PO/PR DAILY:PRN Constipation', 'Carvedilol 25 mg PO BID', 'clotrimazole-betamethasone ___ % topical BID:PRN', 'Fenofibrate 160 mg PO DAILY', 'Finasteride 5 mg PO DAILY', 'Fluocinonide 0.05% Cream 1 Appl TP BID:PRN flares', 'Ketoconazole Shampoo 1 Appl TP ASDIR', 'Senna 8.6 mg PO BID', 'Sertraline 50 mg PO DAILY', 'Spironolactone 50 mg PO DAILY', 'Tamsulosin 0.8 mg PO QHS', 'Torsemide 20 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 70, 'gender': 'F', 'symptoms': 'lower extremity edema', 'medical_history': ['Type 2 diabetes', 'Osteoarthritis', 'Chronic cough', 'Gout', 'Hypertension', 'Hyperlipidemia', 'Hypothyroidism', 'Obesity', 'Palpitations', 'Lower extremity edema', 'Chronic kidney disease', 'Retinal vascular occlusion', 'Diabetic retinopathy', 'Tremor, action', 'Anemia', 'S/P TAH/BSO'], 'family_history': 'Father and mother with heart problems. Mother died of colon \ncancer; sister with colon polyps removed on colonoscopy.', 'present_illness': '___ is a ___ year old woman with DM2 (diet controlled), \nOA, HTN, gout, obesity, hypothyroidism, chronic lower extremity \nedema attributed to venous stasis, and CKD, who presented to \nclinic yesterday with worsening lower extremity edema and was \nfound to have hyponatremia and hyperkalemia.\n\nThe patient reports that for the most part she has been at her \nbaseline health recently. The only exception to this is her \nlower extremity edema, which has been slowly worsening in recent \nmonths. She notes that she has a prescription for torsemide, \nwhich she typically takes about 3 times weekly because of the \ninconvenience of the diuretic effect given her incontinence and \nactivities. She also notes that her RLE is typically more \nedematous than the L and that both are tender to palpation \nchronically. these patterns have not changed. her daughter notes \nthat she once had a duplex study that was inconclusive due to \nher firm distended lower legs. She denies any CP, dyspnea or \northopnea. She does endorse being cold for about one month. She \nnotes that her legs feel heavy from the edema, but otherwise she \nhas not appreciated any weakness or numbness. She has not been \nchecking her weights at home but her daughter noted that in the \noffice yesterday her weight was up about ___ lbs from her last \nclinic weight (from 8 months ago). She notes that she has been \neating many foods high in potassium, including oranges, bananas, \nand avocados. She endorsed some mild improvement in her lower \nextremity edema upon arrival to the floor after receiving Lasix \nin the ED.\n\nIn the ED she had normal vital signs. She received calcium, \ninsulin, dextrose, and 20 mg IV Lasix, as well as other home \nmeds. Labs notable for K of 6.3 initially, sodium around 130, \nTSH of 21 with free T4 of 1.4, AM cortisol of 7.6, and cre \nstable at 1.8-1.9.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron 4mg/2mL 2mL VIAL', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'PARoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.2', 'valuenum': 49.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '469', 'valuenum': 469.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely between 54 and 66 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '35', 'valuenum': 35.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-27', 'valuenum': -27.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-86', 'valuenum': -86.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-47', 'valuenum': -47.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '348', 'valuenum': 348.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.2', 'valuenum': 48.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '326', 'valuenum': 326.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.3', 'valuenum': 49.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION: \n==========\nVital signs:\n___ 1815 Temp: 97.8 PO BP: 135/61 HR: 89 RR: 18 O2 sat: 97%\nO2 delivery: Ra \nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma.\nMMMs\nCV: Heart regular, no murmur\nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. Obese\nGU: No CVA/suprapubic tenderness\nMSK: No swollen or erythematous joints\nSKIN: No rashes or ulcerations noted\nEXTR: wwp, bilateral edema and tenderness, R>L, in compression\nstockings\nNEURO: Alert, interactive, face symmetric, gaze conjugate with\nEOMI, speech fluent, motor function grossly symmetric, reduced \nin\nlower extremities\nPSYCH: pleasant, appropriate affect\n\nDischarge Physical Exam:\n========================\nVital signs: see Eflowsheets \nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma\nCV: Heart regular\nRESP: Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. Obese\nGU: No foley\nMSK: No swollen or erythematous joints\nSKIN: No rashes or ulcerations noted\nEXTR: warm and well perfused, b/l venous stasis changes\nNEURO: Alert, interactive, face symmetric, gaze conjugate with\nEOMI, speech fluent, motor function grossly symmetric, reduced \nin\nlower extremities\nPSYCH: pleasant, appropriate affect', 'diagnoses': [{'icd_code': 'S069X0A', 'desc': 'Unspecified intracranial injury without loss of consciousness, initial encounter'}, {'icd_code': 'S22021A', 'desc': 'Stable burst fracture of second thoracic vertebra, initial encounter for closed fracture'}, {'icd_code': 'S0101XA', 'desc': 'Laceration without foreign body of scalp, initial encounter'}, {'icd_code': 'S40022A', 'desc': 'Contusion of left upper arm, initial encounter'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Q7649', 'desc': 'Other congenital malformations of spine, not associated with scoliosis'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'V470XXA', 'desc': 'Car driver injured in collision with fixed or stationary object in nontraffic accident, initial encounter'}, {'icd_code': 'Y92410', 'desc': 'Unspecified street and highway as the place of occurrence of the external cause'}, {'icd_code': 'M4312', 'desc': 'Spondylolisthesis, cervical region'}, {'icd_code': 'R402362', 'desc': 'Coma scale, best motor response, obeys commands, at arrival to emergency department'}, {'icd_code': 'R402142', 'desc': 'Coma scale, eyes open, spontaneous, at arrival to emergency department'}, {'icd_code': 'R402252', 'desc': 'Coma scale, best verbal response, oriented, at arrival to emergency department'}], 'summary': 'Admission Labs:\n===============\n___ 12:30AM BLOOD WBC-6.8 RBC-3.21* Hgb-9.5* Hct-29.7* \nMCV-93 MCH-29.6 MCHC-32.0 RDW-14.0 RDWSD-47.0* Plt ___\n___ 12:30AM BLOOD Neuts-45.4 ___ Monos-12.8 Eos-2.6 \nBaso-0.4 Im ___ AbsNeut-3.09 AbsLymp-2.64 AbsMono-0.87* \nAbsEos-0.18 AbsBaso-0.03\n___ 03:01PM BLOOD UreaN-30* Creat-1.8* Na-130* K-6.3* \nCl-94* HCO3-22 AnGap-14\n___ 06:30AM BLOOD Calcium-9.4 Phos-3.7 Mg-2.1\n___ 12:30AM BLOOD %HbA1c-5.7 eAG-117\n___ 03:01PM BLOOD TSH-21*\n___ 06:30AM BLOOD Cortsol-7.6\n\nImaging:\n========\nLENIs:\nNo evidence of deep venous thrombosis in the left lower \nextremity veins. \nPlease note that evaluation of the calf veins is limited \n\nDischarge Labs:\n===============\n___ 05:50AM BLOOD WBC-5.8 RBC-3.02* Hgb-9.1* Hct-27.9* \nMCV-92 MCH-30.1 MCHC-32.6 RDW-14.2 RDWSD-48.2* Plt ___\n___ 12:36PM BLOOD Glucose-115* UreaN-34* Creat-1.9* Na-132* \nK-4.8 Cl-93* HCO3-27 AnGap-12\n___ 12:36PM BLOOD Calcium-9.4 Phos-4.5 Mg-1.___ is a ___ year old woman with DM2 (diet controlled), \nOA, HTN, gout, obesity, hypothyroidism, chronic lower extremity \nedema attributed to venous stasis, and CKD, who presented to \nclinic with worsening lower extremity edema and was found to \nhave hyponatremia and hyperkalemia.\n# Hyperkalemia \n# CKD\nPatient has been high-normal and intermittently hyperkalemic in \nthe past. Her worsening hyperkalemia is likely related to \nprogressive CKD, her ACE inhibitor, and dietary intake. Improved \nwith diuresis, holding ACEi, low K diet, and regular BMs. She \nwill be discharged on 20mg of torsemide daily. Enalapril was \ndiscontinued. She will follow up at ___ on ___ and should have \nelectrolytes rechecked at that time\n\n# Hyponatremia: \nChronic issue. Stable in mid to low 130s throughout admission\n\n# Lower extremity edema \n# Venous stasis\nPatient with known venous stasis, for which she uses compression \nstockings and takes torsemide. However her use of torsemide has \nbeen limited due to her preference, and she notes worsening \nedema in recent months, which is asymmetric per baseline and \ntender to palpation per baseline. US was negative for L DVT. \nPain/swelling improved with resuming torsemide, and she will be \ndischarged on torsemide 20mg daily (until HCA follow up on \n___. Discharge weight is 109.5kg\n\n# Hypothyroidism:\nHer TSH of ___ indicate inadequate thyroid replacement \n(despite the normal free T4), which could be playing a role in \nhyponatremia, although the thyroid function tests are known to \nbe unreliable in the setting of acute illness. Additionally, \npatient admits to intermittent noncompliance with levothyroxine. \nContinued home levothyroxine 50 mcg, counsel on compliance. Will \nneed repeat TFTs as an outpatient. \n\n# Chronic pain Intermittently takes Tylenol-codeine at home for \nmultiple chronic back/knee pains. Continued daily home PRN \nTylenol-codeine + additional PRN tylenol\n\n# DM: diet controlled\n\n# Gout: continued home allopurinol, reduced from 200mg daily to \n100mg based on renal function. \n\n> 30 minutes spent on discharge coordination and planning'}}
{'final_diagnoses': ['# Hyperkalemia', '# Lower extremity edema secondary to:', '# Stage IIIb CKD', '# Venous insufficiency'], 'procedures': ['none'], 'visit_summary': '# Hyperkalemia \n# CKD\nPatient has been high-normal and intermittently hyperkalemic in \nthe past. Her worsening hyperkalemia is likely related to \nprogressive CKD, her ACE inhibitor, and dietary intake. Improved \nwith diuresis, holding ACEi, low K diet, and regular BMs. She \nwill be discharged on 20mg of torsemide daily. Enalapril was \ndiscontinued. She will follow up at ___ on ___ and should have \nelectrolytes rechecked at that time\n\n# Hyponatremia: \nChronic issue. Stable in mid to low 130s throughout admission\n\n# Lower extremity edema \n# Venous stasis\nPatient with known venous stasis, for which she uses compression \nstockings and takes torsemide. However her use of torsemide has \nbeen limited due to her preference, and she notes worsening \nedema in recent months, which is asymmetric per baseline and \ntender to palpation per baseline. US was negative for L DVT. \nPain/swelling improved with resuming torsemide, and she will be \ndischarged on torsemide 20mg daily (until HCA follow up on \n___. Discharge weight is 109.5kg\n\n# Hypothyroidism:\nHer TSH of ___ indicate inadequate thyroid replacement \n(despite the normal free T4), which could be playing a role in \nhyponatremia, although the thyroid function tests are known to \nbe unreliable in the setting of acute illness. Additionally, \npatient admits to intermittent noncompliance with levothyroxine. \nContinued home levothyroxine 50 mcg, counsel on compliance. Will \nneed repeat TFTs as an outpatient. \n\n# Chronic pain Intermittently takes Tylenol-codeine at home for \nmultiple chronic back/knee pains. Continued daily home PRN \nTylenol-codeine + additional PRN tylenol\n\n# DM: diet controlled\n\n# Gout: continued home allopurinol, reduced from 200mg daily to \n100mg based on renal function. \n\n> 30 minutes spent on discharge coordination and planning', 'medications_prescribed': ['Allopurinol ___ mg PO DAILY', 'Torsemide 20 mg PO DAILY', 'Acetaminophen w/Codeine 1 TAB PO Q8H:PRN Pain - Moderate', 'Calcium Carbonate 1000 mg PO DAILY', 'Levothyroxine Sodium 100 mcg PO DAILY', 'Lidocaine 5% Patch 1 PTCH TD QAM', 'Naloxone Nasal Spray 4 mg IH ONCE MR1', 'Simvastatin 10 mg PO QPM', 'Vitamin D 4000 UNIT PO DAILY', 'HELD- Enalapril Maleate 20 mg PO DAILY This medication was \nheld. Do not restart Enalapril Maleate until you discuss with \nDr. ___ nephrologist']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 53, 'gender': 'F', 'symptoms': 'Abdominal Pain', 'medical_history': ['GERD', 'cholecystectomy', 'Repeated laparoscopic adhesion lesis by the surgeon who \nperformed the cholecystectomy but no history of bowel \nobstruction', 'C- section'], 'family_history': 'Notable for father who has had reflux disease', 'present_illness': '___ y/o F s/p CCY ___ ago with hx of severe papillary stenosis \nrequiring ERCP with sphincterorotomy ___. Sx\x92s initially \nimproved s/p sphinctertotomy, but have now recurred. She \ndescribes her pain as postprandial in the right upper quadrant \nand radiating to the back. She feels that the discomfort is \nworse with fatty foods. Her pain has occurred since the last 2 \nweeks. Typically her pain comes on, she has LOA or ERCP and her \npain briefly improves. She reports nausea and light colored \nstools with her pain, but denies f/c, CP/SOB, emesis, \nbloody/black stool, dysuria, leg pain or swelling.\n\nShe tolerated her ERCP well. Currently, she complains of mild \n___ pain in her RUQ/epigastrium and above her umbilicus. She \notherwise feels well.\n\nReview of systems: 10 point review of systems negative except as \nlisted above', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': '2X', 'doses_per_24_hrs': 0.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Pentoxifylline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nadolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pentoxifylline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '461', 'valuenum': 461.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.3', 'valuenum': 84.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 52.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.7, 'valueuom': 'mEq/L', 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'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '267', 'valuenum': 267.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 17.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.3,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T 98.5, BP 120/72, HR 60, RR 18, 97%RA\nGen: well appearing, NAD\nHEENT: EOMI, anicteric sclera, MMM, OP clear\nNeck: supple no LAD\nHeart: RRR no m/r/g\nLung: CTAB no wheezes rales or crackles\nAbd: soft, + tenderness over RUQ, epigastrium, and above \numbilicus. soft, no rebound or guarding. +BS\nSkin: pale. no rashes or bruising\nExt: warm well perfused no pitting edema\nNeuro: no focal deficits', 'diagnoses': [{'icd_code': '5722', 'desc': 'Hepatic encephalopathy'}, {'icd_code': '45620', 'desc': 'Esophageal varices in diseases classified elsewhere, with bleeding'}, {'icd_code': '53784', 'desc': 'Dieulafoy lesion (hemorrhagic) of stomach and duodenum'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '5711', 'desc': 'Acute alcoholic hepatitis'}, {'icd_code': '2800', 'desc': 'Iron deficiency anemia secondary to blood loss (chronic)'}, {'icd_code': '07070', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}], 'summary': '138 / 107/ 9 \n5.1 / 0.7 \n \nALT: 15 AP: 36 Tbili: 0.6 Alb: \nAST: 25 LDH: Dbili: 0.1 TProt: \n___: 25 Lip: 27 \n\n5.0 \\ 12.7 / 167 \n /36.9 \\\n\n___: 14.1 PTT: 21.2 INR: 1.2 \n\nERCP\nImpression: Partial pancreatogram at cannulation was normal. \nSuccessful biliary cannulation \nNormal biliary tree \nSevere stenosis of the major papilla noted at cannulation. \nA small extension sphincterotomy was performed due to the tight \nstenosis. \nSmall amount of biliary sludge. \nOtherwise normal ercp to third part of the duodenum\n___ with recurrent abdominal pain s/p ERCP with extension \nsphincterotomy\n\nAbdominal pain, RUQ/epigastrium: Likely multifactorial. s/p \nERCP with sphincterotomy for stenosis. Patient tolerated the \nprocedure well. She had minimal pain post op and her exam was \nbenign. She tolerated oral challenge prior to discharge\n- follow up with PCP and GI. ___ home medications.'}}
{'final_diagnoses': ['Abdominal pain', 'stenosis of biliary system', 'Adhesions'], 'procedures': ['ERCP with spincterotomy'], 'visit_summary': '___ with recurrent abdominal pain s/p ERCP with extension \nsphincterotomy\n\nAbdominal pain, RUQ/epigastrium: Likely multifactorial. s/p \nERCP with sphincterotomy for stenosis. Patient tolerated the \nprocedure well. She had minimal pain post op and her exam was \nbenign. She tolerated oral challenge prior to discharge\n- follow up with PCP and GI. ___ home medications.', 'medications_prescribed': ['1. acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for pain fever. ', '2. Tigan 300 mg Capsule Sig: One (1) Capsule PO every eight (8) \nhours as needed for nausea.\nDisp:*15 Capsule(s)* Refills:*0*', '3. Dilaudid 2 mg Tablet Sig: ___ Tablets PO at bedtime as needed \nfor pain. ', '4. polyethylene glycol 3350 17 gram/dose Powder Sig: One (1) \ndose PO DAILY (Daily): with narcotics.\nDisp:*60 dose* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 61, 'gender': 'F', 'symptoms': 'Bright red blood per rectum', 'medical_history': ['Diverticulosis', 'Internal hemorrhoids', 'GERD', 'h/o colonic adenoma on ___ colonoscopy', 'Hypertension', 'Asthma', 'Obesity', 'Migraines'], 'family_history': "Father- HTN\nMother- stroke\nMultiple members of mother's family with h/o stroke\nUncle- died of colon cancer age ___\nUncle- died of stomach cancer age ___", 'present_illness': '___ hx of HTN, HLD on ASA and diverticular bleed ___ presents \nwith painless BRBPR x3. He was driving his bus when he had \nurgency to stool, bright red blood mixed with stool came out, no \nabd pain, no lightheadedness, no chest pain or shortness of \nbreath. He finished his shift and had further movements similar \n2PM, 6PM, 10PM, 2AM. \nIn the ED, initial vitals: 98.1 92 198/111 18 100% \nLabs/Studies notable for: Crit 40.5->39.0 INR 1.2 plt 177. He \nhad one episode of BRBPR in the ED, vitals remained stable. 2 18 \nG placed, T&C, GI consulted with plan for CT abd/pelvis with \ncontrast. \nOn arrival pt again has BRBPR but no associated cardiopulmonary \nsymptoms or lightheadedness. \n', 'medications': [{'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.1, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 186.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'umol/L', 'ref_range_lower': 10.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT RELIABLY DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = 57 if non African-American (mL/min/1.73 m2). Estimated GFR = 68 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '___', 'valuenum': 194.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '___', 'valuenum': 907.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.010', 'valuenum': 1.01, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY. INTERFERING SUBSTANCES MINIMIZED.'}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 219.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY. INTERFERING SUBSTANCES MINIMIZED.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY. INTERFERING SUBSTANCES MINIMIZED.'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '396', 'valuenum': 396.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55.0', 'valuenum': 55.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '315', 'valuenum': 315.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T 98.2 138/91 HR 90 RR 20 O2 98%RA SBP 130-140 HR 90-100 \n\nGeneral: AAOx3, comfortable appearing, in NAD \nHEENT: NCAT, EOMI, PERRL. Sclera anicteric, conjunctiva pink. \nMMM. OP clear. \nNeck: supple, no LAD, no JVP elevation \nLungs: CTAB, no w/r/r \nCV: RRR, normal S1 and S2, no m/g/r \nAbdomen: NABS, soft, nondistended, nontender. No HSM. \nGU: no foley \nExt: WWP. 2+ peripheral pulses. No edema. \nNeuro: CNs II-XII intact. MAEE. Grossly normal strength and \nsensation. ', 'diagnoses': [{'icd_code': '29040', 'desc': 'Vascular dementia, uncomplicated'}, {'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '4370', 'desc': 'Cerebral atherosclerosis'}, {'icd_code': '78194', 'desc': 'Facial weakness'}, {'icd_code': '72989', 'desc': 'Other musculoskeletal symptoms referable to limbs'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}], 'summary': "___ 02:45AM BLOOD WBC-8.3 RBC-4.64 Hgb-14.2 Hct-40.5 MCV-87 \nMCH-30.5 MCHC-34.9 RDW-15.1 Plt ___\n___ 08:09AM BLOOD WBC-9.0 RBC-4.48* Hgb-13.3* Hct-39.0* \nMCV-87 MCH-29.7 MCHC-34.2 RDW-15.0 Plt ___\n___ 10:30AM BLOOD Hct-40.2\n___ 03:20PM BLOOD Hct-35.3*\n___ 07:02PM BLOOD Hct-34.6*\n___ 12:36AM BLOOD Hct-29.8*\n___ 04:02AM BLOOD Hct-30.4*\n___ 07:55AM BLOOD Hct-31.7*\n___ 02:50PM BLOOD Hct-28.8*\n___ 05:00AM BLOOD WBC-7.4 RBC-3.40* Hgb-10.3* Hct-30.0* \nMCV-88 MCH-30.2 MCHC-34.2 RDW-15.4 Plt ___\n___ 02:45AM BLOOD ___ PTT-31.5 ___\n___ 02:45AM BLOOD Glucose-144* UreaN-13 Creat-1.1 Na-136 \nK-3.4 Cl-102 HCO3-25 AnGap-12\n\nIMAGING\nCTA ___. Colonic diverticulosis, without evidence of active \nextravasation of \ncontrast to suggest a site of enteric bleeding. \n2. Mild stenosis of the celiac origin could be related in part \nto arcuate \nligament compression. Significance is uncertain. Patent superior \nand inferior \nmesenteric arteries. \n3. 9 mm hemorrhagic cyst interpolar region right kidney. \n \n___ hx of HTN, HLD, hx of diverticulosis and diverticular bleed, \non ASA 325mg presenting with painless ongoing BRBPR. \n\n# BRBPR: Given history of diverticular bleed, this is most \nlikely recurrence. Hemodynamically stable, but with ongoing \nbleeding. The low BUN and known history of diverticulosis point \ntoward a lower GI etiology of the patient's bleeding and his \n___ score is 0. Potentially provoked by the patient \nraising his ASA 81mg to ASA 325mg 2 weeks ago. CTA confirms \ndivertics wtihout evidence of active extravasation so no role \nfor ___. He was observed to have decreasing bloody BM's and \nstabilizing hematocrit, and in conference with GI it was \ndetermined that he could safely discharge with outpatient \ncolonoscopy. Aspirin was held at discharge since he has no \nhistory of coronary disease.\n\n# HTN: Atenolol was held in the context of normal BP's and HR, \nto be restarted by PCP. "}}
{'final_diagnoses': ['Lower gastrointestinal bleed'], 'procedures': ['None'], 'visit_summary': "___ hx of HTN, HLD, hx of diverticulosis and diverticular bleed, \non ASA 325mg presenting with painless ongoing BRBPR. \n\n# BRBPR: Given history of diverticular bleed, this is most \nlikely recurrence. Hemodynamically stable, but with ongoing \nbleeding. The low BUN and known history of diverticulosis point \ntoward a lower GI etiology of the patient's bleeding and his \n___ score is 0. Potentially provoked by the patient \nraising his ASA 81mg to ASA 325mg 2 weeks ago. CTA confirms \ndivertics wtihout evidence of active extravasation so no role \nfor ___. He was observed to have decreasing bloody BM's and \nstabilizing hematocrit, and in conference with GI it was \ndetermined that he could safely discharge with outpatient \ncolonoscopy. Aspirin was held at discharge since he has no \nhistory of coronary disease.\n\n# HTN: Atenolol was held in the context of normal BP's and HR, \nto be restarted by PCP. ", 'medications_prescribed': ['Simvastatin 20 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'Dyspnea', 'medical_history': ['HTN', 'Gout', 'Personal history of DVT (deep vein thrombosis)', 'Neuropathy, peripheral ', 'HLD', 'Prior Lyme disease', 'Narcolepsy ', 'Hemothorax, traumatic ', 'Sleep apnea ', 'Afib', 'Bradycardia with ___ pause -> Pacemaker', 'Sensorineural hearing loss, bilateral ', 'Asthma ', 'Melanoma in situ of back', 'SCC/back'], 'family_history': 'Not relevant to current admission', 'present_illness': "Mr. ___ is a ___ year old man with afib on warfarin, AVB s/p\nPPM, recent admission with RSV, sigmoid volvulus, and strep \nmitis\nbacteremia/suspected endocarditis, discharged to rehab on\n___, who presented back from his rehab with abdominal\ndistension and was found to have likely bacterial pneumonia and\nalso the flu.\n\nBrief summary of recent admissions:\nPatient was admitted to ___ from ___ with RSV bronchitis\nand was on prednisone. He then presented back to ___ with\nmultifocal pneumonia and respiratory failure, strep mitis\nbacteremia suspected due to endocarditis, and volvulus \n(suspected\nto be chronic) s/p colonoscopic decompression. he was planned \nfor\nfollow-up with GI and surgery. For her endocarditis/bacteremia\nshe was started on a 4 week course of ceftriaxone. TEE not\npursued. He had thrombocytopenia felt to be due to ceftriaxone\npotentially, although stable, so ceftriaxone continued. He was\nalso treated for suspected strep pneumo PNA. He was continued on\nsteroid taper (planned through ___ that had been started at \ntime\nof RSV bronchitis. His dilt was increased from 180 to 240 due to\nintermittent afib with RVR, and Coumadin was continued. A ___\nwas placed for urinary retention, with follow-up planned with\nurology. \n\nBrief summary of rehab/ED course:\nPer discussion with the patient's son the patient had initially\ndone well in rehab but about 10 days ago seemed to have \ngradually\nworsening respiratory status. Per ___ records it appears that \nthe\npatient was started on azithromycin and steroids were increased\non ___. The patient presented to the ED on ___, where he was\nmanaged from ___. Per the ED dash the patient was \ninitially\nsent to the ED for abdominal distension and concern for \nrecurrent\nvolvulus. While in the ED the patient underwent CT scan that\nshowed lung opacification concerning for potential bilateral\npneumonia, and abdominal findings potentially consistent with\nintermittent sigmoid volvulus. He was managed with vanc/cefepime\nfor the pneumonia. He was passing bowel movements and so was not\nfelt to have active volvulus. He was also flu+, started on\nTamiflu. Also received IVFs, albuterol nebs, potassium for\nhypokalemia, and vitamin K for supratherapeutic INR. HRs from\n___, BPs ___, RR16-33, satting 92-98% on RA-3L.\n\n\nWhen seen on the floor both the patient and his son felt that \nhis\nbreathing had improved slightly since his arrival to the ED 2\ndays ago. He denied CP, abdominal pain, and endorsed bowel\nmovements since his arrival to ED (also had one during\nencounter). His son notes that the patient had not seemed to \nmake\nsignificant progress in rehab. He also reported that the patient\nwas somewhat disoriented for a time while in the ED.", 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Alendronate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QSUN', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dipyridamole-Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 3.9,. Estimated GFR = 11 if non African-American (mL/min/1.73 m2). Estimated GFR = 13 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65.5', 'valuenum': 65.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '345', 'valuenum': 345.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '831', 'valuenum': 831.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '422', 'valuenum': 422.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '595', 'valuenum': 595.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '301', 'valuenum': 301.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYZED SPECIMEN. VERIFIED.'}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.9', 'valuenum': 63.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION\n=========\nVital signs reviewed in flowsheet. \n___ 1814 Temp: 97.6 PO BP: 121/66 HR: 76 RR: 20 O2 sat: 96%\nO2 delivery: 3L NC Pain Score: ___\nGENERAL: Alert, appears mildly dyspneic\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma.\nsomewhat dry MMs\nCV: difficult to hear due to respiratory sounds\nRESP: loud bilateral rhonchi vs upper airway secretions\nGI: Abdomen soft, moderately distended, non-tender to palpation.\nTympanitic. Large loose brown bowel movement during encounter\nGU: No suprapubic tenderness\nMSK: No swollen or erythematous joints\nSKIN: scaly dry skin of BLE, scattered ecchymoses\nEXTR: wwp, no edema\nNEURO: Alert, interactive, face symmetric, gaze conjugate with\nEOMI, speech fluent, motor function grossly intact/symmetric;\na&ox3, ___ backwards intact\nPSYCH: pleasant, appropriate affect\n\nDISCHARGE\n==========\n98.1\nPO 95 / 54\nR Sitting 65 18 95 RA\nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma.\nOropharynx without visible lesion, erythema or exudate\nCV: Irreg irreg, no murmur\nRESP: Lungs relatively clear throughout\nGI: Abdomen soft, non-distended, non-tender to palpation\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities. LUE PICC in place.\nPSYCH: pleasant, appropriate affect\nNEUROLOGIC:\nMENTATION: alert and cooperative. Oriented to person and place\nand time.', 'diagnoses': [{'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '43820', 'desc': 'Late effects of cerebrovascular disease, hemiplegia affecting unspecified side'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '3310', 'desc': "Alzheimer's disease"}, {'icd_code': '29410', 'desc': 'Dementia in conditions classified elsewhere without behavioral disturbance'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '0413', 'desc': "Friedländer's bacillus infection in conditions classified elsewhere and of unspecified site"}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}], 'summary': 'ADMISSION:\n==========\n___ 06:20AM BLOOD WBC: 8.7 RBC: 2.99* Hgb: 9.8* Hct: 29.4*\nMCV: 98 MCH: 32.8* MCHC: 33.3 RDW: 16.2* RDWSD: 58.8* Plt Ct: \n187\n\n___ 06:20AM BLOOD ___: 92.8* PTT: 53.9* ___: 8.7*\n___ 04:32PM BLOOD ___: 26.2* PTT: 37.5* ___: 2.4*\n___ 06:20AM BLOOD Glucose: 61* UreaN: 15 Creat: 0.7 Na: 147\nK: 2.6* Cl: 106 HCO3: 23 AnGap: 18\n___ 04:10PM BLOOD Glucose: 147* UreaN: 16 Creat: 0.8 Na: \n147\nK: 3.1* Cl: 108 HCO3: 24 AnGap: 15\n___ 06:20AM BLOOD Calcium: 7.7* Phos: 3.1 Mg: 2.3\n\nLFTs WNL\nLactate 2.7\nBNP (___): 2231\nFlu B: positive\n\nStrep pneumo (___): pending\nLegionella (___): negative\nMRSA screen (___): pending\nBCx (___): pending\n\nDISCHARGE\n=========\nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD Plt \nCt \n___ 04:58 11.3* 2.95* 9.6* 28.7* 97 32.5* 33.4 16.4*\n58.2* \n BASIC COAGULATION ___, PTT, PLT, INR) ___ PTT Plt Smr Plt Ct \n___\n___ 05:16 38.1* 3.5*\nSource: Line-LUE PICC\n___ 04:58 242\nSource: Line-LUE PICC\n___ 04:58 26.2* 2.4*\nSource: Line-LUE PICC\n___ 06:23 25.6* 2.4*\nSource: Line-LUE PICC\n___ 05:44 25.8* 2.4*\nRENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap\n___ 05:16 3.9\nSource: Line-LUE PICC\n___ 04:58 193*1 23* 0.8 1422 3.1* ___\n\n___ 12:13 am STOOL CONSISTENCY: WATERY Source: \nStool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___:\n Negative for toxigenic C. difficile by the Cepheid nucleic \nacid\n amplification assay..\n (Reference Range-Negative).\n\nIMAGING:\n========\nCXR ___:\nLeft PICC terminates in the mid to lower SVC without\nevidence of pneumothorax. Left base opacity could be due to\natelectasis or pneumonia. Dedicated PA and lateral views be\nhelpful for further evaluation, if/when patient able.\n\nCT C/A/P ___:\n1. Increased opacification in the left lower lobe with \nsuggestion\nof air bronchograms, likely due to left lower lobe pneumonia.\nOpacification of the right base may represent atelectasis,\nalthough additional focus of pneumonia cannot be excluded.\n___ opacification in the posterior right upper lobe may\nrepresent infectious or inflammatory small airways disease.\nTrace bilateral pleural effusions, right greater than left.\nIntrathoracic examination is slightly limited due to respiratory\nmotion.\n2. Distension of the slightly proximal sigmoid colon with abrupt\ntransition and narrowing the distal colon. No swirling of the\nmesentery. No dilatation of the colon proximal to the sigmoid.\nThese findings raise the question of intermittent sigmoid\nvolvulus. No pneumatosis, free air, or free fluid.\n3. 2 small saccular aneurysms in the distal aorta, medially\nproximal to the common iliac bifurcation, measuring up to 3.0 cm\nin diameter.\n4. Moderate cardiomegaly.\n\nKUB ___\nDistended loop of colon the mid abdomen compatible with sigmoid\ncolon is in a similar configuration compared to prior exams\nthough slightly more distended, now up to 14 cm in diameter.\n___ year old man with afib on warfarin, AVB s/p PPM, recent \nadmission with RSV, sigmoid volvulus, and strep mitis \nbacteremia/suspected endocarditis, discharged to rehab on \n___ to complete course of CTX, who presented back from his \nrehab with abdominal distension and was found to have influenza \nB and likely bacterial PNA.\n\nBriefly, he was admitted to ___ ___ with RSV bronchitis \nand was treated with prednisone. He presented back to ___ \nwith MF PNA nad strep mitis bacteremia with suspected \nendocarditis (not confirmed w/TEE). He was found to have sigmoid \nvolvulus (thought chronic) s/p colonoscopic decompression with \nplan for outpatient GI/surgery f/u. He was started on CTX x ___nd continued on pred taper through ___, started for \nRSV bronchitis. His dilt was increased for afib w/RVR and a \n___ was placed for retention (w/plan for outpatient voiding \ntrial). He was at rehab for a short while when he developed more \nrespiratory symptoms and was started on aizthro/steroids again. \nHe was sent to the ED here at ___. On arrival, he had a CT \nC/A/P that showed no obstruction but likely intermittent \nvolvulus and b/l PNA. He was also flu + and started on Tamiflu. \n\n#Acute hypoxic respiratory failure\n#Suspected bacterial pneumonia due to strep pneumoniae\n#Influenza B\n#Metabolic encephalopathy (slight disorientation on ___\nPatient p/w hypoxia, found to have influenza B and LLL vs b/l LL\npneumonia. Given the potential occurrence of bacterial pneumonia\nwhile on ceftriaxone, he was started on cefepime/vanc in ED,\nalong with Tamiflu for influenza.\nDx:\n- Blood cultures NGTD\n- Strep pneumonia Ag urine is positive.\n- MRSA Swab negative, stopped IV vanc.\nTx:\n- Finished 5 day Tamiflu course on ___.\n- Finished 7 days of cefepime 2g q24h\n- His lungs were quite rhonchus and wheezy; IV steroids\nstarted on ___, stopped after ___, as his lungs are now\nCTAB. No oral steroids needed.\n- Now on room air.\n- He was on duonebs q6h + PRN albuterol\n\n# Hx sigmoid volvulus:\n# Abdominal distension:\n# Diarrhea:\nLikely intermittently occurring prior to admission. Currently\nwith abdominal distension and diarrhea without clear evidence of\nobstruction. Diarrhea chronic "for weeks," may be secondary to\nintermittent volvulus itself or antibiotic associated.\nDx:\n- C.diff check was negative.\n- GI/surgery follow-up as outpatient.\n- We discussed with GI fellow Dr. ___ on ___. There\nis no indication for repeat decompressive colonoscopy at this\ntime, based on patient\'s improved clinical status and\nintermittent sigmoid volvulus symptoms\n\n# Afib on Coumadin\n# History of DVT\n# Supratherapeutic INR\nINR up to ___ range on admission (likely abx/poor PO intake), \ns/p\nvitamin K in ED (5 mg on ___, 5 mg ___. \nTx:\n- On Coumadin, goal INR ___. It was INR 3.5 on ___ so no\nCoumadin given for ___.\n-Have uptitrated the diltiazem to 90 q6h PO for better rate\ncontrol while hospitalized. This can be converted to extended\nrelease at rehab.\n\n# Recent strep mitis bacteremia/suspected endocarditis:\nHas been on ceftriaxone 2G Q24 with planned course ___.\nWas\non cefepime since ___ to ___ for pneumonia treatment in \nlieu\nof the IV CTX. No TEE pursued on\nprior admission due to family preference given risk:benefit.\n-Discussed with ID fellow Dr. ___. No need for more \nsuppressive\nantibiotics for the presumed endocarditis. He has ID follow up\nvisit scheduled regardless.\n\n# Normocytic anemia:\nHgb 11.3 on discharge ___. Hgb 10.0 on admission and stable,\nwith low suspicion for active bleeding.\n\n# Urinary retention:\nReportedly failed voiding trial on ___. Repeat trial on \n___,\nfailed, so ___ reinserted. Needs urology follow up \n(scheduled).\n\n#Gout:\n- continuing home allopurinol\n\n#HL\n- continue statin\n\n#Narcolepsy\n- continue modafinil\n\n#CODE STATUS - FULL as per MOLST as well. Updated ___, the \nHCP,\non ___. \n#DIET - cardiac'}}
{'final_diagnoses': ['#Acute hypoxic respiratory failure', '#Suspected bacterial pneumonia due to strep pneumoniae', '#Influenza B', '#Metabolic encephalopathy (slight disorientation on ___, \nresolved)', '#History of sigmoid volvulus', '#Chronic diarrhea, possibly due to sigmoid voluvus or antibiotic \nassociated', '#Urinary retention', '#Afib on Coumadin', '#History of DVT', '#Supratherapeutic INR', '#Recent strep mitis bacteremia/suspected endocarditis:'], 'procedures': ['None'], 'visit_summary': '___ year old man with afib on warfarin, AVB s/p PPM, recent \nadmission with RSV, sigmoid volvulus, and strep mitis \nbacteremia/suspected endocarditis, discharged to rehab on \n___ to complete course of CTX, who presented back from his \nrehab with abdominal distension and was found to have influenza \nB and likely bacterial PNA.\n\nBriefly, he was admitted to ___ ___ with RSV bronchitis \nand was treated with prednisone. He presented back to ___ \nwith MF PNA nad strep mitis bacteremia with suspected \nendocarditis (not confirmed w/TEE). He was found to have sigmoid \nvolvulus (thought chronic) s/p colonoscopic decompression with \nplan for outpatient GI/surgery f/u. He was started on CTX x ___nd continued on pred taper through ___, started for \nRSV bronchitis. His dilt was increased for afib w/RVR and a \n___ was placed for retention (w/plan for outpatient voiding \ntrial). He was at rehab for a short while when he developed more \nrespiratory symptoms and was started on aizthro/steroids again. \nHe was sent to the ED here at ___. On arrival, he had a CT \nC/A/P that showed no obstruction but likely intermittent \nvolvulus and b/l PNA. He was also flu + and started on Tamiflu. \n\n#Acute hypoxic respiratory failure\n#Suspected bacterial pneumonia due to strep pneumoniae\n#Influenza B\n#Metabolic encephalopathy (slight disorientation on ___\nPatient p/w hypoxia, found to have influenza B and LLL vs b/l LL\npneumonia. Given the potential occurrence of bacterial pneumonia\nwhile on ceftriaxone, he was started on cefepime/vanc in ED,\nalong with Tamiflu for influenza.\nDx:\n- Blood cultures NGTD\n- Strep pneumonia Ag urine is positive.\n- MRSA Swab negative, stopped IV vanc.\nTx:\n- Finished 5 day Tamiflu course on ___.\n- Finished 7 days of cefepime 2g q24h\n- His lungs were quite rhonchus and wheezy; IV steroids\nstarted on ___, stopped after ___, as his lungs are now\nCTAB. No oral steroids needed.\n- Now on room air.\n- He was on duonebs q6h + PRN albuterol\n\n# Hx sigmoid volvulus:\n# Abdominal distension:\n# Diarrhea:\nLikely intermittently occurring prior to admission. Currently\nwith abdominal distension and diarrhea without clear evidence of\nobstruction. Diarrhea chronic "for weeks," may be secondary to\nintermittent volvulus itself or antibiotic associated.\nDx:\n- C.diff check was negative.\n- GI/surgery follow-up as outpatient.\n- We discussed with GI fellow Dr. ___ on ___. There\nis no indication for repeat decompressive colonoscopy at this\ntime, based on patient\'s improved clinical status and\nintermittent sigmoid volvulus symptoms\n\n# Afib on Coumadin\n# History of DVT\n# Supratherapeutic INR\nINR up to ___ range on admission (likely abx/poor PO intake), \ns/p\nvitamin K in ED (5 mg on ___, 5 mg ___. \nTx:\n- On Coumadin, goal INR ___. It was INR 3.5 on ___ so no\nCoumadin given for ___.\n-Have uptitrated the diltiazem to 90 q6h PO for better rate\ncontrol while hospitalized. This can be converted to extended\nrelease at rehab.\n\n# Recent strep mitis bacteremia/suspected endocarditis:\nHas been on ceftriaxone 2G Q24 with planned course ___.\nWas\non cefepime since ___ to ___ for pneumonia treatment in \nlieu\nof the IV CTX. No TEE pursued on\nprior admission due to family preference given risk:benefit.\n-Discussed with ID fellow Dr. ___. No need for more \nsuppressive\nantibiotics for the presumed endocarditis. He has ID follow up\nvisit scheduled regardless.\n\n# Normocytic anemia:\nHgb 11.3 on discharge ___. Hgb 10.0 on admission and stable,\nwith low suspicion for active bleeding.\n\n# Urinary retention:\nReportedly failed voiding trial on ___. Repeat trial on \n___,\nfailed, so ___ reinserted. Needs urology follow up \n(scheduled).\n\n#Gout:\n- continuing home allopurinol\n\n#HL\n- continue statin\n\n#Narcolepsy\n- continue modafinil\n\n#CODE STATUS - FULL as per MOLST as well. Updated ___, the \nHCP,\non ___. \n#DIET - cardiac', 'medications_prescribed': ['Diltiazem 90 mg PO Q6H', 'Psyllium Powder 1 PKT PO TID', 'Acetaminophen 650 mg PO Q6H:PRN Pain - Mild', 'Albuterol Inhaler 1 PUFF IH Q6H:PRN dyspnea', 'Allopurinol ___ mg PO DAILY', 'Atorvastatin 20 mg PO DAILY', 'Colchicine 0.6 mg PO BID:PRN Gout Flare', 'Docusate Sodium 100 mg PO DAILY', 'Dulera (mometasone-formoterol) 100-5 mcg/actuation \ninhalation BID', 'Finasteride 5 mg PO DAILY', 'Fish Oil (Omega 3) 1000 mg PO QAM', 'Fleet Enema (Saline) ___AILY:PRN constipation', 'Florastor (Saccharomyces bo___) 250 mg oral BID', 'Fluticasone Propionate NASAL 2 SPRY NU DAILY', 'GuaiFENesin ER 400 mg PO TID', 'Ipratropium-Albuterol Neb 1 NEB NEB Q4H', 'Milk of Magnesia 30 mL PO DAILY:PRN constipation', 'Modafinil 200 mg PO DAILY \nRX *modafinil 200 mg 1 tablet(s) by mouth once daily Disp #*5 \nTablet Refills:*0', 'One-A-Day Mens Multivitamin (multivit-min-folic-vit \nK-lycop) 400-20-300 mcg oral DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Senna 8.6 mg PO BID:PRN constipation', 'Tamsulosin 0.4 mg PO QHS', 'Vitamin B Complex 1 CAP PO BID', 'Vitamin D 400 UNIT PO QPM', 'Warfarin ___ mg PO DAILY16']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 63, 'gender': 'M', 'symptoms': 'L periprosthetic proximal femur fracture', 'medical_history': ["Alzheimer's dementia", 'HTN', 's/p Bilateral THAs'], 'family_history': 'NC', 'present_illness': "___ with Alzheimer's and HTN and history of bilateral THAs who\npresents as OSH transfer from ___ s/p fall at nursing \nhome\nwith L periprosthetic proximal femur fracture. The patient got \nup\nfrom bed, walked to her dresser, opened a drawer and somehow \nlost\nher balance and fell onto her left side. She had immediate left\nhip pain and inability to ambulate. Taken to ___ where\nx-rays showed L periprosthetic proximal femur fracture.\nTransferred to ___. Ortho consulted. Denies numbness/tingling\nor weakness.", 'medications': [{'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam - CIWA protocol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hepatitis A Vaccine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam - CIWA protocol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hepatitis B Vaccine (20 mcg/mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.2.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.2.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'POS*. First-time positive HCV Ab will automatically reflex HCV viral load.. See results in Chemistry section..'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.1, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '0.384', 'valuenum': 0.384, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '1.94', 'valuenum': 1.94, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.57', 'valuenum': 33.57, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Exam on admission:\nVitals: 98.1, 177/67, 74, 12, 96% RA\nGeneral: NAD, A&Ox2 (person, time)\n\nMini-cog assesment:\n - ___ draw: could not complete (ie, failure)\n - 3-word recall: could not complete (ie, failure)\n\nPsych: flat affect, poor eye contact\nMusculoskeletal:\n\nRight Lower Extremity:\nSkin clean - no abrasions, induration, ecchymosis\nThigh and leg compartments soft and compressible\nFires ___\nSensation intact to light touch sural, saphenous, tibial,\nsuperficial and deep peroneal nerve distributions\n1+ dorsal pedis and posterior tibial pulses\n\nLeft Lower extremity\n+leg shortened and externally rotated\nSkin clean - no abrasions, induration, ecchymosis\nThigh and leg compartments soft and compressible\nFires ___\nSensation intact to light touch sural, saphenous, tibial,\nsuperficial and deep peroneal nerve distributions\n1+ dorsal pedis and posterior tibial pulses\n\nExam on discharge:\n___\nGen: NAD\nLeft Lower extremity\nDressings c/d/i\nThigh and leg compartments soft and compressible\nFires ___\nSensation intact to light touch sural, saphenous, tibial,\nsuperficial and deep peroneal nerve distributions\n1+ dorsal pedis and posterior tibial pulses', 'diagnoses': [{'icd_code': 'F332', 'desc': 'Major depressive disorder, recurrent severe without psychotic features'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'F1120', 'desc': 'Opioid dependence, uncomplicated'}, {'icd_code': 'G4089', 'desc': 'Other seizures'}, {'icd_code': 'Z915', 'desc': 'Personal history of self-harm'}, {'icd_code': 'F1020', 'desc': 'Alcohol dependence, uncomplicated'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'M25552', 'desc': 'Pain in left hip'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'Z811', 'desc': 'Family history of alcohol abuse and dependence'}, {'icd_code': 'Z818', 'desc': 'Family history of other mental and behavioral disorders'}, {'icd_code': 'Z87820', 'desc': 'Personal history of traumatic brain injury'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'Z634', 'desc': 'Disappearance and death of family member'}, {'icd_code': 'Z560', 'desc': 'Unemployment, unspecified'}], 'summary': '___ 04:50AM BLOOD WBC-10.3 RBC-2.61* Hgb-8.3* Hct-25.0* \nMCV-96 MCH-31.8 MCHC-33.2 RDW-14.7 Plt ___\n___ 07:00AM BLOOD Neuts-87.2* Lymphs-8.2* Monos-3.7 Eos-0.4 \nBaso-0.6\n___ 04:50AM BLOOD Plt ___\n___ 02:24PM BLOOD ___ PTT-22.8* ___\n___ 04:50AM BLOOD Glucose-131* UreaN-32* Creat-1.3* Na-143 \nK-4.0 Cl-109* HCO3-24 AnGap-14\n___ 04:50AM BLOOD Calcium-7.9* Phos-1.9*# Mg-2.3\nThe patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have a left periprosthetic femur fracture and was admitted to \nthe orthopedic surgery service. The patient was taken to the \noperating room on ___ for open reduction and internal \nfixation, which the patient tolerated well (for full details \nplease see the separately dictated operative report). The \npatient was taken from the OR to the PACU in stable condition \nand after recovery from anesthesia was transferred to the floor. \n The patient was initially given IV fluids and IV pain \nmedications, and progressed to a regular diet and oral \nmedications by POD#1. The patient was given perioperative \nantibiotics and anticoagulation per routine. The patients home \nmedications were continued throughout this hospitalization. The \npatient worked with ___ who determined that discharge to rehab \nwas appropriate. The ___ hospital course was otherwise \nunremarkable.\n\nAt the time of discharge the patient was afebrile with stable \nvital signs that were within normal limits, pain was well \ncontrolled with oral medications, incisions were \nclean/dry/intact, and the patient was voiding/moving bowels \nspontaneously. The patient is touch-down weight bearing in the \nleft lower extremity, and will be discharged on lovenox for DVT \nprophylaxis. The patient will follow up in two weeks per \nroutine. A thorough discussion was had with the patient \nregarding the diagnosis and expected post-discharge course, and \nall questions were answered prior to discharge.'}}
{'final_diagnoses': ['Left periprosthetic femur fracture'], 'procedures': ['Open reduction and internal fixation of left periprosthetic \nfemur fracture'], 'visit_summary': 'The patient presented to the emergency department and was \nevaluated by the orthopedic surgery team. The patient was found \nto have a left periprosthetic femur fracture and was admitted to \nthe orthopedic surgery service. The patient was taken to the \noperating room on ___ for open reduction and internal \nfixation, which the patient tolerated well (for full details \nplease see the separately dictated operative report). The \npatient was taken from the OR to the PACU in stable condition \nand after recovery from anesthesia was transferred to the floor. \n The patient was initially given IV fluids and IV pain \nmedications, and progressed to a regular diet and oral \nmedications by POD#1. The patient was given perioperative \nantibiotics and anticoagulation per routine. The patients home \nmedications were continued throughout this hospitalization. The \npatient worked with ___ who determined that discharge to rehab \nwas appropriate. The ___ hospital course was otherwise \nunremarkable.\n\nAt the time of discharge the patient was afebrile with stable \nvital signs that were within normal limits, pain was well \ncontrolled with oral medications, incisions were \nclean/dry/intact, and the patient was voiding/moving bowels \nspontaneously. The patient is touch-down weight bearing in the \nleft lower extremity, and will be discharged on lovenox for DVT \nprophylaxis. The patient will follow up in two weeks per \nroutine. A thorough discussion was had with the patient \nregarding the diagnosis and expected post-discharge course, and \nall questions were answered prior to discharge.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H', 'Atenolol 37.5 mg PO DAILY', 'Furosemide 40 mg PO DAILY', 'Mirtazapine 30 mg PO HS', 'Lisinopril 2.5 mg PO DAILY', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp \n#*50 Tablet Refills:*0', 'Enoxaparin Sodium 30 mg SC Q24H \nStart: Today - ___, First Dose: Next Routine Administration \nTime \nRX *enoxaparin 30 mg/0.3 mL 30 mg SC once a day Disp #*14 \nSyringe Refills:*0', 'OxycoDONE (Immediate Release) 2.5 mg PO Q6H:PRN pain \nRX *oxycodone 5 mg 0.5 (One half) tablet(s) by mouth every six \n(6) hours Disp #*70 Tablet Refills:*0', 'Senna 8.6 mg PO DAILY \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp \n#*50 Tablet Refills:*0', 'Aspirin 81 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 65, 'gender': 'M', 'symptoms': 'Non healing infected ulcer left foot', 'medical_history': ['PMH: DM2 c/b retinopathy, Charcot LLE, PVD, CKD, HTN, HLD, \ndepression, chronic microcytic anemia, obesity, erectile \ndysfunction, hx bacteremia', 'PSH: R BKA ___, B/L ___ debridements, L shoulder surgery, s/p \nsurgical pin placement for L hip dislocation, herniorraphy'], 'family_history': 'Mother - Type 2 ___. Father - healthy', 'present_illness': '___ man with a history of diabetes and Charcot foot \ndeformity with open\nulceration and chronic, nonresponsive infection. In order to \nimprove the quality of his life, he desires to proceed with \namputation.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Clevidipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Clevidipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Esmolol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'CARVedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MOD*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '1.028', 'valuenum': 1.028, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.7', 'valuenum': 46.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.03, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 309.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.03, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.4', 'valuenum': 47.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.23', 'valuenum': 1.23, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '463', 'valuenum': 463.0, 'valueuom': 'mm 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'comments': '___'}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': None, 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 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None}, {'value': '1.25', 'valuenum': 1.25, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 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{'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.45', 'valuenum': 1.45, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 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'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional 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'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-6', 'valuenum': -6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'mm 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'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '74', 'valuenum': 74.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.9', 'valuenum': 49.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.5', 'valuenum': 49.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.7', 'valuenum': 48.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.21', 'valuenum': 1.21, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.5', 'valuenum': 48.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.4', 'valuenum': 46.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.60', 'valuenum': 3.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3, . estimated GFR (eGFR) is likely between 54 and 66 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '215', 'valuenum': 215.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.40', 'valuenum': 3.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.32', 'valuenum': 3.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.5', 'valuenum': 47.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Gen: WDWN male in NAD\nCard: RRR\nLungs: CTA bilat\nAbd: Soft no masses/tenderness\nExtremities: Bilat bka stumps c/d/i.', 'diagnoses': [{'icd_code': 'I714', 'desc': 'Abdominal aortic aneurysm, without rupture'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'I130', 'desc': 'Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'L97419', 'desc': 'Non-pressure chronic ulcer of right heel and midfoot with unspecified severity'}, {'icd_code': 'I5022', 'desc': 'Chronic systolic (congestive) heart failure'}, {'icd_code': 'N184', 'desc': 'Chronic kidney disease, stage 4 (severe)'}, {'icd_code': 'E440', 'desc': 'Moderate protein-calorie malnutrition'}, {'icd_code': 'Z681', 'desc': 'Body mass index [BMI] 19.9 or less, adult'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I083', 'desc': 'Combined rheumatic disorders of mitral, aortic and tricuspid valves'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'I255', 'desc': 'Ischemic cardiomyopathy'}, {'icd_code': 'I2720', 'desc': 'Pulmonary hypertension, unspecified'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'L89152', 'desc': 'Pressure ulcer of sacral region, stage 2'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'M542', 'desc': 'Cervicalgia'}, {'icd_code': 'G629', 'desc': 'Polyneuropathy, unspecified'}, {'icd_code': 'K3184', 'desc': 'Gastroparesis'}, {'icd_code': 'Z951', 'desc': 'Presence of aortocoronary bypass graft'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z45018', 'desc': 'Encounter for adjustment and management of other part of cardiac pacemaker'}], 'summary': '___ 05:53AM BLOOD Hct-25.2*\n___ 04:45AM BLOOD WBC-7.5 RBC-3.01* Hgb-7.9* Hct-24.4* \nMCV-81* MCH-26.3* MCHC-32.5 RDW-16.3* Plt ___\n___ 07:04AM BLOOD WBC-6.1 RBC-3.16* Hgb-8.3* Hct-26.2* \nMCV-83 MCH-26.1* MCHC-31.6 RDW-16.2* Plt ___\n___ 05:00AM BLOOD WBC-4.7 RBC-3.05* Hgb-8.1* Hct-24.5* \nMCV-81* MCH-26.5* MCHC-32.9 RDW-16.1* Plt ___\n___ 05:00AM BLOOD WBC-4.5 RBC-2.98* Hgb-8.0* Hct-24.0* \nMCV-80* MCH-26.9* MCHC-33.4 RDW-15.7* Plt ___\n___ 04:26AM BLOOD WBC-5.2 RBC-3.63* Hgb-9.5* Hct-29.3* \nMCV-81* MCH-26.1* MCHC-32.4 RDW-15.8* Plt ___\n___ 05:16AM BLOOD WBC-4.4 RBC-3.28* Hgb-8.5* Hct-26.4* \nMCV-81* MCH-25.9* MCHC-32.1 RDW-15.6* Plt ___\n___ 05:09AM BLOOD WBC-5.6 RBC-3.31* Hgb-8.5* Hct-27.0* \nMCV-82 MCH-25.7* MCHC-31.5 RDW-15.6* Plt ___\n___ 04:02PM BLOOD WBC-5.5 RBC-3.52* Hgb-9.2* Hct-28.5* \nMCV-81* MCH-26.0* MCHC-32.1 RDW-15.6* Plt ___\n___ 05:53AM BLOOD UreaN-40* Creat-1.9*\n___ 02:19PM BLOOD Glucose-50* UreaN-46* Creat-2.4* Na-143 \nK-4.8 Cl-106 HCO3-27 AnGap-15\n___ 04:45AM BLOOD Glucose-180* UreaN-47* Creat-2.5* Na-139 \nK-5.1 Cl-103 HCO3-26 AnGap-15\n___ 10:00PM BLOOD UreaN-48* Creat-2.7*\n___ 07:04AM BLOOD Glucose-298* UreaN-42* Creat-2.7* Na-138 \nK-5.0 Cl-99 HCO3-28 AnGap-16\n___ 05:00AM BLOOD Glucose-194* UreaN-28* Creat-1.9* Na-138 \nK-4.8 Cl-102 HCO3-29 AnGap-12\n___ 05:00AM BLOOD Glucose-186* UreaN-26* Creat-1.8* Na-140 \nK-4.6 Cl-105 HCO3-28 AnGap-12\n___ 04:26AM BLOOD Glucose-183* UreaN-30* Creat-2.0* Na-139 \nK-5.0 Cl-104 HCO3-26 AnGap-14\n___ 04:26AM BLOOD Glucose-183* UreaN-30* Creat-2.0* Na-139 \nK-5.0 Cl-104 HCO3-26 AnGap-14\n___ 05:16AM BLOOD Glucose-109* UreaN-36* Creat-2.0* Na-142 \nK-5.0 Cl-108 HCO3-27 AnGap-12\n___ 05:09AM BLOOD Glucose-75 UreaN-45* Creat-1.9* Na-141 \nK-4.8 Cl-109* HCO3-24 AnGap-13\n___ 04:02PM BLOOD Glucose-104* UreaN-52* Creat-1.9* Na-140 \nK-5.0 Cl-109* HCO3-23 AnGap-13\n___ 12:30AM URINE Hours-RANDOM Creat-155 Na-25 K-49 Cl-27 \nHCO3-LESS THAN \n___ with L Charcot foot and chronic infection who presented for \na planned L BKA for definitive managment of his significant LLE \nproblems. On ___ day of admission he underwent a L below \nknee guillotine amputation as part of a 2-stage operation. \nPostoperatively he did well and was placed on a regular diet and \nnarcotic pain medicines with daptomycin, cefepime, and flagyl \nfor broad spectrum antibiotic coverage per the infectious \ndiseases team. His hematocrit remained stable in the post-op \nperiod (had 250cc blood loss during operation). On ___ his \ndressing was taken down and his amputation was evaluated for \nclosure potential and found to have significantly decreased \nswelling and edema than before the guillotine amputation and it \nwas determined that he would be ready to have his completion L \nBKA the following day. On ___ he underwent a completion L \nbelow knee amputation. Postoperatively he had severe pain at his \namputation site in the PACU, so L femoral and popliteal blocks \nwere performed by anesthesia with some effect, and his dressing \nwas taken down sterilly in the PACU to ensure his pain was not \nbeing caused by a developing hematoma or other wound issue and \nnone was identified. He was hemodynamically stable and \ntranferred to the floor where his diet was advanced to regular \nand he was placed on his home medicines and his pain was \ncontrolled with narcotic pain medicines. ___ and OT consults were \nplaced for immediate rehabilitation of his new amputation, and \nhe was encouraged to keep his knee straight as much as possible \nwhen at rest to prevent contracture. He did continue to struggle \nwith post-op pain issues, which were managed by the acute pain \nservice. The infectious diseases team continued to follow him, \nand determined that given his definitive surgical management \nthat his antibiotics could be discontinued 48 hours \npost-operatively with close monitoring of his surgical site for \nevidence of infection. He did have a bump in his creatinine \nseveral days post op, and was seen by the renal team. He was \nstarted on iv fluids, and creatinine returned to normal within 2 \ndays. He was also tranfsued 2 units of blood while in house for \nacute blood loss anemia. An h/h should be followed up at rehab \nin a few days. He was deemed stable for d/c on ___ with 10 days \nof keflex. He will follow up in the office for wound check and \nstaple removal.'}}
{'final_diagnoses': ['Peripheral arterial disease', 'Non healing ulcer left lower extremity', 'Diabetes', 'Acute blood loss anemia'], 'procedures': ['___: Left below the knee guillotine amputation', '___: Left below the knee amputation closure'], 'visit_summary': '___ with L Charcot foot and chronic infection who presented for \na planned L BKA for definitive managment of his significant LLE \nproblems. On ___ day of admission he underwent a L below \nknee guillotine amputation as part of a 2-stage operation. \nPostoperatively he did well and was placed on a regular diet and \nnarcotic pain medicines with daptomycin, cefepime, and flagyl \nfor broad spectrum antibiotic coverage per the infectious \ndiseases team. His hematocrit remained stable in the post-op \nperiod (had 250cc blood loss during operation). On ___ his \ndressing was taken down and his amputation was evaluated for \nclosure potential and found to have significantly decreased \nswelling and edema than before the guillotine amputation and it \nwas determined that he would be ready to have his completion L \nBKA the following day. On ___ he underwent a completion L \nbelow knee amputation. Postoperatively he had severe pain at his \namputation site in the PACU, so L femoral and popliteal blocks \nwere performed by anesthesia with some effect, and his dressing \nwas taken down sterilly in the PACU to ensure his pain was not \nbeing caused by a developing hematoma or other wound issue and \nnone was identified. He was hemodynamically stable and \ntranferred to the floor where his diet was advanced to regular \nand he was placed on his home medicines and his pain was \ncontrolled with narcotic pain medicines. ___ and OT consults were \nplaced for immediate rehabilitation of his new amputation, and \nhe was encouraged to keep his knee straight as much as possible \nwhen at rest to prevent contracture. He did continue to struggle \nwith post-op pain issues, which were managed by the acute pain \nservice. The infectious diseases team continued to follow him, \nand determined that given his definitive surgical management \nthat his antibiotics could be discontinued 48 hours \npost-operatively with close monitoring of his surgical site for \nevidence of infection. He did have a bump in his creatinine \nseveral days post op, and was seen by the renal team. He was \nstarted on iv fluids, and creatinine returned to normal within 2 \ndays. He was also tranfsued 2 units of blood while in house for \nacute blood loss anemia. An h/h should be followed up at rehab \nin a few days. He was deemed stable for d/c on ___ with 10 days \nof keflex. He will follow up in the office for wound check and \nstaple removal.', 'medications_prescribed': ['1. Amlodipine 5 mg PO DAILY', '2. Aspirin EC 81 mg PO DAILY', '3. Atorvastatin 20 mg PO DAILY', '4. Carvedilol 12.5 mg PO BID', '5. Gabapentin 600 mg PO Q12H', '6. Ranitidine 150 mg PO HS', '7. Fluoxetine 20 mg PO DAILY', '8. Cephalexin 500 mg PO Q8H Duration: 10 Days', '9. Furosemide 20 mg PO DAILY', '10. Oxycodone SR (OxyconTIN) 30 mg PO Q8H', '11. Senna 1 TAB PO BID:PRN constipation', '12. Glargine 40 Units Breakfast\nGlargine 66 Units Bedtime\nHumalog 25 Units Breakfast\nHumalog 25 Units Lunch\nHumalog 25 Units Dinner\nInsulin SC Sliding Scale using HUM Insulin', '13. Hydrocodone-Acetaminophen (5mg-500mg) 1.5 TAB PO Q4H:PRN \npain', '14. Ferrous Sulfate 325 mg PO BID', '15. Docusate Sodium 100 mg PO BID', '16. Bisacodyl 10 mg PO/PR DAILY:PRN constipation', '17. Polyethylene Glycol 17 g PO DAILY:PRN constipation']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Fever, headaches and shortness of breath', 'medical_history': ['- Mitral stenosis s/p valvuloplasty in ___', '- RESTLESS LEG Syndrome', '- OSTEOARTHRITIS', '- Low back pain', '- VITAMIN D DEFICIENCY', '- HYPOTHYROIDISM', '- s/p appy, LKR'], 'family_history': '2 brothers and 1 sister all healthy\nmaternal and paternal aunts/uncles all died in their ___', 'present_illness': '___ w/ hx of Mitral valvuloplasty, afib p/w fevers, HA, SOB. Pt \njust\ndischarged from BI today after cardioversion preceded by TEE.\nProcedure was successful and she was discharged home. Later this\nafternoon she developed frontal HA, not worst of life, gradual\nonset. She also felt warm and felt SOB w/ exertion. She denies\nany CP, blurry vision, weakness, numbness, abd pain, N, V. No ___ pain or swelling. She reports a similar reaction \n(fevers/chills/headaches)\nafter mitral valvuloplasty.\nThere is no history of lightheadedness, palpitations, syncope,\northopnea, PND or increasing lower extremity edema.', 'medications': [{'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dabigatran Etexilate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'METHADONE ASSAY DETECTS ONLY METHADONE (NOT OTHER OPIATES/OPIOIDS).'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OPIATE IMMUNOASSAY SCREEN DOES NOT DETECT SYNTHETIC OPIOIDS;SUCH AS METHADONE, OXYCODONE, FENTANYL, BUPRENORPHINE, TRAMADOL,;NALOXONE, MEPERIDINE. SEE ONLINE LAB MANUAL FOR DETAILS.'}], 'exams': "ADMISSION:\nVitals: 159/94 pulse 106 beats/min and regular. rr 12 \nbreaths/min.\nGeneral: well developed, well nourished and well groomed. The \npatient\nwas oriented to person, place and time. The patient's mood and\naffect were not inappropriate.\nHEENT: no icterus. The mucous membranes were moist and pink.\nThe neck was supple with JVP of 5 cm and no thyromegaly. The\nwere no chest wall deformities. \nRESPIRATORY: effort was normal.CTAB with bibasilar crackles a \nbit bronchiolar BS.\nHEART: PMI to be located in the ___ intercostal space, mid clavicular line. There were no thrills,lifts or palpable S3 or S4.normal S1 and the S2 was normal. There were no rubs, murmurs, clicks or gallops.\nABDOMEN: no hepatosplenomegaly, pulsatile mass, or tenderness.\nThere were no abdominal aortic, femoral or carotid bruits. \nExtremities:no cyanosis, clubbing or edema. \nskin and subcutaneous tissue showed no stasis dermatitis, ulcers, or xanthomas. \nThe gait and muscle tone were grossly normal.\nPulses:\nRight: Carotid 2+ Femoral 2+ DP 2+ ___ 2+\nLeft: Carotid 2+ Femoral 2+ DP 2+ ___ 2+\n\nDISCHARGE:\nVS: T=99.1 BP=113/57 HR=72 RR=18 O2 sat=94%RA \nGENERAL: Alert and oriented x 3. NAD\nNECK: Supple. No appreciable JVD \nCARDIAC: Regular rhythm. no appreciable murmurs\nLUNGS: CTAB with good air entry\nEXTREMITIES: No c/c/e. \nRight: 2+ DP 2+ radial \nLeft: 2+ DP 2+ radial", 'diagnoses': [{'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '28521', 'desc': 'Anemia in chronic kidney disease'}, {'icd_code': '7820', 'desc': 'Disturbance of skin sensation'}, {'icd_code': '72989', 'desc': 'Other musculoskeletal symptoms referable to limbs'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '53390', 'desc': 'Peptic ulcer of unspecified site, unspecified as acute or chronic, without mention of hemorrhage or perforation, without mention of obstruction'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': '___ 09:50PM BLOOD WBC-17.5*# RBC-4.53 Hgb-13.5 Hct-40.7 \nMCV-90 MCH-29.8 MCHC-33.2 RDW-12.2 Plt ___\n___ 06:00AM BLOOD WBC-12.2* RBC-3.96* Hgb-11.7* Hct-36.0 \nMCV-91 MCH-29.6 MCHC-32.5 RDW-12.2 Plt ___\n___ 07:20AM BLOOD WBC-9.3 RBC-4.24 Hgb-12.6 Hct-39.3 MCV-93 \nMCH-29.7 MCHC-32.0 RDW-12.2 Plt ___\n___ 05:00AM BLOOD Neuts-74.1* Lymphs-17.1* Monos-5.5 \nEos-2.6 Baso-0.7\n___ 09:50PM BLOOD Neuts-86.0* Lymphs-8.5* Monos-4.0 Eos-1.1 \nBaso-0.3\n___ 09:50PM BLOOD Glucose-120* UreaN-19 Creat-0.9 Na-134 \nK-4.4 Cl-99 HCO3-24 AnGap-15\n___ 06:00AM BLOOD Glucose-106* UreaN-19 Creat-1.0 Na-136 \nK-3.8 Cl-104 HCO3-25 AnGap-11\n___ 07:20AM BLOOD Glucose-108* UreaN-16 Creat-0.9 Na-136 \nK-4.7 Cl-100 HCO3-28 AnGap-13\n\n \n___ 9:28 ___\nCHEST (PA & LAT) \n \nFINDINGS: Compared with the prior examination, there is significant increase in conspicuity of interstitial markings, more pronounced in the lung bases, with indistinctness of the hila. There might be small bilateral pleural effusion, which were not clearly seen in the prior exam. There is no pneumothorax. Unchanged cardiomegaly. \n \nIMPRESSION: Constellation of findings compatible with mild interstitial \nedema.\n___ yo female with a h/o mitral stenosis s/p valvuloplasty in ___ and recent admission for new-onset atrial fibrillation s/p \nTEE/cardioversion (discharged ___ who presents with shortness \nof breath, fevers and headache. \n\n# Fevers/chills and HA - Patient has had similar symptoms with prior sedation. Likely reaction to anesthetics. Was treated symptomatically with tylenol and prn antiemetics. No evidence of infection; CXR mild edema on ___. U/A neg. blood cx ___ growth so far at discharge. Febrile episodes resolved and headaches subsided. Leukocytosis resolved. \n\n# Shortness of breath - CXR is significantly worse from prior to admission and consistent with pulmonary edema. Likely ___ to post cardioversion depression of cardiac output. No further O2 requirements after diuresis and improving SOB\nTreated with IV furosemide and switch to po furosemide. \n \n# Atrial fibrillation - Resolved s/p cardioversion. Continued amiodarone to help maintain sinus rhythm and rivaroxaban for anticoagulation\n \n# Hypothyroidism: continued levothyroxine \n\nTRANSITIONAL ISSUES:\nStarted on po furosemide upon discharge due to pulmonary edema \nwith increased SOB. ___ require chronic low dose diuretic therapy.'}}
{'final_diagnoses': ['Febrile illness and headache ___ anesthesia', 'Mitral stenosis s/p valvuloplasty', 'Atrial fibrillation'], 'procedures': ['none'], 'visit_summary': '___ yo female with a h/o mitral stenosis s/p valvuloplasty in ___ and recent admission for new-onset atrial fibrillation s/p \nTEE/cardioversion (discharged ___ who presents with shortness \nof breath, fevers and headache. \n\n# Fevers/chills and HA - Patient has had similar symptoms with prior sedation. Likely reaction to anesthetics. Was treated symptomatically with tylenol and prn antiemetics. No evidence of infection; CXR mild edema on ___. U/A neg. blood cx ___ growth so far at discharge. Febrile episodes resolved and headaches subsided. Leukocytosis resolved. \n\n# Shortness of breath - CXR is significantly worse from prior to admission and consistent with pulmonary edema. Likely ___ to post cardioversion depression of cardiac output. No further O2 requirements after diuresis and improving SOB\nTreated with IV furosemide and switch to po furosemide. \n \n# Atrial fibrillation - Resolved s/p cardioversion. Continued amiodarone to help maintain sinus rhythm and rivaroxaban for anticoagulation\n \n# Hypothyroidism: continued levothyroxine \n\nTRANSITIONAL ISSUES:\nStarted on po furosemide upon discharge due to pulmonary edema \nwith increased SOB. ___ require chronic low dose diuretic therapy.', 'medications_prescribed': ['1. Amiodarone 400 mg PO TID', '2. Levothyroxine Sodium 25 mcg PO DAILY', '3. pramipexole 0.5 mg Oral qhs', '4. Rivaroxaban 20 mg PO DAILY', '5. TraMADOL (Ultram) 50 mg PO Q8H:PRN pain', '6. Vitamin D 5000 UNIT PO DAILY', '7. Acetaminophen 1000 mg PO Q6H:PRN pain', '8. Furosemide 20 mg PO DAILY', 'RX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Hypoglycemia', 'medical_history': ['-Type 2 diabetes', '-Chronic renal insufficiency', '-Cataracts', '-Anxiety', '-Hammer toe status post removal', '-Tonsillectomy', '-Adenoidectomy', '-Coronary artery disease w/ CABG in ___', '-Congestive heart failure', '-Atrial fibrillation', '-Arthritis', '-status post ICD placement', '- Dementia', '- Depression w/ psychosis', '- h.o. ___'], 'family_history': 'Noncontributory', 'present_illness': "___ yo male with history of DM, CAD, CHF w/ PPM, PVD s/p L BKA in \n \n___ presents with hypoglycemic episode. The patient had \nwalked to dining room this AM and reportedly had two episodes of \nincontinence and fell asleep. The patient was lethargic and was \ndifficult to arouse. The patient's BS was 20 and received got \nglucose and glucagon. The patient went to an OSH and got D50 \nthere and had BS in 500s. Because of the elevated BS, patient \ngot 40u Insulin IV and got potassium and the became hypoglycemic \nagain. CT Head at OSH was normal. \n\nAt the ___ ED, patient's Initiial VS: 96.7 60 136/80 18 99%RA. \nPatient has an old R necrotic heel ulcer that was warm and \nerythematous. The patient got Vancomycin at ___ and and got \nlevaquin at OSH for ?UTI. XRay of R foot negative for osteo. On \ntransfer, VS: 97.1, 60,173/98, 100%RA. ", 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetronidAZOLE Topical 1 % Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Betamethasone Valerate 0.1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.5', 'valuenum': 79.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '582', 'valuenum': 582.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 61 if non African-American (mL/min/1.73 m2). Estimated GFR = 74 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (THESE UNITS) = 0.08 (% BY WEIGHT).'}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.014', 'valuenum': 1.014, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '60', 'valuenum': 60.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '517', 'valuenum': 517.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.45', 'valuenum': 3.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '378', 'valuenum': 378.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '197', 'valuenum': 197.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '151', 'valuenum': 151.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1157', 'valuenum': 1157.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '543', 'valuenum': 543.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '621', 'valuenum': 621.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VSs: Tm 98.7, BP 118-127/46-50, HR 61-66, RR ___, Sat 93-95% \nCBG: 142, 173, 168, 244 \nGENERAL: Elderly gentleman sitting up in bed in NARD. \nCARDIAC: S1,S2, regular rate, III/VI systolic ejection murmur \nPULMONARY: Bibasilar crackles noted otherwise CTA. \nABDOMEN: soft, ND, NT, +BS \nEXTREMITIES: Left - BKA, slightly tender to touch. RLE - \ncurrently dressed, drssing c/d/i, in heel boot. \nNEURO: CN II-XII grossly intact, orientated x 3 \nPSYCH: Pt is calm and compliant with examination ', 'diagnoses': [{'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '5939', 'desc': 'Unspecified disorder of kidney and ureter'}], 'summary': "___ 09:30AM BLOOD WBC-8.5 RBC-3.42* Hgb-10.6* Hct-32.8* \nMCV-96 MCH-31.0 MCHC-32.2 RDW-17.6* Plt ___\n___ 10:25AM BLOOD WBC-9.0 RBC-3.06* Hgb-9.7* Hct-29.1* \nMCV-95 MCH-31.8 MCHC-33.5 RDW-17.0* Plt ___\n___ 09:55AM BLOOD WBC-6.1 RBC-3.29* Hgb-10.1* Hct-31.7* \nMCV-96 MCH-30.8 MCHC-31.9 RDW-17.0* Plt ___\n___ 06:05PM BLOOD WBC-8.0 RBC-3.52* Hgb-11.1* Hct-33.9* \nMCV-96 MCH-31.5 MCHC-32.6 RDW-17.7* Plt ___\n___ 09:30AM BLOOD ___ PTT-33.1 ___\n___ 10:25AM BLOOD ___ PTT-31.1 ___\n___ 06:09PM BLOOD ___ PTT-35.3* ___\n___ 09:30AM BLOOD Glucose-165* UreaN-20 Creat-1.0 Na-140 \nK-3.7 Cl-102 HCO3-31 AnGap-11\n___ 10:25AM BLOOD Glucose-237* UreaN-18 Creat-1.0 Na-139 \nK-3.7 Cl-103 HCO3-27 AnGap-13\n___ 09:55AM BLOOD Glucose-240* UreaN-19 Creat-1.0 Na-142 \nK-3.9 Cl-104 HCO3-29 AnGap-13\n___ 06:05PM BLOOD Glucose-125* UreaN-24* Creat-1.0 Na-143 \nK-3.9 Cl-105 HCO3-29 AnGap-13\n___ 06:05PM BLOOD CK(CPK)-74\n___ 09:30AM BLOOD Calcium-8.4 Phos-2.7 Mg-2.0\n___ 10:25AM BLOOD Calcium-8.0* Phos-1.9* Mg-1.___\nyo male with history of dementia, depressio with psychosis, \nDM II, CAD, CHF w/ PPM, PVD s/p L BKA in ___ presents with \nhypoglycemic episode. \n\n# Hypoglycemia: Pt was referred to the ED and subsequently \nadmitted for his episode of hypoglycemia at ___. His \nepisode of hypoglycemia is likely a combination of him taking \nhis 70/30 Insulin without eating and also his urinary tract \ninfection. During his hospitalization he was maintained on an \ninsulin sliding scale.\n- recommend continuing on Insulin Humalog sliding scale only\n\n# Emesis: Pt had 2 episodes of emesis yesterday. Upon discussion \nwith the patient and his daughter this is due to his reflux \nepisodes. He also was started on Clindamycin yesterday which may \nhave aggravated his reflux. He was started on Ranitidine 150mg \ndaily, Maalox PRN. The Clindamycin was also changed to Keflex. \nPrior to his discharge he was able to tolerate dinner and \nbreakfast without any episodes.\n- recommend continuing on Maalox four times a day PRN\n- recommend continuing Ranitidine 150mg daily\n- recommend patient follow up with his appointment with his \ngastroenterologist Dr. ___\n \n# R Heel ulcer: Patient's Right heel has a chronic ulcer that \nappeared mildly erythematous. Vascular surgery were consulted \nbut did not need to debride the ulcer. Pt was initially on IV \nVancomycin in addition to the Levofloxacin. Patient was changed \nto Clindamycin and the Keflex per Vascular recommendations. He \nhas a follow up appointment with Dr. ___. \n-Recommend continuing Keflex for the next 6 days, his last dose \nwill be on ___ (total 10 days of treatment)\n-Recommend he follow up with his appointment to see Dr. ___. \n\n# Dementia/Depression w/ Psychosis: During his admission he was \naccidently told by the Vascular Consult team that he could go \nhome (instead of rehab). Pt perseverated on this even after he \nwas told that it was the medicine team who were his doctors and \n___ would be better served at ___. Patient became \nverbally aggressive several times, however after his family \nvisited him and explained his situation he calmed down. He has \nsince apologized and stated he was just disappointed he could \nnot be home with his wife.\n- Continued him on his pre-hospitalization regimen of Buspirone, \nDepakote, Trazadone, Paxil\n\n# Coronary Artery Diseas: Stable during hospitalization. He was \ncontinued on his regimen of ASA, Statin, Carvedilol, Isosorbide, \nPlavix\n\n# Paroxysmal Atrial Fibrillation: Pt currently on Digoxin and \nCoumadin. Recommend that he have his INR check once a week to \nmaintain an INR goal of ___. \n\n#. H/o dCHF: He was continued on his home regimen of Furosemide."}}
{'final_diagnoses': ['Hypoglycemia', 'Urinary Tract Infection', 'Right lower leg ulcer', 'Dementia', 'Depression'], 'procedures': ['None'], 'visit_summary': "yo male with history of dementia, depressio with psychosis, \nDM II, CAD, CHF w/ PPM, PVD s/p L BKA in ___ presents with \nhypoglycemic episode. \n\n# Hypoglycemia: Pt was referred to the ED and subsequently \nadmitted for his episode of hypoglycemia at ___. His \nepisode of hypoglycemia is likely a combination of him taking \nhis 70/30 Insulin without eating and also his urinary tract \ninfection. During his hospitalization he was maintained on an \ninsulin sliding scale.\n- recommend continuing on Insulin Humalog sliding scale only\n\n# Emesis: Pt had 2 episodes of emesis yesterday. Upon discussion \nwith the patient and his daughter this is due to his reflux \nepisodes. He also was started on Clindamycin yesterday which may \nhave aggravated his reflux. He was started on Ranitidine 150mg \ndaily, Maalox PRN. The Clindamycin was also changed to Keflex. \nPrior to his discharge he was able to tolerate dinner and \nbreakfast without any episodes.\n- recommend continuing on Maalox four times a day PRN\n- recommend continuing Ranitidine 150mg daily\n- recommend patient follow up with his appointment with his \ngastroenterologist Dr. ___\n \n# R Heel ulcer: Patient's Right heel has a chronic ulcer that \nappeared mildly erythematous. Vascular surgery were consulted \nbut did not need to debride the ulcer. Pt was initially on IV \nVancomycin in addition to the Levofloxacin. Patient was changed \nto Clindamycin and the Keflex per Vascular recommendations. He \nhas a follow up appointment with Dr. ___. \n-Recommend continuing Keflex for the next 6 days, his last dose \nwill be on ___ (total 10 days of treatment)\n-Recommend he follow up with his appointment to see Dr. ___. \n\n# Dementia/Depression w/ Psychosis: During his admission he was \naccidently told by the Vascular Consult team that he could go \nhome (instead of rehab). Pt perseverated on this even after he \nwas told that it was the medicine team who were his doctors and \n___ would be better served at ___. Patient became \nverbally aggressive several times, however after his family \nvisited him and explained his situation he calmed down. He has \nsince apologized and stated he was just disappointed he could \nnot be home with his wife.\n- Continued him on his pre-hospitalization regimen of Buspirone, \nDepakote, Trazadone, Paxil\n\n# Coronary Artery Diseas: Stable during hospitalization. He was \ncontinued on his regimen of ASA, Statin, Carvedilol, Isosorbide, \nPlavix\n\n# Paroxysmal Atrial Fibrillation: Pt currently on Digoxin and \nCoumadin. Recommend that he have his INR check once a week to \nmaintain an INR goal of ___. \n\n#. H/o dCHF: He was continued on his home regimen of Furosemide.", 'medications_prescribed': ['1. Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours) for 6 days: Your last dose will be on ___. ', '2. Cephalexin 500 mg Capsule Sig: One (1) Capsule PO Q6H (every \n6 hours) for 6 days: Your last dose will be on ___. ', '3. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '4. Ecotrin Low Strength 81 mg Tablet, Delayed Release (E.C.) \nSig: One (1) Tablet, Delayed Release (E.C.) PO once a day. ', '5. Warfarin 1 mg Tablet Sig: Three (3) Tablet PO Once Daily at 4 \n___. ', '6. Carvedilol 12.5 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day). ', '7. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '8. Furosemide 40 mg Tablet Sig: One (1) Tablet PO three times a \nday. ', '9. Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). ', '10. Simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '11. Gabapentin 400 mg Capsule Sig: One (1) Capsule PO Q 8H \n(Every 8 Hours). ', '12. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. ', '13. Multivitamin Tablet Sig: One (1) Tablet PO once a day. ', '14. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO once a day. ', '15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for constipation. ', '16. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime). ', '17. Paroxetine HCl 20 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '18. Trazodone 50 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for insomnia. ', '19. Divalproex ___ mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO TID (3 times a day). ', '20. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily): 12 \nhours on during day 12 hours off during night. ', '21. Buspirone 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday). ', '22. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '23. Methyl Salicylate-Menthol Ointment Sig: One (1) Appl \nTopical BID (2 times a day) as needed for shoulder pain. ', '24. Alum-Mag Hydroxide-Simeth 200-200-20 mg/5 mL Suspension Sig: \n___ MLs PO QID (4 times a day) as needed for indigestion. ', '25. Insulin Lispro 100 unit/mL Solution Sig: One (1) unit \nSubcutaneous ASDIR (AS DIRECTED): per sliding scale.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'Gangrene', 'medical_history': ['PVD', 'CAD', 'HTN', 'COCAINE ABUSE', 'LOWER BACK PAIN'], 'family_history': 'Mother had diabetes ___.', 'present_illness': 'Mr. ___ is a ___ with a history of PVD s/p right-sided \nabove-knee popliteal-to-dorsalis pedis bypass graft in ___ and \nrecent angiogram showing occlusion proximal to graft who \npresents with right foot pain.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Psyllium Powder', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'BuPROPion XL (Once Daily)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Nasacort', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Symbicort', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'INHALATION', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Amphetamine-Dextroamphetamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '39', 'valuenum': 39.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '215', 'valuenum': 215.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.7', 'valuenum': 44.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION/DISCHARGE EXAM:\nVS 98.1 76 145/87 20 98%RA\nGen: Well appearing ___ gentleman, in NAD\nHEENT: Sclera anicteric, MMM, oropharynx clear, pinpoint pupils \nsluggishly reactive to light, EOMI\nNeck: Supple, JVP not elevated\nCV: RRRR, normal s1/s2, no ___: CTAB, no wheezes, rales, rhonchi\nAbdomen: Soft, NTND, +BS\nExt: Warm, DP and ___ pulses not palpable bilaterally (per RN \nbilateral DP pulses were dopplerable) no edema\nSkin: Right great toe amputated, black area of blistering over \nhealed scar, black skin across proximal second digits, very \ntender to palpation, sensation intact\nNeuro. Alert and oriented, moving all extremities normally', 'diagnoses': [{'icd_code': 'K623', 'desc': 'Rectal prolapse'}, {'icd_code': 'Q438', 'desc': 'Other specified congenital malformations of intestine'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'G43909', 'desc': 'Migraine, unspecified, not intractable, without status migrainosus'}, {'icd_code': 'I7300', 'desc': "Raynaud's syndrome without gangrene"}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z981', 'desc': 'Arthrodesis status'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R918', 'desc': 'Other nonspecific abnormal finding of lung field'}], 'summary': '___ 10:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 10:00PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 10:00PM URINE GR HOLD-HOLD\n___ 10:00PM URINE UHOLD-HOLD\n___ 10:00PM URINE HOURS-RANDOM\n___ 10:00PM URINE HOURS-RANDOM\n___ 11:39PM ___ PTT-33.7 ___\n___ 11:39PM PLT COUNT-345\n___ 11:39PM NEUTS-37.6 ___ MONOS-10.1 EOS-3.5 \nBASOS-0.8 IM ___ AbsNeut-1.50* AbsLymp-1.90 AbsMono-0.40 \nAbsEos-0.14 AbsBaso-0.03\n___ 11:39PM WBC-4.0 RBC-4.36* HGB-12.3* HCT-37.2* MCV-85 \nMCH-28.2 MCHC-33.1 RDW-13.6 RDWSD-42.4\n___ 11:39PM estGFR-Using this\n___ 11:39PM GLUCOSE-80 UREA N-20 CREAT-1.4* SODIUM-139 \nPOTASSIUM-4.0 CHLORIDE-103 TOTAL CO2-22 ANION GAP-18\n\nDISCHARGE LABS:\n\n___ 02:38AM LACTATE-1.0\n___ 08:25AM PLT COUNT-334\n___ 08:25AM WBC-4.0 RBC-4.22* HGB-12.1* HCT-35.8* MCV-85 \nMCH-28.7 MCHC-33.8 RDW-13.7 RDWSD-42.2\n___ 08:25AM CALCIUM-9.5 PHOSPHATE-3.4 MAGNESIUM-2.2\n___ 08:25AM GLUCOSE-90 UREA N-15 CREAT-1.3* SODIUM-139 \nPOTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-27 ANION GAP-13\n___ 08:25AM CALCIUM-9.5 PHOSPHATE-3.4 MAGNESIUM-2.2\n\nMICRO: Bcx x2 negative\n\nIMAGING: None\n#Peripheral vascular disease:\nHe reports chronic right foot pain (localized to amputated first \ndigit and second digit) that has worsened since angiogram on \n___. Angiogram during that admission showed an occluded \ngraft and reconstitution of the popliteal below the knee but no \ntibial flow. He had previously undergone angioplasty of the \ndistal DP artery as well as stenting of the bypass graft in \n___. Unfortunately there were no further revascularization \nprocedures that were available to him. Patient was admitted to \nmedicine for dry gangrene and was briefly on broad spectrum \nantibiotics but without evidence of infection these were rapidly \ndiscontinued. He was discharged with plans for outpatient pain \nmanagement as well as further consideration of right BKA. \nPatient with mild ___ in setting of NSAID use- NSAIDs and \nlisinopril should be held until ___ resolves.'}}
{'final_diagnoses': ['dry gangrene', 'peripheral vascular disease', 'hypertension', 'diabetes ___ 2'], 'procedures': ['None'], 'visit_summary': '#Peripheral vascular disease:\nHe reports chronic right foot pain (localized to amputated first \ndigit and second digit) that has worsened since angiogram on \n___. Angiogram during that admission showed an occluded \ngraft and reconstitution of the popliteal below the knee but no \ntibial flow. He had previously undergone angioplasty of the \ndistal DP artery as well as stenting of the bypass graft in \n___. Unfortunately there were no further revascularization \nprocedures that were available to him. Patient was admitted to \nmedicine for dry gangrene and was briefly on broad spectrum \nantibiotics but without evidence of infection these were rapidly \ndiscontinued. He was discharged with plans for outpatient pain \nmanagement as well as further consideration of right BKA. \nPatient with mild ___ in setting of NSAID use- NSAIDs and \nlisinopril should be held until ___ resolves.', 'medications_prescribed': ['Amlodipine 10 mg PO DAILY', 'Aspirin 81 mg PO DAILY', 'Baclofen 10 mg PO DAILY', 'Cilostazol 100 mg PO BID', 'Clopidogrel 75 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN Pain', 'Simvastatin 20 mg PO QPM', 'TraZODone 50 mg PO QHS:PRN insomnia', 'Acetaminophen 650 mg PO Q8H']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 29, 'gender': 'M', 'symptoms': 'palpitations, chest pain and dyspnea', 'medical_history': ['myelodysplastic syndrome (currently on Aranesp)', 'atrial fibrillation'], 'family_history': None, 'present_illness': 'Ms. ___ is a ___ year old female with history of myelodysplastic syndrome (currently on Aranesp) with recent diagnosis of atrial fibrillation who presents to the ED with palpitations, chest pain and dyspnea found to be in atrial flutter with multiple pauses after receiving IV diltiazem in the ED, subsequently converted to sinus rhythm. She continued to have episodes of flutter while in the hospital without any further pauses on telemetry. She was seen by the electrophysiology team who felt that the best option was to start anticoagulation with Eliquis in the hospital with plan for an ablation procedure as an outpatient.', 'medications': [{'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LACOSamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Zonisamide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENObarbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Baclofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glycerin Supps', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Zonisamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Zonisamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.7', 'valuenum': 22.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.5', 'valuenum': 67.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.30', 'valuenum': 4.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': None, 'diagnoses': [{'icd_code': '43889', 'desc': 'Other late effects of cerebrovascular disease'}, {'icd_code': '34511', 'desc': 'Generalized convulsive epilepsy, with intractable epilepsy'}, {'icd_code': '37775', 'desc': 'Cortical blindness'}, {'icd_code': '3181', 'desc': 'Severe intellectual disabilities'}, {'icd_code': '3432', 'desc': 'Congenital quadriplegia'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '78060', 'desc': 'Fever, unspecified'}], 'summary': 'ADMISSION LABS:\n================\n___ 12:25PM BLOOD WBC-2.1* RBC-3.01* Hgb-9.0* Hct-27.6* \nMCV-92 MCH-29.9 MCHC-32.6 RDW-18.3* RDWSD-58.2* Plt ___\n___ 12:25PM BLOOD ___ PTT-29.6 ___\n___ 12:25PM BLOOD Glucose-102* UreaN-19 Creat-1.0 Na-142 \nK-4.5 Cl-105 HCO3-25 AnGap-12\n___ 12:25PM BLOOD ALT-12 AST-18 AlkPhos-87 TotBili-0.6\n___ 12:25PM BLOOD CK-MB-1\n___ 12:25PM BLOOD cTropnT-<0.01\n___ 12:25PM BLOOD Lipase-14\n___ 12:25PM BLOOD Albumin-3.8 Calcium-8.9 Phos-3.7 Mg-1.8\n___ 11:17AM BLOOD Hapto-149\n\nPHARM NUCLEAR STRESS TEST ___\nINTERPRETATION: This is a ___ year old woman here for the \nevaluation \nof chest pain. The patient was infused with 0.4mg/5mL \nregadenoson over \n20 seconds, immediately followed by isotope injection. There was \na \nchest pressure with the infusion. There were no significant ECG \nchanges. The rhythm was sinus without ectopy. The blood pressure \n\nresponse was appropriate and the heart rate response was \nblunted. The \nregadenoson was reversed with 60mg caffeine/3mL. \nIMPRESSION: Atypical symptom with no significant ECG changes. \nBlunted \nheart response. Nuclear report sent separately. \n\nDISCHARGE LABS:\n================\n___ 06:18AM BLOOD WBC-1.6* RBC-2.61* Hgb-7.5* Hct-24.1* \nMCV-92 MCH-28.7 MCHC-31.1* RDW-18.4* RDWSD-60.7* Plt Ct-91*\n___ 01:05PM BLOOD PTT-55.5*\n___ 06:18AM BLOOD Glucose-96 UreaN-20 Creat-1.2* Na-145 \nK-3.7 Cl-109* HCO3-26 AnGap-10\n___ 11:17AM BLOOD LD(LDH)-165 TotBili-0.5\n___ 06:18AM BLOOD Calcium-8.3* Phos-3.7 Mg-1.9\nTRANSITIONAL ISSUES:\n=====================\n[] Pt was started on anticoagulation with Eliquis 5mg BID in \nanticipation of ablation procedure for Atrial flutter as an \noutpatient. If ablation procedure is successful without further \narrhythmia, should be able to d/c anticoagulation in the future \nper EP.\n[] Pt to follow-up with heme/onc on ___ - may need additional \ntransfusions while on anticoagulation\n\n \nBRIEF HOSPITAL COURSE: \n====================== \nMs. ___ is a ___ year old female with history of \nmyelodysplastic syndrome (currently on Aranesp) with recent \ndiagnosis of atrial fibrillation who presents to the ED with \npalpitation'}}
{'final_diagnoses': ['Atrial flutter with RVR', 'Myelodysplastic syndrome'], 'procedures': ['None'], 'visit_summary': 'TRANSITIONAL ISSUES:\n=====================\n[] Pt was started on anticoagulation with Eliquis 5mg BID in \nanticipation of ablation procedure for Atrial flutter as an \noutpatient. If ablation procedure is successful without further \narrhythmia, should be able to d/c anticoagulation in the future \nper EP.\n[] Pt to follow-up with heme/onc on ___ - may need additional \ntransfusions while on anticoagulation\n\n \nBRIEF HOSPITAL COURSE: \n====================== \nMs. ___ is a ___ year old female with history of \nmyelodysplastic syndrome (currently on Aranesp) with recent \ndiagnosis of atrial fibrillation who presents to the ED with \npalpitation', 'medications_prescribed': ['Apixaban 5 mg PO BID \nRX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', 'Amitriptyline 50 mg PO QHS', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 10 mg PO QPM', 'ClonazePAM 0.5 mg PO BID Anxiety', 'Esomeprazole 40 mg PO DAILY', 'Furosemide 40 mg PO PRN lymphedema', 'Hydroxychloroquine Sulfate 200 mg PO BID', 'Linzess (linaCLOtide) 145 mcg oral prn', 'Metoprolol Succinate XL 100 mg PO BID', 'PredniSONE 2.5 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'Left leg weakness', 'medical_history': ['Admitted to medicine with a SAH and stroke in ___ (Small SAH\nover the right cerebral convexity with an evolving cortical\ninfarct, 7 x 5 mm calcified mass in the R CP angle likely a\nmeningioma)', 'HTN', 'HLD', 'Polio with no residual paralysis'], 'family_history': 'Father : valve replacement\nMother : died of pancreatic Ca.', 'present_illness': 'HPI: ___ yo LHM with a prior SAH (___), HTN, HLD, was out \nbowling\ntoday, as he does routinely on a ___ morning at 10 am, and\nwhile attempting to bend down and aim the ball, his left leg\nsuddenly felt weak, numb, and heavy. He could not move his left\nleg, and the EMS took him to his nearest hospital. He was found\nto have a 3.4 x 2.4 cm new parenchymal hemorrhage at the right\nvertex in the parietal lobe with a small amount of blood \ntracking\nalong the falx, with associated sulcal effacement without \nmidline\nshift in his CT head.\n\nROS: negative for aphasia, vertigo, headache, seizures, syncope,\npalpitations, chest pain, dyspnea, nausea, abdominal pain,\ndysuria, fevers or chills.', 'medications': [{'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Moexipril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Disopyramide CR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ezetimibe', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin E', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '2.8', 'valuenum': 2.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '349', 'valuenum': 349.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'GREATER THAN 20 NG/ML.'}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '421', 'valuenum': 421.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '852', 'valuenum': 852.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '302', 'valuenum': 302.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.76', 'valuenum': 3.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T-97 BP-189/110 HR-90 RR-16 O2Sat-99%\nGen: Lying in bed, talking incessantly, R eye pterygium\nHEENT: NC/AT, moist oral mucosa \nNeck: No tenderness to palpation, normal ROM, supple, no carotid\nor vertebral bruit\nBack: No point tenderness or erythema\nCV: RRR, Nl S1 and S2, no murmurs/gallops/rubs \nLung: Clear to auscultation bilaterally \naBd: +BS soft, nontender \next: no edema\n\nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal \naffect. Oriented to person, place, but not date. Attentive,\nsays ___ backwards. Speech is fluent with normal comprehension\nand repetition, however, he perseverates with subject matter; he\nhas an anomia for low frequency objects (called a hammock on the\nstroke card a hamper, when asked about parts of a watch, stated,\n"why do I need to know that." No dysarthria. Reading and writing\nintact. Registers ___, recalls ___ in 5 minutes. No right left\nconfusion. No evidence of apraxia or neglect.\n \nCranial Nerves: \nPupils equally round and reactive to light, 3 to 2 mm\nbilaterally. Discs are well demarcated bilaterally. Visual \nfields\nare full to confrontation. Extraocular movements intact\nbilaterally, no nystagmus. Sensation intact V1-V3. Facial\nmovement symmetric. Hearing intact to finger rub bilaterally. \nPalate elevation symmetrical. Sternocleidomastoid and trapezius\nnormal bilaterally. Tongue midline, movements intact\n \nMotor: \nNormal bulk bilaterally. Tone increased in the left leg. No\nobserved myoclonus or tremor\nNo pronator drift\n Del Tri Bi WF WE FE FF IP H Q DF PF TE TF\nR ___ ___ ___ ___ 5 5\nL ___ ___ 5 - - - - - - -\n \nSensation: Intact to light touch, pinprick, vibration preserved\nin the medial malleoli b/l. JPS reduced in the left big toe. No\nextinction to DSS\n \nReflexes: \n+2 and symmetric in the arms, 2 in the legs.\nLeft Babinski, Right predominantly a withdrawal response\n \nCoordination: finger-nose-finger with mild dysmetria noted on \nthe\nleft, heel to shin normal on the R only, RAMs normal. \n \nGait: he cannot walk due to his L leg\n\nAt time of discharge neurological examination included:\n\nVS 98.1F/Tm 98.8F 118/63 (SBP 113->140); HR 90-100; RR ___ O2 \nsat 95%-99% on RA. \n\nMental status:\n\nFluctuates between being awake, opening eyes to voice and \nrequiring noxious stimulation to open eyes. During either time \nof fluctuation, does not respond to commands. Able to express \npain with grimace but no vocal output. Abulic. \n\nCNs: 5->3mm pupils b/l, VF intact to threat b/l, face appears \nsymmetric, able to stick out tongue spontaneously. Unable to \nassess sensation. \n\nMotor: RUE rigid, spastic, antigravity, decreased bulk. LUE \n___ throughout. RLE spastic, retracts both legs from stimuli, \nslight response to stimuli in L arm.\n\nSensory: withdraws to noxious in all extremities. ', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5781', 'desc': 'Blood in stool'}, {'icd_code': '2113', 'desc': 'Benign neoplasm of colon'}, {'icd_code': '53782', 'desc': 'Angiodysplasia of stomach and duodenum without mention of hemorrhage'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}, {'icd_code': '4550', 'desc': 'Internal hemorrhoids without mention of complication'}, {'icd_code': '53560', 'desc': 'Duodenitis, without mention of hemorrhage'}], 'summary': "Labs on admission:\n\n___ 04:46PM BLOOD WBC-6.5# RBC-4.67 Hgb-13.8* Hct-40.7 \nMCV-87 MCH-29.5 MCHC-33.9 RDW-13.4 Plt ___\n___ 04:46PM BLOOD ___ PTT-23.6 ___\n___ 04:46PM BLOOD Glucose-101 UreaN-16 Creat-1.0 Na-141 \nK-4.3 Cl-103 HCO3-29 AnGap-13\n___ 02:07AM BLOOD Calcium-9.1 Phos-3.7 Mg-2.1 Cholest-212*\n___ 02:07AM BLOOD Triglyc-70 HDL-74 CHOL/HD-2.9 LDLcalc-124\n___ 04:46PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\nImaging:\n\nRadiology Report CT HEAD W/O CONTRAST Study Date of ___ \n5:35 ___\nFINDINGS: Non-contrast head CT with coronal and sagittal \nreformations were \nprovided. There is a 2.4 x 2.7 x 2.8 cm parenchymal hemorrhage \nin the high \nconvexity of the right posterior frontal lobe. There is also \nsurrounding areas of linear hyperdensity likely representing \nsubarachnoid hemorrhage. There is also likely a small amount of \nadjacent acute SDH layering along the midline falx. Overall, \nfindings suggest intraparenchymal hemorrhage with cortical \nbreakthrough and hemorrhage extending to the extra-axial space. \nCompared with the prior outside hospital CT, there is slight \ninterval increase in size of the intraparenchymal hemorrhagic \nfocus. Surrounding hypodensity is compatible with edema. There \nis again note made of patchy subcortical and periventricular \nwhite matter hypodensity which is likely related to underlying \nmicrovascular ischemic disease. There is no shift of midline \nstructures or evidence of downward transtentorial herniation. \nGlobal involutional changes compatible with age-related atrophy. \nVascular calcifications along the carotid siphon is noted \nbilaterally. The paranasal sinuses are clear. Mastoid air cells \nand middle ear cavities are well aerated. No calvarial fracture \nis seen. \n \nIMPRESSION: \nParenchymal hemorrhage at the right frontal high convexity with \ncortical \nbreakthrough and resultant adjacent extra-axial hemorrhage. \nOverall, slightly larger when compared with outside hospital \nstudy. Given the location of the hemorrhage and the underlying \nwhite matter disease, the possibility of amyloid angiopathy may \nbe considered. An underlying lesion cannot be excluded, though \nnone was seen on a prior brain MR from ___. \n\nCT head ___\n\nFINDINGS: There is new intraparenchymal hemorrhage of the left \nfrontal lobe, \nwith adjacent subarachnoid blood. There is a rim of edema around \nthis new \nhemorrhage, which measures approximately 4.1 cm (TRV) x 2.4 cm \n(AP). The \nright posterior frontal lobe parenchymal hemorrhage with \nadjacent subarachnoid \nhemorrhage is similar in size and morphology to the previous \nstudy. The \nventricles are similar in size and configuration. There is no \nuncal or \ntranstentorial herniation. There is no shift of midline \nstructures. Gray- \nwhite matter differentiation is preserved. No intraventricular \nblood is \nidentified. Basal cisterns are patent. The paranasal sinuses and \nmastoid air \ncells remain clear. \n \nIMPRESSION: \n1. New left frontal parenchymal hemorrhage with adjacent \nsubarachnoid \nhemorrhage and surrounding edema. \n2. Little change of the right posterior frontal lobe parenchymal \nhemorrhage \nwith adjacent subarachnoid hemorrhage \n\nMR head w/ and w/o, MRV\n\nIMPRESSION: \n1. Redemonstration of the areas of acute-subacute hemorrhage, in \nthe right \nfrontal/parietal location and acute hemorrhage, in the acute \nintraparenchymal \nhemorrhage, in the left frontal lobe. The etiology for the \nhemorrhage is \nunclear from the present study. Can relate to amyloid \nangiopathy, HTN, \nor other etiologies; no obvious mass lesions, aneurysm noted; \nassessment for \ncortical venous thrombosis is limited due to superimposed SAH \nand cannot be \ncompletely excluded. Major venous sinuses are patent, however. \nD/w ___ by ___ on ___. \n \n2. Areas of subarachnoid hemorrhage, in the right frontal lobe \nas well as \npart of the parietal lobe, better seen on the prior study. \n \n3. No other areas of abnormal enhancement. Small foci of \nincreased DWI \nsignal in the cerebellar hemispheres are artifactual. \n \n4. Patent major intracranial arteries without focal \nflow-limiting stenosis, \nocclusion or aneurysm. \n\nCT head ___\n\nNON-CONTRAST HEAD CT: The patient is noted to be intubated with \nan NG tube in \nplace. Areas of intraparenchymal hemorrhage within the posterior \nright \nfrontal lobe and also the left frontal lobe, with surrounding \nedema and with \nnearby regions of subarachnoid appear similar to that seen one \nday prior. \nThere is no shift of normally midline structures nor effacement \nof the basal \ncisterns. Size and configuration of the ventricles is unchanged. \nNo new acute \nintracranial hemorrhage is seen, nor evidence of large vascular \nterritory \ninfarction. Periventricular white matter hypodensities are noted \nas well as \nvascular calcifications along the carotid siphons. The paranasal \nsinuses and \nmastoid air cells remain well aerated. \n \nIMPRESSIONS: Intraparenchymal hemorrhage in bilateral frontal \nlobes along the \nsuperior convexity, with surrounding edema and foci of \nsubarachnoid hemorrhage \nnot appreciably changed in size or configuration compared to one \nday prior. No \nnew focus of acute hemorrhage seen. \n\nCT head ___\n\nIMPRESSION: Minimal change from the study done one day prior, \nwith \nredemonstration of bilateral intraparenchymal hemorrhage similar \nin size, and no new focus of hemorrhage. \n\nCT head ___\n\nIMPRESSION: Stable or slightly decreased in size bilateral \nintraparenchymal hemorrhage with small amount of subarachnoid \nextension, surrounding edema, and Mild hydrocephalus. \n\nCXR ___\n\nPulmonary mediastinal vascular engorgement are new, but there is \nno pulmonary \nedema. Atelectasis at the right base is mild. There are no \nfindings to \nsuggest pneumonia. Heart size normal. Nasogastric tube is coiled \nin the \nstomach. No pleural abnormality \n\nCXR ___\n\nIMPRESSION: Malpositioned PICC, recommend retraction by 4.5-5 \ncm, for a tip location at the superior cavoatrial junction \n\nEEG:\n\n___\n\nIMPRESSION: Abnormal EEG due to the effects of Propofol inducing \na \ndrug-induced light plane of anesthesia. No discharging features \nwere \nseen. \n\n___\n\nIMPRESSION: Abnormal EEG due to diffuse slowing over both \nanterior and \nposterior head regions with some excess of slowing at times over \nthe \nleft hemisphere and more marked in the left anterior quadrant. \nThe \nrecord is suggestive of a diffuse moderate encephalopathy with \naccentuation over the left hemisphere and to the left anterior \nquadrant. \nNo frank epileptiform discharges were seen \n\n___\n\nIMPRESSION: This telemetry captured no pushbutton activations. \nRoutine \nsampling showed a slow background with occasional bursts of \ngeneralized \nslowing, indicating widespread encephalopathy. Medications, \nmetabolic \ndisturbances, and infection are among the most common causes. \nThere \nwere no prominent focal abnormalities, but encephalopathies may \nobscure \nfocal findings. There were no epileptiform features. No \nelectrographic \nseizures were seen \n\nECHO ___\n\nThe left atrium and right atrium are normal in cavity size. No \natrial septal defect is seen by 2D or color Doppler. Left \nventricular wall thickness, cavity size and regional/global \nsystolic function are normal (LVEF >55%). The estimated cardiac \nindex is high (>4.0L/min/m2). Right ventricular chamber size and \nfree wall motion are normal. The aortic root is mildly dilated \nat the sinus level. The ascending aorta is mildly dilated. The \naortic valve leaflets (3) appear structurally normal with good \nleaflet excursion and no aortic regurgitation. The mitral valve \nappears structurally normal with trivial mitral regurgitation. \nThere is no mitral valve prolapse. The estimated pulmonary \nartery systolic pressure is normal. There is a \ntrivial/physiologic pericardial effusion. \n\nIMPRESSION: Normal biventricular cavity sizes with preserved \nglobal and regional biventricular systolic function. No definite \nstructural cardiac source of embolism identified.\n\nStudies at time of discharge:\n\nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct \n___ 04:36AM 7.8 3.45* 10.3* 29.7* 86 30.0 34.9 13.4 \n302 \n\nRENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 04:36AM 100 35* 0.7 141 3.9 ___\n\nENZYMES & BILIRUBIN \n ALT AST LD(LDH) CK(CPK) AlkPhos \n___ 02:07AM 21 21 131 52 \n\n Albumin Calcium Phos Mg \n___ 04:36AM 3.0* 7.8* 2.8 2.0\n\n Cholest Triglyc HDL CHOL/HD LDLcalc \n___ 02:07AM 212* 70 74 2.9 124 \n\nPITUITARY TSH \n___ 05:50AM 0.66 \n\nMicrobiology:\n\nMRSA screen negative\nBCx ___ - negative\n\nGRAM STAIN (Final ___: \n >25 PMNs and <10 epithelial cells/100X field. \n 3+ ___ per 1000X FIELD): GRAM POSITIVE ROD(S). \n SMEAR REVIEWED; RESULTS CONFIRMED. \n\n RESPIRATORY CULTURE (Final ___: \n MODERATE GROWTH Commensal Respiratory Flora. \n HAEMOPHILUS INFLUENZAE, BETA-LACTAMASE NEGATIVE. \nMODERATE GROWTH. \n Beta-lactamse negative: presumptively sensitive to \nampicillin. \n Confirmation should be requested in cases of treatment \nfailure in\n life-threatening infections..\n\n LEGIONELLA CULTURE (Final ___: NO LEGIONELLA \nISOLATED.\n\nCLOSTRIDIUM DIFFICILE TOXIN A & B TEST (Final ___: \n Feces negative for C.difficile toxin A & B by EIA. \n (Reference Range-Negative).\n\nCSF ___\n#4; #4 \n___ 04:02PM 3 710* 50 25 0 ___ yo man w/history of prior SDH, now presenting with left leg \nweakness, found to have an intraparenchymal hemorrhage.\n\n1. Neuro - CT scan showed a 2x3cm intraparenchymal hemorrhage. \nHe had a repeat CT scan on ___ which showed stable hemorrhage. \nHe was transferred to the floor on ___. Overnight on ___ he \nbecame more confused, with rhythmic R arm twitching and R gaze \ndeviation. He was given Ativan, and then loaded with Dilantin \nin order to stop his seizure. A stat repeat head CT showed an \nextensive new left frontal lobe hemorrhage. On his way back \nfrom CT he became apneic, and was intubated and transferred to \nthe ICU. He underwent a routine EEG which showed no signs of \nseizure. He was extubated on ___, however his mental status \ndid not clear significantly. He underwent continuous EEG \nmonitoring which showed findings consistent with encephalopathy \nand no frank seizure activity. \n\nGiven seizure on single AED and now extensive cortical bleeds, \nhe was started on Keppra and Dilantin 1g BID and Dilantin 100mg \nTID. Dilantin level goal is ___ trough. At time of discharge \nDilantin level was 15. Patient will require dilantin level \nfollow up on a weekly basis until stable levels are achieved. \nOf note, patient had been on keppra prior to admission, and has \nhad irritability on this medication. Should he be deemed at \nsome point acceptable for monotherapy, would recommend the use \nof Dilantin.\n\nThe hemorrhage was felt to be due to either a hypertensive or \namyloid etiology. MRI did not show evidence of acute stroke and \nECHO did not find a source for a thrombus, making hemorrhagic \nstroke much less likely, along with a repeat hemorrhage. Given \nthe extent and location of the hemorrhages and MRI findings, the \nmost likely etiology was felt to be amyloid angiopathy. \n\nFor HTN control, patient was treated with lisinopril 10mg daily, \nmetoprolol 25mg TID and hydralazine prn. On day of discharge, \npatient's SBP ranged between 110 - 130 mmHg on BB and ACE-I. He \ndid not require Hydralazine prn over the last 3 days of hospital \nstay.\n\nPatient's outpatient Neurologist is Dr. ___ in ___, \nNE Associates.\n\n2. ID - On ___ he developed a fever and was thought to have an \naspiration pneumonia. He was initially started on \nvancomycin/zosyn/flagyl. As his mental status was not clearing \nsignificantly, and he was also noted to have a stiff neck, he \nunderwent an LP, which was negative for any sign of infection. \nSputum cultures eventually grew h. influenzae and he was \nnarrowed to levoquin, continued for a total of 10 days, ended on \n___. EEG showed encephalopathy.\n\n3. Pulmonary. On ___ patient was noted to have multiple \nepisodes of apnea on telemetry with desaturations to < 80% O2. \nApneic episodes varied between ___ seconds. It was felt that \nlocation of ICH would not account for apneic episodes. It was \nfelt that he may have had underlying OSA. As patient's \nalertness improved, ___ no apneic episodes were noted. \n It is recommended that continuous O2 monitoring be maintained \nto assess for further apneic episodes, and should they recurr, \nan evaluation for OSA or CPAP trial can be performed.\n\n4. Nutrition. Due to above hemorrhage and prolonged ICU stay, \npatient required nutritional support, initially via NGT, \nfollowed by PEG tube placement on ___. This was \nuncomplicated, PEG TF were reached to goal at time of discharge. \nHe will require nutrition follow up. Albumin on ___ was 3.0.\n\n5. Anemia. Patient was admitted with HCT of 40, felt to be \nhemoconcentrated. During admission, HCT trended down to 32-33 \nby HD 4 and remained stable, fluctuating in ___ range until \ndischarge (HD 14, 29%). Anemia was normocytic. He was \nmaintained on Famontidine while in ICU. He was guiac positive \nafter PEG placement, felt to be secondary to some mucosal injury \ns/p procedure. Pt. remained HD stable. He will require a HCT \ncheck within one week of discharge.\n\nContact: ___ (wife) ___\n___ (sister-in-law)"}}
{'final_diagnoses': ['Primary: Multiple intracranial hemorrhages, right, left. Likely \ndue to amyloid angiopathy in setting of hypertension', 'Secondary: Subarachnoid hemorrhage, HTN'], 'procedures': ['Lumbar puncture', 'intubation/extubation', 'PEG placment.'], 'visit_summary': "#4; #4 \n___ 04:02PM 3 710* 50 25 0 ___ yo man w/history of prior SDH, now presenting with left leg \nweakness, found to have an intraparenchymal hemorrhage.\n\n1. Neuro - CT scan showed a 2x3cm intraparenchymal hemorrhage. \nHe had a repeat CT scan on ___ which showed stable hemorrhage. \nHe was transferred to the floor on ___. Overnight on ___ he \nbecame more confused, with rhythmic R arm twitching and R gaze \ndeviation. He was given Ativan, and then loaded with Dilantin \nin order to stop his seizure. A stat repeat head CT showed an \nextensive new left frontal lobe hemorrhage. On his way back \nfrom CT he became apneic, and was intubated and transferred to \nthe ICU. He underwent a routine EEG which showed no signs of \nseizure. He was extubated on ___, however his mental status \ndid not clear significantly. He underwent continuous EEG \nmonitoring which showed findings consistent with encephalopathy \nand no frank seizure activity. \n\nGiven seizure on single AED and now extensive cortical bleeds, \nhe was started on Keppra and Dilantin 1g BID and Dilantin 100mg \nTID. Dilantin level goal is ___ trough. At time of discharge \nDilantin level was 15. Patient will require dilantin level \nfollow up on a weekly basis until stable levels are achieved. \nOf note, patient had been on keppra prior to admission, and has \nhad irritability on this medication. Should he be deemed at \nsome point acceptable for monotherapy, would recommend the use \nof Dilantin.\n\nThe hemorrhage was felt to be due to either a hypertensive or \namyloid etiology. MRI did not show evidence of acute stroke and \nECHO did not find a source for a thrombus, making hemorrhagic \nstroke much less likely, along with a repeat hemorrhage. Given \nthe extent and location of the hemorrhages and MRI findings, the \nmost likely etiology was felt to be amyloid angiopathy. \n\nFor HTN control, patient was treated with lisinopril 10mg daily, \nmetoprolol 25mg TID and hydralazine prn. On day of discharge, \npatient's SBP ranged between 110 - 130 mmHg on BB and ACE-I. He \ndid not require Hydralazine prn over the last 3 days of hospital \nstay.\n\nPatient's outpatient Neurologist is Dr. ___ in ___, \nNE Associates.\n\n2. ID - On ___ he developed a fever and was thought to have an \naspiration pneumonia. He was initially started on \nvancomycin/zosyn/flagyl. As his mental status was not clearing \nsignificantly, and he was also noted to have a stiff neck, he \nunderwent an LP, which was negative for any sign of infection. \nSputum cultures eventually grew h. influenzae and he was \nnarrowed to levoquin, continued for a total of 10 days, ended on \n___. EEG showed encephalopathy.\n\n3. Pulmonary. On ___ patient was noted to have multiple \nepisodes of apnea on telemetry with desaturations to < 80% O2. \nApneic episodes varied between ___ seconds. It was felt that \nlocation of ICH would not account for apneic episodes. It was \nfelt that he may have had underlying OSA. As patient's \nalertness improved, ___ no apneic episodes were noted. \n It is recommended that continuous O2 monitoring be maintained \nto assess for further apneic episodes, and should they recurr, \nan evaluation for OSA or CPAP trial can be performed.\n\n4. Nutrition. Due to above hemorrhage and prolonged ICU stay, \npatient required nutritional support, initially via NGT, \nfollowed by PEG tube placement on ___. This was \nuncomplicated, PEG TF were reached to goal at time of discharge. \nHe will require nutrition follow up. Albumin on ___ was 3.0.\n\n5. Anemia. Patient was admitted with HCT of 40, felt to be \nhemoconcentrated. During admission, HCT trended down to 32-33 \nby HD 4 and remained stable, fluctuating in ___ range until \ndischarge (HD 14, 29%). Anemia was normocytic. He was \nmaintained on Famontidine while in ICU. He was guiac positive \nafter PEG placement, felt to be secondary to some mucosal injury \ns/p procedure. Pt. remained HD stable. He will require a HCT \ncheck within one week of discharge.\n\nContact: ___ (wife) ___\n___ (sister-in-law)", 'medications_prescribed': ['1. Phenytoin 125 mg/5 mL Suspension Sig: One Hundred (100) mg PO \nTID (3 times a day).', '2. Levetiracetam 100 mg/mL Solution Sig: 1000 (1000) mg PO BID \n(2 times a day).', '3. Lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. Metoprolol Tartrate 25 mg Tablet Sig: One (1) Tablet PO TID \n(3 times a day).', '5. HydrALAzine 10 mg IV Q6H:PRN SBP>160', '6. Bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \nHS (at bedtime) as needed for constipation.', '7. Nystatin 100,000 unit/g Cream Sig: One (1) Appl Topical BID \n(2 times a day).', '8. Acetaminophen 160 mg/5 mL Solution Sig: Six Hundred Fifty \n(650) mg PO Q6H (every 6 hours) as needed for pain / fever.', '9. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day) as needed.', '10. Simvastatin 40 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).', '11. Lorazepam ___ mg IV Q4H:PRN sz > 3 minutes or clusters \ncall house officer if planning to administer', '12. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush \nPeripheral line: Flush with 3 mL Normal Saline every 8 hours and \nPRN.', '13. Outpatient Lab Work\nWeekly CBC, chem 10 after discharge from the hospital. \nPhenytoin level by ___', '14. Famotidine 40 mg/5 mL Suspension Sig: Twenty (20) mg PO once \na day.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 41, 'gender': 'M', 'symptoms': 'Left ICA aneurysm', 'medical_history': ['Her past medical history is significant for vertigo, AFib,\nhypothyroidism.'], 'family_history': 'She has no family history of aneurysm.', 'present_illness': '___ female electively admitted for planned craniotomy \nfor clipping of an incidental left ICA aneurysm found on workup \nof headache.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-38', 'valuenum': -38.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-82', 'valuenum': -82.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-75', 'valuenum': -75.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '>1.050*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'PRE-OPERATIVE:\nOn physical exam, blood pressure 128/70 with a heart rate of 58. \n\nShe is awake and alert. Cranial nerves are intact. She has \nfull\nstrength throughout. She is able to ambulate unaided.\n\nAT DISCHARGE:\nOpens Eyes: [x]Spontaneous [ ]To voice [ ]To noxious \n\nOrientation: [x]Person [x]Place [x]Time \n\nFollows Commands: [ ]Simple [x]Complex [ ]None\n\nPupils: PERRL 3-2mm - L eye edema improving \n\nExtraocular Movements: [x]Full \n\nFace Symmetric: [x]Yes [ ]No Tongue Midline: [x]Yes [ ]No\n\nDrift: [x]Yes [ ]No - Slight Right pronator \n\nSpeech Fluent: [x]Yes [ ]No \n\nComprehension Intact: [x]Yes [ ]No\n\nMotor: LEFT Full strength ___ throughout. Right 4+/5 LUE and LLE\n\nSensation: Intact to light touch.\n\nIncision:\n[x]clean, dry and intact\n[x]staples', 'diagnoses': [{'icd_code': 'S2241XA', 'desc': 'Multiple fractures of ribs, right side, initial encounter for closed fracture'}, {'icd_code': 'S27321A', 'desc': 'Contusion of lung, unilateral, initial encounter'}, {'icd_code': 'S50812A', 'desc': 'Abrasion of left forearm, initial encounter'}, {'icd_code': 'S80212A', 'desc': 'Abrasion, left knee, initial encounter'}, {'icd_code': 'S80211A', 'desc': 'Abrasion, right knee, initial encounter'}, {'icd_code': 'S90512A', 'desc': 'Abrasion, left ankle, initial encounter'}, {'icd_code': 'V5949XA', 'desc': 'Driver of pick-up truck or van injured in collision with other motor vehicles in traffic accident, initial encounter'}, {'icd_code': 'Y92410', 'desc': 'Unspecified street and highway as the place of occurrence of the external cause'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}], 'summary': 'see OMR\n#L pcomm unruptured aneurysm\nShe underwent diagnostic cerebral angiogram on ___, which \nconfirmed L pcomm aneurysm. Right radial artery was accessed. \nShe was admitted to floor and taken to OR on ___ for left \ncraniotomy for pcomm clipping with Dr. ___. Procedure was \nuncomplicated; please see operative report for full details. \nPostoperativley she was very lethargic and slow to wake from \nanesthesia and decreased movement right side. STAT head CT was \nunremarkable, just very small left temporal subdural collection, \nsome pneumo. She remained in PACU overnight. Exam slowly \nimproved but she remained lethargic. She was started on keppra. \nRepeat head CT POD#1 was stable. She was transferred to ___. \nWhile in ___, she initially had altered mental status as below \nwhich has resolved at the time of discharge. \n\n#Altered mental status\nNICU was consulted and attributes AMS to delayed emergence from \ngeneral anesthesia. All narccotics, bupropion and oxybutynin \nwere discontinued. She was given 1L fluid bolus given fluid \nvolume negative. Exam slowly improved POD#2. Foley was removed. \nShe stood OOB with ___ with max encouragement. Exam continued \nto wax and wane and she was put on cEEG. On ___, cvEEG was \nconsistent with significant L hemisphere slowing without \nseizures. The patient was more alert and therefore further \nimaging was deferred. Per ICU recommendations, the patient was \ngiven 1L IVB to promote perfusion with higher BP. By ___, the \npatients exam continued to improve and she was much more alert. \nEEG on ___ showed slightly more slowing in L hemisphere, but \nburst less prominent. No seizures or epileptiform activity. EEG \nwas discontinued ___. \n\n#Headache \nThe patient was provided with a dexamethasone taper in \nconjunction with fioricet for headaches with relief.'}}
{'final_diagnoses': ['Left pcomm unruptured aneurysm'], 'procedures': ['___ Diagnostic cerebral angiogram (L pcomm aneurysm)', '___ Left craniotomy for clipping of pcomm aneurysm'], 'visit_summary': '#L pcomm unruptured aneurysm\nShe underwent diagnostic cerebral angiogram on ___, which \nconfirmed L pcomm aneurysm. Right radial artery was accessed. \nShe was admitted to floor and taken to OR on ___ for left \ncraniotomy for pcomm clipping with Dr. ___. Procedure was \nuncomplicated; please see operative report for full details. \nPostoperativley she was very lethargic and slow to wake from \nanesthesia and decreased movement right side. STAT head CT was \nunremarkable, just very small left temporal subdural collection, \nsome pneumo. She remained in PACU overnight. Exam slowly \nimproved but she remained lethargic. She was started on keppra. \nRepeat head CT POD#1 was stable. She was transferred to ___. \nWhile in ___, she initially had altered mental status as below \nwhich has resolved at the time of discharge. \n\n#Altered mental status\nNICU was consulted and attributes AMS to delayed emergence from \ngeneral anesthesia. All narccotics, bupropion and oxybutynin \nwere discontinued. She was given 1L fluid bolus given fluid \nvolume negative. Exam slowly improved POD#2. Foley was removed. \nShe stood OOB with ___ with max encouragement. Exam continued \nto wax and wane and she was put on cEEG. On ___, cvEEG was \nconsistent with significant L hemisphere slowing without \nseizures. The patient was more alert and therefore further \nimaging was deferred. Per ICU recommendations, the patient was \ngiven 1L IVB to promote perfusion with higher BP. By ___, the \npatients exam continued to improve and she was much more alert. \nEEG on ___ showed slightly more slowing in L hemisphere, but \nburst less prominent. No seizures or epileptiform activity. EEG \nwas discontinued ___. \n\n#Headache \nThe patient was provided with a dexamethasone taper in \nconjunction with fioricet for headaches with relief.', 'medications_prescribed': ['1. Acetaminophen-Caff-Butalbital ___ TAB PO Q4H:PRN Pain - Mild \n\nRX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg ___ tab-cap \nby mouth Q4H PRN Disp #*12 Tablet Refills:*0 ', '2. Acetaminophen 325 mg PO Q4H:PRN Pain - Mild/Fever ', '3. Bisacodyl 10 mg PO/PR DAILY:PRN constipation ', '4. Docusate Sodium 100 mg PO BID ', '5. Heparin 5000 UNIT SC BID ', '6. LevETIRAcetam 500 mg PO BID ', '7. Pantoprazole 40 mg PO Q24H ', '8. Senna 17.2 mg PO QHS ', '9. Levothyroxine Sodium 75 mcg PO DAILY ', '10. Metoprolol Succinate XL 25 mg PO DAILY ', '11. Vitamin D ___ UNIT PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 62, 'gender': 'F', 'symptoms': 'Vision changes', 'medical_history': ['GERD', 'Hypertension', 'Anemia', 'Fibromyalgia', 'Chronic back pain'], 'family_history': 'Unknown if family history of aneurysm', 'present_illness': '___ year old female electively admitted for left craniotomy for \nclipping of left ICA aneurysm found on workup for visual \nchanges.', 'medications': [{'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '893', 'valuenum': 893.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '885', 'valuenum': 885.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '907', 'valuenum': 907.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'Ratio', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1040.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'PLT VERIFIED.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'VERY HIGH.'}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'AT DISCHARGE: \nTmax 98.6, HR 45-90, BP 115-125/65, RR ___, 95% on RA\n\nExam:\n\nOpens eyes: [x]Spontaneous [ ]To voice [ ]To noxious\nOrientation: [x]Person [x]Place [x]Time\nFollows commands: [ ]Simple [x]Complex [ ]None\n\nPupils: PERRL 4-3mm bilat\nEOM: [x]Full [ ]Restricted\n\nFace Symmetric: [x]Yes [ ]No\nTongue Midline: [x]Yes [ ]No\n\nPronator Drift: [ ]Yes [x]No \n\nSpeech Fluent: [x]Yes [ ]No\nComprehension Intact: [x]Yes [ ]No\n\nMotor:\nTrapDeltoidBicepTricepGrip\nIPQuadHamATEHLGast\n[x]Sensation intact to light touch\n\nWound: Left crani dressing removed, incision closed with \nsutures,\nopen to air well approximated, no drainage.', 'diagnoses': [{'icd_code': '1970', 'desc': 'Secondary malignant neoplasm of lung'}, {'icd_code': '5121', 'desc': 'Iatrogenic pneumothorax'}, {'icd_code': '1719', 'desc': 'Malignant neoplasm of connective and other soft tissue, site unspecified'}, {'icd_code': 'V103'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'E8786', 'desc': 'Removal of other organ (partial) (total) causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'E8792', 'desc': 'Radiological procedure and radiotherapy as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}, {'icd_code': 'E8498', 'desc': 'Accidents occurring in other specified places'}], 'summary': 'Please refer to ___ for relevant imaging and lab results.\n#Left ICA aneurysm\nOn ___, the patient was electively admitted and underwent \nplanned left craniotomy for left ICA aneurysm clipping. Please \nrefer to ___ for further procedure details. The patient was \ntransferred to the ___ for post-anesthesia care and monitoring. \nShe remained hemodynamically and neurologically stable, and was \ntransferred to the intermediate care unit for ongoing \nmanagement. On POD1 her arterial line and foley were removed. \nPatient was reporting adequate pain control, improved nausea, \nwas ambulating independently, tolerating regular diet and \nvoiding without issue. \n\n#Nausea\nShe experienced severe nausea, refractory to Ondansetron, \nprochlorperizine, and scopolamine patch. She was given 10mg \ndexamethasone IV, and started on a 3 day burst/rapid taper, with \ngood effect.\n\nPatient was discharged home on POD 2 with prescriptions and \nplanned neurosurgical follow-up.'}}
{'final_diagnoses': ['left ICA aneurysm'], 'procedures': ['___: left craniotomy for left ICA aneurysm clipping'], 'visit_summary': '#Left ICA aneurysm\nOn ___, the patient was electively admitted and underwent \nplanned left craniotomy for left ICA aneurysm clipping. Please \nrefer to ___ for further procedure details. The patient was \ntransferred to the ___ for post-anesthesia care and monitoring. \nShe remained hemodynamically and neurologically stable, and was \ntransferred to the intermediate care unit for ongoing \nmanagement. On POD1 her arterial line and foley were removed. \nPatient was reporting adequate pain control, improved nausea, \nwas ambulating independently, tolerating regular diet and \nvoiding without issue. \n\n#Nausea\nShe experienced severe nausea, refractory to Ondansetron, \nprochlorperizine, and scopolamine patch. She was given 10mg \ndexamethasone IV, and started on a 3 day burst/rapid taper, with \ngood effect.\n\nPatient was discharged home on POD 2 with prescriptions and \nplanned neurosurgical follow-up.', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild/Fever', '2. Bisacodyl 10 mg PO/PR DAILY:PRN constipation', '3. Dexamethasone 1 mg PO TAPERED DOSE \nSee additional instructions for detailed description of \ndexamethasone taper. \nTapered dose - DOWN \nRX *dexamethasone 1 mg 1 tablet(s) by mouth See additional \ninstructions for taper Disp #*15 Tablet Refills:*0', '4. Docusate Sodium 100 mg PO BID', '5. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth Q6hr Disp #*10 Tablet \nRefills:*0', '6. Senna 17.2 mg PO QHS', '7. Albuterol Inhaler ___ PUFF IH Q6H:PRN SOB', '8. amLODIPine 5 mg PO DAILY', '9. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', '10. Gabapentin 300 mg PO QHS', '11. Polyethylene Glycol 17 g PO DAILY', '12. Pravastatin 20 mg PO QPM', '13. Sertraline 100 mg PO QHS', '14. Topiramate (Topamax) 50 mg PO BID', '15. Topiramate (Topamax) 100 mg PO QHS']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 40, 'gender': 'M', 'symptoms': 'Seizure', 'medical_history': ['AAA s/p repair (___)', '3-vessel bypass (___)', 'Left-upper lobe lung ___ (___) s/p chemo x2, rads x7\nweeks.', 'HTN', 'HLD', 'Anxiety', 'Degenerative disc disease'], 'family_history': 'Retired ___. Smokes ___ cigarettes per day for the \nlast\n___ years. Does not drink alcohol.', 'present_illness': '___ is a ___ right-handed man with a history\nof glial sarcoma who presents with seizures.\n\nHe presented to ___ on ___ with blurry vision and\nheadache, and CT scan showed intracranial hemorrhage. \nSubsequent\nworkup revealed a tumor which was quickly resected by\nneurosurgery on ___. He has residual partial left visual\nfield deficit which has since improved. One month later he began\nchemotherapy with temozolomide 140mg daily, and radiation 5 days\nper week. He was also started on Keppra 500 mg twice daily, as\nwell as Decadron 4 mg TID. Two weeks ago the Decadron was\nreduced to 2mg TID due to insomnia.\n\nEarlier this week on ___, he was noted to be "not himself"\nwas having difficulty buttoning his shirt and finding words. \nThe\nnext day during his radiation treatment his Decadron was\nincreased back to 4 mg. On ___ he seems to be back to his\nbaseline. However on ___ morning he was again having\ndifficulty buttoning his shirt and seems to be "off" according \nto\nhis son and wife. He underwent radiation, then when he was back\nhome was noted to be acting strangely. His son observed him\nstanding in the bathroom holding a towel between his hands,\ntrembling, and appearing confused. He was moving very slowly as\nthey went to the kitchen. He had trouble using a straw. He was\nable to speak but was very slow, and his hands are trembling. \nThen, while standing in the kitchen he had a five-minute staring\nspell looking at his son the entire time. He was unresponsive \nto\ncommands and did not appear to track some. He then recovered\nsomewhat, but remained tremulous and confused. His son gave him\na drink of water, and he again froze, this time holding the \nwater\nin his mouth for over 2 minutes. His son called ___ and sat \ndown\nin the chair. He then vomited, and immediately returned to his\n"100%" baseline, better than he had been all week.\n\nHe was taken to ___ ___ morning. In the ED \nhe\nhad another episode. He remembers saying "I am not taking any\nmore steroids", then his family reports he became unresponsive\nfor ~2 minutes, staring straight ahead. He had eyelid \nfluttering\nfor another ___ minutes, then shaking of his lower legs \n(possibly\nsynchronously, according to son), and both hands (which were\nunder the covers). He then became heaving, then vomited, after\nwhich he again returned to his completely normal baseline. He\nwas admitted to the hospital and appeared well during the\novernight admission. His Keppra was increased from 500mg BID to\n___ BID.\n\nHe was discharged ___ morning, and on the way home they\nstopped at a store. He had another episode while lifting up his\nwife\'s purse, he became unresponsive and would not follow\ncommands to let go. His wife again called ___. This episode \nwas\nshorter lasting only 5 minutes and was not followed by emesis.\nRepeat CT at ___ showed unchanged edema, and the \nphysician\ndid not think his seizures were associated with the edema, so he\nwas transferred to ___ for further management.\n\nHe had another brief episode in the ambulance which was\nreportedly aborted by Ativan. In the ED here ~6:30pm, he had\nanother episode with both hands shaking and unreponsiveness,\nthough he appeared to regard.\n\nHe does not have clear memory during the middle of these\nepisodes, though says he did remember saying "I\'m not taking \nmore\nsteroids" before one episode, and typically remembers vomiting\nafterwards.\n\nHe says that the chemotherapy makes him feel "drunk" every time\nhe takes it.\n\nROS: As per HPI.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Droperidol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Droperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE-Acetaminophen Elixir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 7.18, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 190.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89.2', 'valuenum': 89.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '177', 'valuenum': 177.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL\n=======================\nVitals: T: 98.2 BP: 153/87 HR: 85 RR: 18 SaO2: 95%\n-General: Awake, cooperative, NAD.\n-HEENT: NC/AT. No scleral icterus noted. MMM. No lesions noted \nin\noropharynx.\n-Neck: Supple. No nuchal rigidity.\n-Cardiac: Well perfused. \n-Pulmonary: Breathing comfortably on room air.\n-Abdomen: Soft, NT/ND. \n-Extremities: No cyanosis, clubbing, or edema bilaterally. \n-Skin: No rashes or other lesions noted.\n\nNEUROLOGIC EXAM:\n-Mental Status: Alert, oriented x 3. Wife and son presented\nmajority of history, while he only occasionally chimed in. \nUnable\nto name ___ backwards ("I won\'t be able to do that" before\ntrying), though able to give ___ backwards albeit slowly.\nLanguage is fluent with intact repetition and comprehension.\nNormal prosody. There are no paraphasic errors. Able to name \nboth\nhigh and low frequency objects (cuticle). Speech is not\ndysarthric. Able to follow both midline and appendicular\ncommands. Able to register 3 objects and recall ___ at 5 minutes\n(answered others correctly only with multiple choice). There is\nno evidence of apraxia or neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk. VFF to confrontation and no\nextinction. \nIII, IV, VI: EOMI without nystagmus. Normal saccades.\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing grossly intact to speech.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline and equal strength bilaterally.\n\n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally. No adventitious movements, such as tremor, noted. \nNo\nasterixis noted.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 5 \nR 5 ___ ___ 5 5 5 5 5 \n\n-Sensory: No deficits to light touch throughout. No extinction \nto\nDSS.\n\n-DTRs:\n Bi Tri ___ Pat Ach \nL 2 1 2 2 1 \nR 2 1 2 2 1 \nPlantar response was flexor bilaterally.\n\n-Coordination: Bilateral postural tremor (L>R). No dysmetria on\nFNF. \n\n-Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Romberg absent.\n\nDISCHARGE EXAM:\n=======================\n24 HR Data (last updated ___ @ 451)\n Temp: 97.5 (Tm 98.6), BP: 162/93 (131-162/72-93), HR: 80\n(80-101), RR: 18 (___), O2 sat: 97% (94-97%), O2 delivery: ra \n\nGENERAL: Pleasant man laying in bed in no acute distress.\nHEENT: Linear surgical scar noted over right occipital skull. \nPupils equal round reactive to light, extraocular movements \nintact, left upper peripheral visual field defect. Moist mucous\nmembranes, good dentition.\nLUNGS: Clear to auscultation bilaterally. No wheezes, rhonchi, \nrales\nHEART: Normal rate and regular rhythm. Normal S1, S2, no \nmurmurs auscultated.\nABD: Normal bowel sounds. Nondistended, nontender, normal bowel \nsounds.\nEXT: Warm with 2+ dorsal pedis and tibialis posterior pulses\nSKIN: Warm no rashes.\nNEURO: Cranial nerves grossly intact, moving all extremities, no \nfocal deficit.\nACCESS: Peripheral IV', 'diagnoses': [{'icd_code': '1508', 'desc': 'Malignant neoplasm of other specified part of esophagus'}, {'icd_code': '5303', 'desc': 'Stricture and stenosis of esophagus'}, {'icd_code': '53085', 'desc': "Barrett's esophagus"}], 'summary': "ADMISSION LABS:\n====================\n___ 04:30PM BLOOD WBC-8.7 RBC-4.53* Hgb-14.4 Hct-41.7 \nMCV-92 MCH-31.8 MCHC-34.5 RDW-16.2* RDWSD-54.4* Plt ___\n___ 05:34PM BLOOD ___ PTT-24.6* ___\n___ 04:30PM BLOOD Glucose-132* UreaN-25* Creat-1.1 Na-136 \nK-4.3 Cl-95* HCO3-25 AnGap-16\n___ 04:30PM BLOOD ALT-35 AST-25 AlkPhos-56 TotBili-0.5\n___ 04:30PM BLOOD cTropnT-<0.01\n___ 04:30PM BLOOD Lipase-20\n___ 04:30PM BLOOD Albumin-4.4 Calcium-9.7 Phos-3.9 Mg-2.2\n___ 04:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n\nDIAGNOSTIC STUDIES:\n=====================\nMR ___ ___:\n1. Large late subacute intraparenchymal hemorrhage within the \nright occipital and posterior temporal lobes, with partial \neffacement of the occipital horn of the right lateral ventricle, \nbut no shift of midline structures or mass effect on basal \ncisterns. \n2. Encephalomalacia in the posterior right occipital lobe likely \nrepresents the surgical cavity. Surrounding T2 hyperintensity \nextending to the atrium of the right lateral ventricle, without \nprior MRI for comparison. No nodular enhancement is identified. \n\n3. Please note that the inferior portions of the cerebellar \nhemispheres are not adequately imaged.\n\nEEG ___:\nThis is an abnormal continuous EEG monitoring study because of \neight electrographic seizures originating in the right \ncentral/parasagittal region lasting ___ minutes. Clinically, \nthe patient is able to converse at the beginning of these events \nhowever he becomes progressively more tremulous with difficulty \ncommunicating as the event progresses. After the sharply \ncontoured rhythmic activity ceases, there is relatively rapid \nreturn of baseline and he is able to converse and perform \nroutine activities such as eating. The background is mildly \ndisorganized suggesting a mild encephalopathy. This is a \nnonspecific finding with regards to etiology but can be seen in \nthe setting of toxic/metabolic derangements, anoxia, medication \naffect. There is diffuse overriding fast activity which is \ntypically seen in the setting of medication affect, i.e. \nbenzodiazepines and barbiturates. \nThere are multiple pushbutton activation for patient \ntremulousness or \ndifficulty moving his upper extremities which are associated \nwith \nelectrographic seizures. After the patient receives IV \nlorazepam, there is \nimprovement in the background and no further discrete \nelectrographic seizures. \nHowever there continue to be periods of rhythmic slowing lasting \nseconds at a time while the patient appears to be sleeping. \n\nEEG ___:\nThis is an abnormal continuous EEG monitoring study because of \nfocal slowing most prominent over the right parasagittal region \nconsistent \nwith the area of cerebral dysfunction in this region. There are \nalso bursts of focal slowing over the right hemisphere \nconsistent with subcortical or deep midline dysfunction. There \nis a mildly disorganized background consistent with a mild \nencephalopathy. This is a nonspecific finding with regards to \netiology but can be seen in the setting of toxic/metabolic \nderangements, anoxia, and medication effect. There is diffuse \noverriding fast activity which is typically seen in the setting \nof medications, i.e. benzodiazepines and barbiturates. There are \nmultiple pushbutton activations for decreased responsiveness or \npatient tremulousness, which are at times associated with delta \nslowing most prominent over the right posterior quadrant. When \ncompared to the previous day's study, there are no further \nelectrographic seizures, which is an overall improvement. \n\nEEG ___:\nThis is an abnormal continuous EEG monitoring study because of \nfocal slowing most prominent over the right parasagittal region \nconsistent \nwith the area of cerebral dysfunction in this region. There are \nalso bursts of focal slowing over the right hemisphere \nconsistent with subcortical or deep midline dysfunction. There \nis a disorganized background consistent with a mild-moderate \nencephalopathy. This is a nonspecific finding with regards to \netiology but can be seen in the setting of toxic/metabolic \nderangements, anoxia, and medication effect. There is diffuse \noverriding fast activity which is typically seen in the setting \nof medications, i.e. benzodiazepines and barbiturates. There are \nmultiple pushbutton activations for decreased responsiveness or \npatient tremulousness, which are at times associated with delta \nslowing most prominent over the right posterior quadrant, \nhowever this slowing is also present at other times when the \nbutton is not pressed. \nCompared to the previous day's study, there are prolonged \nperiods with \nprominent delta slowing which is an overall worsening. \n\nCHEST X-RAY ___\nThere are low lung volumes. This causes crowding the \nbronchovascular markings\nand exaggeration of heart size. The study is compromised \nsecondary to patient\npositioning.\n \nThe heart is not enlarged. With there may be pulmonary vascular \ncongestion\nversus supine positioning. There is a grossly stable left upper \nlobe mass. \nThere are no large pleural effusions. Degenerative changes are \nseen in the\nspine. Sternal wires appear intact.\n\nCT ___ ___:\nStable subacute parenchymal hematoma, surrounding posttreatment \nchanges. Mass effect on the atrium right lateral ventricle, \nmild prominence of the right temporal horn, similar. \nNo new hemorrhage. \n\nINTERVAL LABS\n==================\n___ 06:55AM BLOOD Glucose-93 UreaN-20 Creat-1.3* Na-143 \nK-4.0 Cl-103 HCO3-27 AnGap-13\n___ 08:03PM BLOOD Phenyto-19.8\n___ 05:40AM BLOOD Phenyto-17.8\n___ 06:18AM BLOOD Phenyto-13.3\n\nMICRO\n==================\nURINE CULTURE (Final ___: < 10,000 CFU/mL. \n\nDISCHARGE LABS\n===================\n___ 07:05AM BLOOD WBC-7.4 RBC-4.01* Hgb-13.0* Hct-37.9* \nMCV-95 MCH-32.4* MCHC-34.3 RDW-15.8* RDWSD-54.6* Plt ___\n___ 07:05AM BLOOD Glucose-129* UreaN-15 Creat-1.1 Na-145 \nK-4.5 Cl-105 HCO3-27 AnGap-13\n___ 07:35AM BLOOD Calcium-8.2* Phos-2.1* Mg-2.0\nMr. ___ is a ___ year old male with history of lung ___\n___ year ago, in remission), R temporal gliosarcoma s/p resection \n1 month ago, with a hemorrhage at the resection site since 1 \nweek prior to admission who presents with frequent seizures \ncharacterized by staring, decreased responsiveness, nonspecific \narm raise and tremor. He was initially on the neurology service \nuntil his seizures were controlled then transferred to the \noncology service where the decision was made to resume \noutpatient radiation. \n\nACUTE ISSUES\n=======================\n#Seizures\nKeppra had been recently increased to 1000 mg BID prior to \nadmission. It was further increased to 1500mg BID upon \nadmission. During the first day of admission, the patient had 8 \nelectro clinical seizures arising from deep midline with \ngeneralization bilaterally. He has given lacosamide 200 mg IV \nload, and continued on 200mg BID. The second day of admission, \nthe patient continued to have clinical events, but no longer had \nEEG correlate. As the semiology was very similar, it was felt \nthat these were epileptic seizures with a deep seizure focus \nthat is difficult to capture on EEG. The seizures are \ncharacterized by suddenly decreased responsiveness with arm \ntremor with nonspecific reaching or picking movements in either \narm. He is intermittently responsive to simple yes/no questions \nand intermittently follows simple commands with delay during the \nseizures. The event ends with slowly improving mental status, \nand it is difficult to tell when the seizure ends vs postictal \nstate. The patient was loaded with phenytoin on ___, and had \ndecreased episodes of paroxysmal poor responsiveness. However, \nhe became more encephalopathic, and phenytoin was discontinued \non ___. He continued on keppra and lacosamide without further \nclinical seizures between ___ - ___. Patient pulled off his EEG \nleads but clinically improved therefore was kept of EEG \nmonitoring. \n\n#Encephalopathy:\nBy ___, he became more encephalopathic and agitated. He had been \nconversant and appropriate on ___. CT ___ was obtained which \nwas stable. Evaluation for infectious etiology was negative with \nblood and urine cultures. Patient had a mild leukocytosis on ___ \nthat downtrended thereafter and was not febrile. His mental \nstatus change was attributed to multiple AEDs, mild \nbenzodiazepine withdrawal (patient refusing home PO doses), and \nhospital acquired delirium. Given urgency of radiation planning, \npatient was given 5mg zyprexa IM BID to help him stay calm \nduring procedures. Home Ativan was converted to IV Ativan (1.5mg \nq6hours) to avoid benzodiazepine withdrawal, as patient \notherwise often refused PO medications. His mental status \nimproved throughout the admission and was able to tolerate PO \nmedications. \n\n#Tachycardia:\nOn the day of discharge patient was working with occupational \ntherapy he became tachycardic to 139 with standing and walking. \nEKG showed sinus tachycardia. He received 500cc bolus with \nresolution of his orthostatic tachycardia and his heart rates \nwere in the ___ with ambulation. \n\n# Gliosarcoma\nMRI showed significant edema in R posterior temporal lobe that \nwas stable. A small area of bleeding was stable, and per family \nhad been present postoperatively. Neuro-oncology was consulted \nduring admission. Radiation oncology was involved to consider \ntransfer radiation plan to ___ but plan was made to \nresume his outpatient radiation at ___ \nsince it was closer to home. Patient underwent CT mapping with \nradiation oncology on ___ and was transferred to the oncology \nservice for further management. He was continued on \ndexamethasone 4mg q8 hours and temazolamide was resumed when he \nwas taking PO at 140mg qdaily.\n\nCHRONIC ISSUES\n=====================\n# Hypertension\nPatient was continued on home antihypertensives. Losartan was \nadded for anti-inflammatory benefit. He had elevated blood \npressures to 140-150s systolic while agitated.\n\n# Hyperlipidemia\n# CAD s/p CABG\nPatient was on rosuvastatin at home. Statin was switched to \npravastatin which has some anti-inflammatory benefit. Patient \nhas been off aspirin since initial presentation for gliosarcoma \ndue to concern for worsening hemorrhage."}}
{'final_diagnoses': ['Focal seizure with altered awareness', 'Gliosarcoma', 'Hypovolemia', 'Encephalopathy', 'Hypertension'], 'procedures': ['None'], 'visit_summary': 'Mr. ___ is a ___ year old male with history of lung ___\n___ year ago, in remission), R temporal gliosarcoma s/p resection \n1 month ago, with a hemorrhage at the resection site since 1 \nweek prior to admission who presents with frequent seizures \ncharacterized by staring, decreased responsiveness, nonspecific \narm raise and tremor. He was initially on the neurology service \nuntil his seizures were controlled then transferred to the \noncology service where the decision was made to resume \noutpatient radiation. \n\nACUTE ISSUES\n=======================\n#Seizures\nKeppra had been recently increased to 1000 mg BID prior to \nadmission. It was further increased to 1500mg BID upon \nadmission. During the first day of admission, the patient had 8 \nelectro clinical seizures arising from deep midline with \ngeneralization bilaterally. He has given lacosamide 200 mg IV \nload, and continued on 200mg BID. The second day of admission, \nthe patient continued to have clinical events, but no longer had \nEEG correlate. As the semiology was very similar, it was felt \nthat these were epileptic seizures with a deep seizure focus \nthat is difficult to capture on EEG. The seizures are \ncharacterized by suddenly decreased responsiveness with arm \ntremor with nonspecific reaching or picking movements in either \narm. He is intermittently responsive to simple yes/no questions \nand intermittently follows simple commands with delay during the \nseizures. The event ends with slowly improving mental status, \nand it is difficult to tell when the seizure ends vs postictal \nstate. The patient was loaded with phenytoin on ___, and had \ndecreased episodes of paroxysmal poor responsiveness. However, \nhe became more encephalopathic, and phenytoin was discontinued \non ___. He continued on keppra and lacosamide without further \nclinical seizures between ___ - ___. Patient pulled off his EEG \nleads but clinically improved therefore was kept of EEG \nmonitoring. \n\n#Encephalopathy:\nBy ___, he became more encephalopathic and agitated. He had been \nconversant and appropriate on ___. CT ___ was obtained which \nwas stable. Evaluation for infectious etiology was negative with \nblood and urine cultures. Patient had a mild leukocytosis on ___ \nthat downtrended thereafter and was not febrile. His mental \nstatus change was attributed to multiple AEDs, mild \nbenzodiazepine withdrawal (patient refusing home PO doses), and \nhospital acquired delirium. Given urgency of radiation planning, \npatient was given 5mg zyprexa IM BID to help him stay calm \nduring procedures. Home Ativan was converted to IV Ativan (1.5mg \nq6hours) to avoid benzodiazepine withdrawal, as patient \notherwise often refused PO medications. His mental status \nimproved throughout the admission and was able to tolerate PO \nmedications. \n\n#Tachycardia:\nOn the day of discharge patient was working with occupational \ntherapy he became tachycardic to 139 with standing and walking. \nEKG showed sinus tachycardia. He received 500cc bolus with \nresolution of his orthostatic tachycardia and his heart rates \nwere in the ___ with ambulation. \n\n# Gliosarcoma\nMRI showed significant edema in R posterior temporal lobe that \nwas stable. A small area of bleeding was stable, and per family \nhad been present postoperatively. Neuro-oncology was consulted \nduring admission. Radiation oncology was involved to consider \ntransfer radiation plan to ___ but plan was made to \nresume his outpatient radiation at ___ \nsince it was closer to home. Patient underwent CT mapping with \nradiation oncology on ___ and was transferred to the oncology \nservice for further management. He was continued on \ndexamethasone 4mg q8 hours and temazolamide was resumed when he \nwas taking PO at 140mg qdaily.\n\nCHRONIC ISSUES\n=====================\n# Hypertension\nPatient was continued on home antihypertensives. Losartan was \nadded for anti-inflammatory benefit. He had elevated blood \npressures to 140-150s systolic while agitated.\n\n# Hyperlipidemia\n# CAD s/p CABG\nPatient was on rosuvastatin at home. Statin was switched to \npravastatin which has some anti-inflammatory benefit. Patient \nhas been off aspirin since initial presentation for gliosarcoma \ndue to concern for worsening hemorrhage.', 'medications_prescribed': ['LACOSamide 200 mg PO BID \nRX *lacosamide [Vimpat] 200 mg 1 tablet(s) by mouth twice daily \nDisp #*60 Tablet Refills:*0', 'Losartan Potassium 25 mg PO DAILY \nRX *losartan 25 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', 'Nicotine Patch 21 mg TD DAILY \nRX *nicotine 21 mg/24 hour apply patch to arm once daily Disp \n#*30 Patch Refills:*0', 'Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0', 'Pravastatin 20 mg PO QPM \nRX *pravastatin 20 mg 1 tablet(s) by mouth once daily at bedtime \nDisp #*30 Tablet Refills:*0', 'LevETIRAcetam 1500 mg PO Q12H \nRX *levetiracetam [Keppra] 750 mg 2 tablet(s) by mouth twice a \nday Disp #*120 Tablet Refills:*0', 'Albuterol Inhaler 1 PUFF IH Q6H:PRN SOB', 'ALPRAZolam 0.5-1 mg PO TID', 'amLODIPine 5 mg PO DAILY', 'Dexamethasone 4 mg PO Q8H', 'Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID', 'Metoprolol Succinate XL 25 mg PO BID', 'OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - \nModerate', 'OxyCODONE SR (OxyconTIN) 15 mg PO Q12H', 'Sertraline 100 mg PO DAILY', 'Sulfameth/Trimethoprim DS 1 TAB PO 3X/WEEK (___)', 'Temodar (temozolomide) 140 mg oral DAILY', 'Xanax XR (ALPRAZolam) 3 mg oral QAM']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 42, 'gender': 'M', 'symptoms': 'Neck pain', 'medical_history': ['Type 2 diabetes mellitus.', 'Hypertension.', 'Obesity.', 'Lupus like syndrome.', 'Obstructive sleep apnea.', 'Asthma.', 'Neuropathy.', 'History of nephrolithiasis.', 'Chronic kidney disease.', 'History of vocal cord paralysis with permanent \ntracheostomy.', 'Gout.', 'History of bigeminy and V-tach.', 'Status post spinal fusion surgeries in ___ and ___.', 'Status post cholecystectomy in ___.', 'Status post rotator cuff repair in ___.', 'Status post appendectomy/ex-lap in the 1990s.', 'Status post sternum separation surgery.', 'Pancreatic cyst followed by ___ ', 'Status post lap colectomy in ___', '___ has an extensive past medical\nhistory including type 2 diabetes mellitus complicated by\nneuropathy, obesity, chronic kidney disease, gout, and prior\nsurgeries complicated by bigeminy and an episode of Vtach. He\npresented with one year of chronic intermittent abdominal pain\nand diarrhea for which he was referred for CT. This study\nidentified a pancreatic cyst. The has been sampled twice by EUS\nand determined to be a benign cyst. He also underwent\ncolonoscopy ___, and this study identified a 5 cm mass in\nthe descending colon with malignant features. Biopsy showed\nlow-grade adenocarcinoma. On ___ Mr. ___ underwent\nlaparoscopic partial left colectomy with takedown of the splenic\nflexure. Pathology revealed a 3.2 x 2.7 x 1.3 cm low-grade\nadenocarcinoma, MSI stable, KRAS wild type. One of 12 lymph\nnodes was involved; no lymphovascular or perineural invasion \nwere seen. Mr. ___ was diagnosed with pT3N1aMx stage IIIB\ncolon\nadenocarcinoma. He initiated adjuvant FOLFOX ___'], 'family_history': 'Does not know his parents, as he is adopted. He has no known \nsiblings. He has one daughter who is healthy.', 'present_illness': 'HPI(4): Mr. ___ is a ___ w/ stage IIIB colon cancer s/p\nresection and completion of adjuvant FOLFOX (in __,\nbilateral vocal cord paralysis w/ permanent tracheostomy, T2DM,\nobesity, HTN/HLD, CKD (baseline Cr 1.3-1.8), palpitations and\nother issues who presented to the ED today for evaluation of \nneck\npain and feverishness. He first developed neck pair, sore\nthroat, and ear pain 1 week ago. He also noted some brownish\ndischarge from around his trach (usually there is no discharge).\n\nHe also reports feeling feverish at home for the past 4 days \nwith\nchills and sweats. He had also developed a non-productive \ncough,\nso he went to see his PCP, who prescribed a 10-day course of\nAzithromycin for presumed pneumonia. Of note, he does describe \na\nsingle episode of coughing up a small amount of old-appearing\nblood, but this has not recurred. He continued feel feverish \nand\nnoted worsening of his R-sided neck pain, which also spread to\nhis shoulder and was worsened with movement. He also notes some\nswelling of his R neck and upper chest. He went to see his ENT\non ___ who performed an endoscopic evaluation\n(laryngoscopy/tracheoscopy) and did not note any erythema,\npurulence, or concerning lesions. However, due to concern for\nlymphadenitis vs. neck abscess, his ENT advised him to go to the\nED. \n\nIn the ED, initial VS were 98.5 87 182/93 26 100% RA. Labs were\nnotable for WBC 12.5 w/ 83% PMNs, Hgb 10.6, (recent baseline\n___, Cr 1.5 (baseline 1.3-1.8), lytes WNL, Lactate 1.4, CXR\nwithout evidence of pneumonia. CT neck was obtained and showed\nsubtle stranding along the right aspect of the tracheostomy tube\nsuggestive of inflammation/infection without a drainable fluid\ncollection. The patient was started on IV Clindamycin and\nreceived IV ketorolac 15 mg x3, acetaminophen, and ondansetron,\nas well as several home medications (Glipizide, omeprazole,\nmetoprolol, and tramadol) and was admitted.\n\nOn arrival to the floor, patient is comfortable but reports\nongoing R sided neck pain. He adds that the pain is worsened\nwith movement, and that he previously had a POC in R chest that\nwas removed a couple of months ago. He has had DVT in the leg \nin\nthe past but never in the UEs.\n\nROS: Pertinent positives and negatives as noted in the HPI. All\nother systems were reviewed and are negative.', 'medications': [{'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BusPIRone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Nafcillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74.9', 'valuenum': 74.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.24', 'valuenum': 4.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission EXAM(8)\nVITALS: 98.1 170 / 90 72 18 99 RA \nGENERAL: Alert and in no apparent distress\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nNECK: Tracheostomy in place just R of midline, no erythema or\ndrainage. There is tenderness to palpation of the soft tissues\nof the R neck and chest. \nCV: Heart regular, no murmur, no S3, no S4. \nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. \nGU: No suprapubic fullness or tenderness to palpation\nMSK: Moves all extremities, strength grossly full and symmetric\nbilaterally in all limbs. There is pitting edema of the\nbilateral lower extremities. The R shoulder ___ and AC joints \nand\nbiceps tendon are nontender to palpation. There is no edema of\nthe RUE and impingement tests to not evoke pain.\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent, moves all limbs, sensation to light touch grossly\nintact throughout\nPSYCH: pleasant, appropriate affect\n\nDischarge Exam: Vitals reviewed and unremarkable. Obese man, \nalert, cooperative, NAD, seated in bed. Anicteric, MMM. The \narea just to the right of his tracheostomy remains somewhat \nindurated, ~2cm x 2cm as before, but it is improved from prior, \nno erythema and almost no tenderness. Equal chest rise, CTAB \nposteriorly, no WOB or cough. Heart regular. Abdomen soft, \nNTND. Extremities warm and well-perfused, no obvious pitting \nedema.', 'diagnoses': [{'icd_code': '6826', 'desc': 'Cellulitis and abscess of leg, except foot'}, {'icd_code': '2662', 'desc': 'Other B-complex deficiencies'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '3004', 'desc': 'Dysthymic disorder'}], 'summary': 'Admission Labs: \n___ 02:30PM BLOOD WBC-12.5*# RBC-4.69 Hgb-12.2* Hct-38.9* \nMCV-83 MCH-26.0 MCHC-31.4* RDW-16.3* RDWSD-49.5* Plt ___\n___ 02:30PM BLOOD Glucose-182* UreaN-15 Creat-1.3* Na-139 \nK-4.6 Cl-101 HCO3-21* AnGap-17\n\nImaging: \nCTA Chest: FINDINGS: The study is non gated. S/p sternotomy, \nremaining wires broken. No evidence of osteomyelitis or \ncollections surrounding the sternal fractures. There is no \ncardiomegaly and no pericardial effusion. Specks of \ncalcifications of the aortic valve leaflets and along the normal \ncaliber thoracic aorta. The aorta and its major branch vessels \nare patent, with no evidence of stenosis, occlusion, dissection, \nor aneurysmal formation. There is no evidence of penetrating \natherosclerotic ulcer. No appreciable atherosclerotic \ncalcifications of the coronaries. The pulmonary arteries are \nwell opacified to the segmental level, with no evidence of \nfilling defect within the main, right, left, lobar, segmental \npulmonary arteries. The main and right pulmonary arteries are \nnormal in caliber, and there is no evidence of right heart \nstrain. There is no supraclavicular, axillary, mediastinal, or \nhilar lymphadenopathy. The thyroid gland appears unremarkable. \nStatus post tracheostomy, in comparison to ___ new \nfat stranding and edema as well as minimal fluid surrounds the \ntracheostomy site especially on the right side (05:46), there \nare no drainable collections. The study was performed in partial \ninspiration and there are bilateral dependent microatelectases. \nNo consolidations to suggest pneumonia. Right lower lobe 0.5 cm \nnodules are unchanged (5: 175, 201). Trace bilateral pleural \neffusions are new in comparison to prior. Image portion of the \nupper abdomen demonstrate small hiatal hernia. 3.8 cm cyst at \nthe level of the pancreas tail is unchanged since at least ___. S/p cholecystectomy. No lytic or blastic osseous \nlesion suspicious for malignancy is identified.\nIMPRESSION: No evidence of pulmonary emboli. New fat stranding \nand edema surround the tracheostomy site especially on the right \nside, suggesting cellulitis and possibly developing abscess. \nThere are no organized drainable fluid collections.\n\nCT Neck: \nFINDINGS: Streak artifact from C7-T1 fusion hardware and \nsurgical clips in the lower pole of the right thyroid limits \ndiagnostic evaluation. Tracheostomy tube is noted.\nThe salivary glands enhance normally and are without mass or \nadjacent fat\nstranding. The left submandibular gland is not well seen, \nunchanged compared to ___, most likely atrophic.The thyroid \ngland appears normal. There is no lymphadenopathy by CT \ncriteria. The neck vessels are patent. There is subtle \nstranding along the right aspect of the tracheostomy tube, which \ncould be due to inflammation/infection. No drainable fluid \ncollection.\nThe imaged portion of the lung apices are clear and there are no \nconcerning pulmonary nodules. There are no osseous lesions. \nMidline sternotomy wires are noted.\nIMPRESSION: Subtle stranding along the right aspect of the \ntracheostomy tube could be due to inflammation/infection. No \ndrainable fluid collection.\n\nMicro: ___ BCx NG final\n\nDischarge Day labs:\n___ 06:59AM BLOOD WBC-6.2 RBC-4.74 Hgb-12.6* Hct-38.6* \nMCV-81* MCH-26.6 MCHC-32.6 RDW-16.1* RDWSD-47.8* Plt ___\n___ 06:59AM BLOOD Glucose-191* UreaN-20 Creat-1.7* Na-138 \nK-5.1 Cl-100 HCO3-23 AnGap-___ man w/ stage IIIB colon cancer s/p resection and completion \nof adjuvant FOLFOX (in ___, bilateral vocal cord \nparalysis w/ permanent tracheostomy, T2DM, obesity, HTN/HLD, CKD \n(baseline Cr 1.3-1.8), palpitations and other issues who \npresented to the ED for evaluation of neck pain and feverishness \nwith imaging findings suggestive of ___ \ncellulitis.\nOn the day of discharge, the patient was feeling better. He was \nlooking forward to going home. He was seen by an ENT resident \nthis morning who agreed with this plan. He has no Qs for me. \nWe reviewed his ___ and medication plan.\n\nPLAN by PROBLEMS\n\n#Tracheitis and ___ cellulitis: Infection seemed \nto be the most likely cause of his tracheal irritation given his \nCT findings, neutrophilia, and report of feverishness at home. \nInitially IV clindamycin was used (___), however he did not clinically improve on this (his WBC \nimproved). An U/S was performed showing no clot in the RUE. He \ncontinued to report new chest pain on ___ and a CTA was \nnegative for clot but showed "New fat stranding and edema \nsurround the tracheostomy site especially on the right side, \nsuggesting cellulitis and possibly developing abscess. There are \nno organized drainable fluid collections." Previous imaging \nshowed inflammation on the right side of the tracheostomy tube, \nand there was some concern for possible tracheitis, however he \ndid not have much cough. Vancomycin was added on ___ given \nthis finding. Given improvement on that, he was changed to PO \nTMP/SMX on ___, and observed. ENT consulted on ___ given \npea-sized hemoptysis (clotted) x 2, they scoped him through the \ntrach, and agreed with the management as well as adding \nhumidified air, and recommended one more night of observation \nand outpatient ___ with Dr. ___ ENT after completing \n7 more days of the antibiotic. He seemed to be tolerating the \nTMP/SMX well while in the hospital (no hyperkalemia, some mild \nexpected increase in creatinine that does not represent \nworsening renal function -- known side effect of medication is \nreabsorption of creatinine). Pain control was achieved with \nacetaminophen + tramadol PRN.\n\n# HTN: Patient with a chart diagnosis of hypertension and his \nSBP was in the 170s here; however, he is no longer on any home \nmedications for this (he weaned himself off). As he is \ncurrently in pain, it is reasonable to treat this before \naddressing\nrestarting BP meds. If re-starting an antihypertensive is \nindicated, would favor\nLisinopril given his CKD and DM2. His BPs improved after his \npain was controlled so no agent was started.\n\n# DM2: \nWe held his home glipizide and gave him insulin sliding scale. \nHe noted he had been able to come off of insulin after losing \nsome weight but in the hospital, his sugars were elevated in the \n200s -- perhaps related to the infection. He should be followed \nup for his as an outpatient, for instance checking a HbA1c. \n\n# Palpitations/SVT:\n- Continued home metoprolol XL 25 mg PO QD\n\n# Lower extremity edema: Patient reports that he was on \nfurosemide in the past and diuresed several kilograms; however, \nhe has also taken himself off of furosemide. There was no \nindication for diuresis during admission.\n\n# Supplement use / other medications: continued his testosterone \ngel, ascorbic acid, cyanocobalamin, magnesium oxide, and others \nas noted in prior progress notes\n\n# Gout: consider allopurinol in the outpatient setting.\n\n# Stage III CKD: Cr was at baseline 1.3-1.8. Avoided \nnephrotoxins (NSAIDs).\n\nOn the day of discharge I spent >30min in discharge day services \nand coordination of care.\n\n___, MD\n___\nPager ___'}}
{'final_diagnoses': ['#Tracheitis and ___ cellulitis'], 'procedures': ['None'], 'visit_summary': 'On the day of discharge, the patient was feeling better. He was \nlooking forward to going home. He was seen by an ENT resident \nthis morning who agreed with this plan. He has no Qs for me. \nWe reviewed his ___ and medication plan.\n\nPLAN by PROBLEMS\n\n#Tracheitis and ___ cellulitis: Infection seemed \nto be the most likely cause of his tracheal irritation given his \nCT findings, neutrophilia, and report of feverishness at home. \nInitially IV clindamycin was used (___), however he did not clinically improve on this (his WBC \nimproved). An U/S was performed showing no clot in the RUE. He \ncontinued to report new chest pain on ___ and a CTA was \nnegative for clot but showed "New fat stranding and edema \nsurround the tracheostomy site especially on the right side, \nsuggesting cellulitis and possibly developing abscess. There are \nno organized drainable fluid collections." Previous imaging \nshowed inflammation on the right side of the tracheostomy tube, \nand there was some concern for possible tracheitis, however he \ndid not have much cough. Vancomycin was added on ___ given \nthis finding. Given improvement on that, he was changed to PO \nTMP/SMX on ___, and observed. ENT consulted on ___ given \npea-sized hemoptysis (clotted) x 2, they scoped him through the \ntrach, and agreed with the management as well as adding \nhumidified air, and recommended one more night of observation \nand outpatient ___ with Dr. ___ ENT after completing \n7 more days of the antibiotic. He seemed to be tolerating the \nTMP/SMX well while in the hospital (no hyperkalemia, some mild \nexpected increase in creatinine that does not represent \nworsening renal function -- known side effect of medication is \nreabsorption of creatinine). Pain control was achieved with \nacetaminophen + tramadol PRN.\n\n# HTN: Patient with a chart diagnosis of hypertension and his \nSBP was in the 170s here; however, he is no longer on any home \nmedications for this (he weaned himself off). As he is \ncurrently in pain, it is reasonable to treat this before \naddressing\nrestarting BP meds. If re-starting an antihypertensive is \nindicated, would favor\nLisinopril given his CKD and DM2. His BPs improved after his \npain was controlled so no agent was started.\n\n# DM2: \nWe held his home glipizide and gave him insulin sliding scale. \nHe noted he had been able to come off of insulin after losing \nsome weight but in the hospital, his sugars were elevated in the \n200s -- perhaps related to the infection. He should be followed \nup for his as an outpatient, for instance checking a HbA1c. \n\n# Palpitations/SVT:\n- Continued home metoprolol XL 25 mg PO QD\n\n# Lower extremity edema: Patient reports that he was on \nfurosemide in the past and diuresed several kilograms; however, \nhe has also taken himself off of furosemide. There was no \nindication for diuresis during admission.\n\n# Supplement use / other medications: continued his testosterone \ngel, ascorbic acid, cyanocobalamin, magnesium oxide, and others \nas noted in prior progress notes\n\n# Gout: consider allopurinol in the outpatient setting.\n\n# Stage III CKD: Cr was at baseline 1.3-1.8. Avoided \nnephrotoxins (NSAIDs).\n\nOn the day of discharge I spent >30min in discharge day services \nand coordination of care.\n\n___, MD\n___\nPager ___', 'medications_prescribed': ['Sulfameth/Trimethoprim DS 2 TAB PO BID Duration: 7 Days \nRX *sulfamethoxazole-trimethoprim [Bactrim DS] 800 mg-160 mg 2 \ntablet(s) by mouth twice a day Disp #*28 Tablet Refills:*0 ', 'alpha lipoic acid ___ mg oral DAILY ', 'AndroGel (testosterone) 1.62 % (20.25 mg/1.25 gram) \ntransdermal ASDIR ', 'Ascorbic Acid ___ mg PO BID ', 'Cyanocobalamin ___ mcg PO DAILY ', 'garlic extract unknown oral DAILY ', 'GlipiZIDE 10 mg PO QAM ', 'GlipiZIDE 5 mg PO QPM ', 'Grapefruit (flavoring agent (bulk)) miscellaneous DAILY ', 'green tea extract miscellaneous DAILY ', 'LOPERamide ___ mg PO QID:PRN diarrhea ', 'Magnesium Oxide 400 mg PO DAILY ', 'Metoprolol Succinate XL 25 mg PO DAILY ', 'Metoprolol Tartrate 25 mg PO DAILY:PRN palpitations ', 'Omeprazole 20 mg PO DAILY ', 'Vitamin D 1000 UNIT PO DAILY ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 58, 'gender': 'M', 'symptoms': 'Chest pain and dizziness', 'medical_history': ['Chronic kidney disease (baseline creatinine 1.6)', 'Hyperlipidemia', 'Hypertension', 'Seizure disorder s/p childhood meningitis', 'Cognitive Impairment s/p childhood meningitis', 'Peripheral neuropathy -- due to medication effect', 'Anemia', 'Osteopenia'], 'family_history': 'Father, mother and sister died of CV events.', 'present_illness': 'The patient is a ___ year old male with a history of seizure \ndisorder, cognitive impairment, hypertension, and CKD who \npresents from home with chest pain, dizziness, hypotension, and \nheadache. He reports that he called his PCP this morning after \ndeveloping a new sharp pain in the right side of his chest. He \nwas diarrhea several times daily for the last few weeks, but \nalso developed nausea and nonbloody, nonbilious vomiting this \nmorning. He was brought in the the ED by EMS. Per EMS, he had \npostural hypotension with reclined BP 128/76, HR 84, sitting BP \n112/72, HR 120, and standing BP unobtainable, HR 150s with no \nLOC. \n. \nIn the ED, initial VS were T 97.2, HR 107, BP 124/69, RR 14, and \nSpO2 96% on RA. The chest pain resolved in the ED without \nspecific tretment. Labs were notable for lactate 2.2, creatinine \n2.5, bicarb 17, anion 18, and Troponin 0.02. CXR showed no \neffusion or opacity and stable compression changes of the spine. \nEKG was sinus at 82 bpm with PACs, first degree AV block, and \nnonspecific ST-T changes without frank evidence of ischemia. He \nwas given IV fluids, unclear how much, and Potassium chloride 40 \nmEq PO. \n. \nHe was admitted to Medicine for ___ and ___ out ACS. Vitals \nprior to floor transfer were T 97.4, BP 122/74, HR 72, RR 18, \nand SpO2 100% on RA. On reaching the floor, he reported feeling \nmuch better. He denied any current chest pain, palpitaions, SOB, \ncough, nausea, vomiting, abdominal pain, or urinary symptoms. He \ndid note a chronic headache, and chronic numbness in his legs \nfrom medication related neuropathy. When asked about his \ndiarrhea, he noted that he often feels constipated and takes \nEx-Lax frequently, leading to diarrhea shortly afterwards.', 'medications': [{'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENObarbital', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENObarbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENObarbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium Extended', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'LaMOTrigine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '14.1', 'valuenum': 14.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '254', 'valuenum': 254.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.33', 'valuenum': 4.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "Transfer VS: T 97.4, BP 158/78, HR 92, RR 20, SpO2 95% on RA \n___: 97.4, 114-158/74-78, 86, 20, 97RA \nGen: Elderly male in NAD. Alert and Oriented x3. \nHEENT: NCAT. Sclera anicteric. Surgical right pupil. Pupils \nreactive to light, EOMI. MMM, OP benign. \nNeck: Supple, full ROM. JVP not elevated. No significant \ncervical lymphadenopathy. \nCV: Irregular with normal S1, S2. Soft systolic murmur heard \nbest at base and apex. \nChest: Respiration unlabored, no accessory muscle use. CTAB \nwithout crackles, wheezes or rhonchi. \nAbd: Normal bowel sounds. Soft, NT, ND. No organomegaly or \nmasses. \nExt: WWP. Digital cap refill <2 sec. No C/C/E. Distal pulses \nintact radial 2+, DP 2+, ___ 2+. \nSkin: No rashes, ulcers, or other lesions noted. \nNeuro: CN II-XII grossly intact. Strength ___ in all \nextremities. Normal speech.\n\nOrthostatics in the AM\nBP 120's/70's stable\nHR 80 to 130\n\nin the ___\nBP 120's/70's stable\nHR 64 to 69", 'diagnoses': [{'icd_code': '80020', 'desc': 'Closed fracture of vault of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '34550', 'desc': 'Localization-related (focal) (partial) epilepsy and epileptic syndromes with simple partial seizures, without mention of intractable epilepsy'}, {'icd_code': '80120', 'desc': 'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, unspecified state of consciousness'}, {'icd_code': 'E887', 'desc': 'Fracture, cause unspecified'}, {'icd_code': 'E8498', 'desc': 'Accidents occurring in other specified places'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}], 'summary': "___ 06:00PM BLOOD WBC-10.4 RBC-5.18 Hgb-11.1* Hct-35.7* \nMCV-69* MCH-21.4* MCHC-31.1 RDW-17.6* Plt ___\n___ 06:18AM BLOOD WBC-8.3 RBC-4.51* Hgb-9.5* Hct-31.6* \nMCV-70* MCH-21.0* MCHC-30.0* RDW-17.9* Plt ___\n___ 06:18AM BLOOD ___ PTT-25.0 ___\n___ 06:00PM BLOOD Glucose-82 UreaN-44* Creat-2.5* Na-133 \nK-3.2* Cl-90* HCO3-17* AnGap-29*\n___ 01:00PM BLOOD Creat-2.0* Na-133 K-3.5 Cl-97\n___ 06:00PM BLOOD cTropnT-0.02*\n___ 06:18AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 06:00PM BLOOD ALT-12 AST-22 LD(LDH)-208 CK(CPK)-81 \nAlkPhos-88 TotBili-0.5\n___ 06:00PM BLOOD calTIBC-386 VitB12-1176* Folate-15.3 \nFerritn-30 TRF-297\n___ 09:59PM BLOOD Lactate-2.2*\n___ 06:28AM BLOOD Lactate-1.5\n\nCXR\nIMPRESSION: No acute cardiopulmonary abnormality. Multilevel \ncompression \ndeformities within the thoracic spine, all of which appear \nrelatively \nunchanged when compared to the prior CT from ___. \n\n___ EKG\nNormal sinus rhythm with frequent atrial premature beats. \nNon-specific \nST segment changes in leads II, III, aVF and V4-V6. RSR' pattern \nin \nleads V1-V2. Compared to the previous tracing of ___ the \nnon-specific \nST segment changes are somewhat more prominent. No other \ndiagnostic interval change. \n\n___ EKG\nNormal sinus rhythm with occasional atrial premature beats with \naberrant \nconduction. Compared to tracing #1 the rate has slowed slightly \nand the ST segment changes previously noted persist but are less \nprominent. \nThese changes may be related to myocardial ischemia.\nMr ___ ___ year old male with a history of seizure disorder, \ncognitive impairment, hypertension, and CKD who presents from \nhome with one month of diarrhea, now with dizziness and \nhypotension. He was found to have significant orthostatic \nhypotension and ___. This is attributable to laxative overuse. \nFamily meeting held to discuss judicious use of medications and \npatient aggressively hydrated and faired well walking about \nindependently on discharge. Elder services and ___ contacted on \ndischarge\n. \n# Diarrhea: He reports that he often feels constipated and has \nbeen taking Ex-Lax frequently, resulting in his diarrhea. Colace \ncontinued and exlax discontinued\n. \n# Orthostatic Hypotension: Diarrhea + poor PO intake (only eats \nmeals on wheels) and HCTZ resulted in volume depletion. \nAgressively volume repleted. DC'd HCTZ (at least temporarily)\n\n# Acute on Chronic Kidney Injury: He has CKD with recent \nbaseline Cr ~1.6, and was up to Cr 2.5 in the ED. See mgmt of \northostasis\n. \n# Chest Pain: He had a brief episode of chest pain prior to \nadmission which sounds noncardiac by description and resolved on \narrival. His EKG showed nonspecific ST-T changes, and his first \nTroponin was 0.02, negative in the setting of his ___, \nsecond set < 0.01. Deferred decision re: stress test to PCP. \nContinued aspirin 81mg and statin\n\n# Thrombocytosis - could reflect infection but more likely iron \ndeficiency. Sent home on iron repletion with vitamin c \n. \n# Anemia - microcytic with ferritin of 30 reflects frank iron \ndeficiency. Sent home on iron repletion with vitamin c. Needs \ncolonoscopy and ? EGD. Scheduled. \n \n# Seizure Disorder: home meds\n# Hyperlipidemia: home meds\n# Osteopenia: home meds\n\nTRANSITIONAL ISSUES\n1. Follow iron repletion, investigate for GI losses\n2. Continue to pursue more structured placement for patient by \nreinforcing needs to brother\n3. Follow up electrolytes and ensure continuing resolution of \ninjury"}}
{'final_diagnoses': ['hypovolemia', 'iron deficiency anemia', 'cognitive impairment', 'seizure disorder', 'Chronic kidney disease', 'Hypertension'], 'procedures': ['none'], 'visit_summary': "Mr ___ ___ year old male with a history of seizure disorder, \ncognitive impairment, hypertension, and CKD who presents from \nhome with one month of diarrhea, now with dizziness and \nhypotension. He was found to have significant orthostatic \nhypotension and ___. This is attributable to laxative overuse. \nFamily meeting held to discuss judicious use of medications and \npatient aggressively hydrated and faired well walking about \nindependently on discharge. Elder services and ___ contacted on \ndischarge\n. \n# Diarrhea: He reports that he often feels constipated and has \nbeen taking Ex-Lax frequently, resulting in his diarrhea. Colace \ncontinued and exlax discontinued\n. \n# Orthostatic Hypotension: Diarrhea + poor PO intake (only eats \nmeals on wheels) and HCTZ resulted in volume depletion. \nAgressively volume repleted. DC'd HCTZ (at least temporarily)\n\n# Acute on Chronic Kidney Injury: He has CKD with recent \nbaseline Cr ~1.6, and was up to Cr 2.5 in the ED. See mgmt of \northostasis\n. \n# Chest Pain: He had a brief episode of chest pain prior to \nadmission which sounds noncardiac by description and resolved on \narrival. His EKG showed nonspecific ST-T changes, and his first \nTroponin was 0.02, negative in the setting of his ___, \nsecond set < 0.01. Deferred decision re: stress test to PCP. \nContinued aspirin 81mg and statin\n\n# Thrombocytosis - could reflect infection but more likely iron \ndeficiency. Sent home on iron repletion with vitamin c \n. \n# Anemia - microcytic with ferritin of 30 reflects frank iron \ndeficiency. Sent home on iron repletion with vitamin c. Needs \ncolonoscopy and ? EGD. Scheduled. \n \n# Seizure Disorder: home meds\n# Hyperlipidemia: home meds\n# Osteopenia: home meds\n\nTRANSITIONAL ISSUES\n1. Follow iron repletion, investigate for GI losses\n2. Continue to pursue more structured placement for patient by \nreinforcing needs to brother\n3. Follow up electrolytes and ensure continuing resolution of \ninjury", 'medications_prescribed': ['aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'lovastatin 40 mg Tablet Sig: Two (2) Tablet PO once a day.', 'amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', 'alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week.', 'calcitriol 0.25 mcg Capsule Sig: One (1) Capsule PO EVERY \nOTHER DAY (Every Other Day).', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', 'folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'calcium carbonate 500 mg calcium (1,250 mg) Tablet Sig: One \n(1) Tablet PO twice a day.', 'Vitamin B-12 2,000 mcg Tablet Extended Release Sig: One (1) \nTablet Extended Release PO once a day.', 'ferrous sulfate 325 mg (65 mg iron) Tablet, Delayed Release \n(E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO twice a \nday.\nDisp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', 'ascorbic acid ___ mg Tablet Sig: One (1) Tablet PO twice a \nday.\nDisp:*60 Tablet(s)* Refills:*2*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 73, 'gender': 'F', 'symptoms': 'weight loss, aspiration', 'medical_history': ['Past Oncologic History:\n- ___ CXR for cough showed R-sided opacity, chest CT which \nshowed a nodular lesions in superior RLL and mod/large R pleural \neffusion\n- ___ pleural effusion tapped and negative for malignancy\nPt then developed hoarseness and was seen by ENT ___ and \ndetermined to have recurrent nerve paralysis, highly concerning \nfor malignancy.\n- ___ repeat imaging disclosed a smaller LUL nodule and \nparatracheal mass, likely a lymph node conglomerage\n- ___ EBUS with FNA sampled paratracheal mass and lymph \nnode, both positive for poorly differentiated adenocarcinoma. \nBrochial brushings of the right lobar bronchi were atypical\n- ___: irreversible EGFR/ErbB2 TKI ___ \n.\nOther Past Medical History: \n1. Stroke.\n2. Right-sided breast cancer: This was about ___ years ago and\n treated with mastectomy and radiation therapy.\n3. Type 2 diabetes: Diet controlled.\n4. Hypertension.\n5. Atrial fibrillation.\n6. Gout.\n7. Hypothyroidism.\n8. Osteopenia/osteoporosis.\n9. Glaucoma.'], 'family_history': 'No family history of lung disease. However, note that her \nhusband who is a long time smoker died of lung cancer.', 'present_illness': 'Ms. ___ is a ___ year old woman w/hx of stage IV NSCLC on \ntreatment with ___: an irreversible EGFR/ErbB2 TKI, who \npresented to ___ clinic with inability to eat due to cough \nwith any oral intake. She has recurrent laryngeal nerve \nparalysis due to tumor compression. She has had associated \nweight loss and fatigue from poor ___ intake.\n.\nIn clinic, she was afebrile with normal vitals. She was \nadmitted for workup of possible aspiration. Of note, her \ncreatinine was elevated above baseline.\n. ', 'medications': [{'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '2X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '5X/WEEK', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '354', 'valuenum': 354.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.9', 'valuenum': 40.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.99', 'valuenum': 2.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'GEN: NAD, daughter at bedside, ___ soft voice\nVS: 98.1, 142/66, 78, 20, 96%/RA; orthostatics with ___ drop \nin BPs\nHEENT: dry MM, +L SCV LN\nCV: mostly regular with occassional dropped beat, no mrg, reg \nrate\nPULM: cta b/l with decreased BS left base\nABD: +BS, soft NTND\nLIMBS: no edema, NT\nSKIN: no rashes\nNEURO: CNS intact, 4.5/5 strength left arm versus right, \notherwise intact sensation, strength, cerebellum\n*********', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '1551', 'desc': 'Malignant neoplasm of intrahepatic bile ducts'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '25040', 'desc': 'Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': 'V0259', 'desc': 'Carrier or suspected carrier of other specified bacterial diseases'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V8534', 'desc': 'Body Mass Index 34.0-34.9, adult'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'V1043', 'desc': 'Personal history of malignant neoplasm of ovary'}], 'summary': "Admission labs:\n\n___ 12:26PM BLOOD Neuts-70.8* ___ Monos-6.0 Eos-3.8 \nBaso-0.1\n___ 12:26PM BLOOD UreaN-26* Creat-1.2* Na-141 K-3.7 Cl-99 \nHCO3-36* AnGap-10\n___ 12:26PM BLOOD ALT-9 AST-22 AlkPhos-50 TotBili-0.9\n___ 12:26PM BLOOD Albumin-3.6 Calcium-9.0\n\nCT chest/neck ___. Interval decrease in size of a left upper mediastinal lesion, \npreviously\ncharacterized as lymph node conglomerate with necrosis. This \nindicates that\npossible left recurrent laryngeal nerve paralysis as suggested \npreviously\nshould not worsen though may persist.\n \n2. A left anterior cervical lymph node identified on prior study \nalso\ndemonstrates interval decrease in size. A probable enhancing \nlymph node as\ndescribed adjacent to the right parotid gland is unchanged.\n \n3. Partial visualization and evaluation of a right upper lobe \npulmonary\nnodule with a large right-sided pleural effusion.\n \n4. Stable appearance of moderate-to-severe multilevel \ndegenerative disease\nwithin the cervical spine.\n \n5. Vascular calcifications as described.\n*****************\nDischarge labs:\n___ 06:05AM BLOOD WBC-10.0 RBC-3.84* Hgb-12.3 Hct-37.5 \nMCV-98 MCH-32.1* MCHC-32.9 RDW-16.2* Plt ___\n___ 06:05AM BLOOD Glucose-134* UreaN-34* Creat-1.6* Na-140 \nK-4.0 Cl-103 HCO3-29 AnGap-12\n___ 03:40PM BLOOD Creat-1.4*\n.\nu/a negative\n.\npleural fluid:\n___ 05:38PM PLEURAL WBC-278* RBC-3067* Polys-11* Lymphs-59* \nMonos-0 Eos-1* Meso-4* Macro-25*\n___ 05:38PM PLEURAL TotProt-2.4 Glucose-134 LD(LDH)-65\n.\n___ video swallow:\nAspiration of multiple consistencies. \n.\n___ pleural fluid cell block:\nNegative for malignant cells.\nReactive mesothelial cells, inflammatory cells. \n.\n___ CXR:\nAP chest compared to ___, read in conjunction with \nintervening chest CT, ___. No right pneumothorax or \nappreciable \nresidual pleural effusion. Moderate cardiomegaly with particular \nenlargement \nof the main pulmonary artery and azygous distention unchanged \nsince ___. Lungs are low in volume aside from relatively mild \natelectasis on the \nleft. They are clear. No left pleural effusion. Rightward \ndeviation by the \ncervicothoracic mass is more pronounced today than on ___, but \ndifficult to compare because of differences in projection and \nlung volumes. \nOne is referred to the report of the neck CT ___ for \nassessment. \nMs. ___ is a ___ F w/stage IV NSCLC and remote hx of breast \ncancer who presents with coughing and possible aspiration due to \nvocal cord paralysis from recurrent laryngeal nerve dysfunction.\n.\n# FTT: Patient has had a 10 lb weight loss in 2 months and is \npossibly aspirating while eating a regular diet. She failed \nbedside and video swallow due to aspiration. Medications were \nchanged to IV form or stopped with the exception of her cancer \nstudy drug and Trazodone. Patient understood risks of \ncontinuing these medications with aspiration. She was placed on \nmaintenance fluids. Patient was started on a PPI. Patient had a \nPEG tube placed on ___ by the Interventional Pulmonary team, she \ntolerated the procedure well. Tubefeeds were started, per \nnutrition recommendations, the following day. Some medications \nwere being given through tubefeeds, with only the study drug \nbeing taken orally.\n.\n# Acute on Chronic Renal Insufficiency: Mildly above baseline at \nadmission. Creatinine improved with gentle IVF and mucomyst was \ngiven before and after CT scan.\nAllopurinol was renally dosed when given. IVF held on procedure \nday ___, and then Cr bumped again - with IVF Cr improved again.\n\n# Vocal cord dysfunction: question whether due to nerve \ninvolvment by malingnancy or nerve dysfuntion. Patient was seen \nby ENT, who recommended outpatient follow-up.\n\n# NSCLC: Study drug was continued. Outpatient oncologist \ninvolved in patient's inpatient care. Patient had a therapeutic \nthoracentesis on ___ by the Interventional Pulmonary team - well \ntolerated.\n \n# Atrial fibrillation: Rate controlled, poor candiditate for \nanticoagulation give age and risk of falls. Atenolol continued; \nnot anticoagulated.\n\n# Hypothyroidism: Recent TSH in ___ at goal of 1.8. Continued \nLevothyroxine.\n\n# HTN: Held HCTZ given mild renal insufficiency.\n# Code: FULL (confirmed)"}}
{'final_diagnoses': ['lung cancer', 'aspiration', 'laryngeal nerve dysfunction', 'atrial fibrillation', 'hypothyroidism'], 'procedures': ['PEG tube placement', 'thoracentesis'], 'visit_summary': "Ms. ___ is a ___ F w/stage IV NSCLC and remote hx of breast \ncancer who presents with coughing and possible aspiration due to \nvocal cord paralysis from recurrent laryngeal nerve dysfunction.\n.\n# FTT: Patient has had a 10 lb weight loss in 2 months and is \npossibly aspirating while eating a regular diet. She failed \nbedside and video swallow due to aspiration. Medications were \nchanged to IV form or stopped with the exception of her cancer \nstudy drug and Trazodone. Patient understood risks of \ncontinuing these medications with aspiration. She was placed on \nmaintenance fluids. Patient was started on a PPI. Patient had a \nPEG tube placed on ___ by the Interventional Pulmonary team, she \ntolerated the procedure well. Tubefeeds were started, per \nnutrition recommendations, the following day. Some medications \nwere being given through tubefeeds, with only the study drug \nbeing taken orally.\n.\n# Acute on Chronic Renal Insufficiency: Mildly above baseline at \nadmission. Creatinine improved with gentle IVF and mucomyst was \ngiven before and after CT scan.\nAllopurinol was renally dosed when given. IVF held on procedure \nday ___, and then Cr bumped again - with IVF Cr improved again.\n\n# Vocal cord dysfunction: question whether due to nerve \ninvolvment by malingnancy or nerve dysfuntion. Patient was seen \nby ENT, who recommended outpatient follow-up.\n\n# NSCLC: Study drug was continued. Outpatient oncologist \ninvolved in patient's inpatient care. Patient had a therapeutic \nthoracentesis on ___ by the Interventional Pulmonary team - well \ntolerated.\n \n# Atrial fibrillation: Rate controlled, poor candiditate for \nanticoagulation give age and risk of falls. Atenolol continued; \nnot anticoagulated.\n\n# Hypothyroidism: Recent TSH in ___ at goal of 1.8. Continued \nLevothyroxine.\n\n# HTN: Held HCTZ given mild renal insufficiency.\n# Code: FULL (confirmed)", 'medications_prescribed': ['1. Cortisone 1 % Cream Sig: One (1) Appl Topical BID (2 times a \nday) as needed for rash. ', '2. Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic BID \n(2 times a day). ', '3. Dexamethasone 0.5 mg/5 mL Elixir Sig: Five (5) ML ___ TID (3 \ntimes a day). ', '4. Clindagel 1 % Gel Sig: One (1) application Topical BID (2 \ntimes a day) as needed. ', '5. Benzonatate 100 mg Capsule Sig: One (1) Capsule ___ TID (3 \ntimes a day). ', '6. Lansoprazole 30 mg Tablet,Rapid Dissolve, ___ Sig: One (1) \nTablet,Rapid Dissolve, ___ ___. \nDisp:*30 Tablet,Rapid Dissolve, ___ Refills:*2*', '7. Loperamide 1 mg/5 mL Liquid Sig: Five (5) ml ___ QID (4 times \na day) as needed for diarrhea.\nDisp:*240 ml* Refills:*0*', '8. Trazodone 50 mg Tablet Sig: One (1) Tablet ___ HS (at \nbedtime). ', '9. Atenolol 50 mg Tablet Sig: One (1) Tablet ___. ', '10. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet ___ \n(___). ', '11. tube feeds\nBoost Glucose control Full strength\n240 cc can per feeding, 5 cans per day\ncheck residuals 2 hours after each feeding and hold for \nresiduals over 200 cc\nflush with 150ml of water three times per day\nplease crush medications and dissolve in warm water prior to \ngiving in tube feeds']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 48, 'gender': 'F', 'symptoms': 'Jaw pain', 'medical_history': ['Hx of DM, now no longer on medications'], 'family_history': 'Non-contributory', 'present_illness': '___ PMH DM, previously on metformin but no longer taking as \nstates he has lost weight, presents after a fight. He is \nreticent to provide details but states he was in an altercation \nnear his home and was punched in the face. He denies LOC. He \ndenies any other areas of injury or pain. He denies headache, \ndizziness,\nvertigo, syncope, weakness, paresthesias, nausea, vomiting, \nhematemesis, bloating, cramping, melena, BRBPR, dysphagia, chest \npain, shortness of breath, cough, edema, urinary frequency, \nurgency', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'Admission Physical Exam:\nGen: Denies changes in weight, appetite, fatigue \nHEENT: Denies headache, changes in vision, changes in hearing,\nnasal epistaxis or tenderness, difficulty swallowing or\ntolerating secretions \nSkin: Denies rash, itching, lacerations\nCV: Denies chest pain, chest pressure or chest discomfort\nPulm: Denies shortness of breath, cough \nGI: Denies constipation, diarrhea \nGU: Denies dysuria, changes in frequency of urination \nNeuro: Denies weakness, paresthesia \nMSK: Denies muscle pain, back pain, and joint pain\nHeme: Denies anemia, bleeding or bruising\n\nDischarge Physical Exam:\nGen: AAOx3, NAD \nHead: Atraumatic and normocephalic \nEyes: EOMI, PERRLA, vision grossly intact b/l \nEars: Hearing intact b/l, right ear normal, left ear normal \nNose: Non-tender to palpation, straight nasal dorsum, no septal\nhematoma, no epistaxis \nThroat: unable to examine due to MMF \nCV: RRR\nPulm: Satting well on room air \nExt: Motor and sensory functionality intact b/l \nEOE: Prolene sutures of trochar incisions dry and intact, CN V3\nparesthesia b/l c/w procedure, CN VII intact b/l\nIOE: 6 IMF screws with 2 wires in place, occlusion stable,\nextraction sites of # 29 and 30 hemostatic, incisions hemostatic\nand intact, tender to palpation \nNeck: FROM, no cervical lymphadenopathy, tender to palpation', 'diagnoses': [{'icd_code': '85221', 'desc': 'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': 'E9178', 'desc': 'Striking against or struck accidentally by other stationary object with subsequent fall'}, {'icd_code': 'E8498', 'desc': 'Accidents occurring in other specified places'}], 'summary': '___ 02:55AM BLOOD WBC-6.8 RBC-4.37* Hgb-12.4* Hct-38.9* \nMCV-89 MCH-28.4 MCHC-31.9* RDW-13.2 RDWSD-43.3 Plt ___\n___ 06:10AM BLOOD WBC-8.3 RBC-4.46* Hgb-12.7* Hct-39.3* \nMCV-88 MCH-28.5 MCHC-32.3 RDW-13.5 RDWSD-43.5 Plt ___\n___ 01:30PM BLOOD WBC-13.2* RBC-4.90 Hgb-13.9 Hct-42.9 \nMCV-88 MCH-28.4 MCHC-32.4 RDW-13.4 RDWSD-42.6 Plt ___\n___ 02:55AM BLOOD Glucose-79 UreaN-7 Creat-0.8 Na-140 K-4.2 \nCl-103 HCO3-25 AnGap-16\n___ 06:10AM BLOOD Glucose-108* UreaN-8 Creat-0.7 Na-140 \nK-3.9 Cl-105 HCO3-24 AnGap-15\n___ 01:30PM BLOOD Glucose-131* UreaN-7 Creat-0.7 Na-141 \nK-3.8 Cl-105 HCO3-22 AnGap-18\n___ 02:55AM BLOOD Calcium-8.2* Phos-3.0 Mg-2.0\n___ 06:10AM BLOOD Calcium-8.6 Phos-2.9 Mg-2.1\n___ 06:10AM BLOOD %HbA1c-6.4* eAG-137*\n\n___cute fractures involving the mandible involves the left \nmandibular ramus and right mandibular body, mildly displaced. \nThe right mandibular body fracture extends between the lateral \nmost right mandibular teeth with probable extension to the \napices of these teeth. No definite dental fracture though \nmultiple teeth are absent.\nMr. ___ is a ___ yo M admitted to the Acute Care surgery \nservice on ___ after reportedly being assaulted in the \nface. CT head and neck from outside hospital negative for acute \nintracranial or cervical spine injury. CT face showed multiple \nfractures including: Acute fractures involving the mandible \ninvolves the left mandibular ramus and right mandibular body, \nmildly displaced. The right mandibular body fracture extends \nbetween the lateral most right mandibular teeth with probable \nextension to the apices of these teeth. No definite dental \nfracture though multiple teeth are absent. ___ team consulted \nand recommended surgical repair. The patient was admitted to the \nAcute Care Trauma Surgery Service on ___ for pain \nmanagement and operative intervention.\n\nOn HD3 the patient was taken to the operating room with OMFS for \nopen reduction and internal fixation of left angle and right \nbody mandibular fractures via intraoral approach. Closed \nreduction maxillomandibular fixation of the left angle and right \nbody mandibular fracture. Extraction of teeth #29 and #30. Post \noperatively pain controlled with liquid medications. On POD1 \ndiet was advanced to full liquids which he tolerated well. He \nwas prescribed 7 days of Keflex and chlorhexidine gluconate \ntwice daily per OMFS. \n\nSocial work and case management were involved in creating a safe \ndischarge plan for the patient. \n\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan. Follow up appointments were \narranged with ___.'}}
{'final_diagnoses': ['Mandibular Fractures'], 'procedures': ['Open reduction and internal fixation of left angle and\n right body mandibular fractures via intraoral approach.', 'Closed reduction maxillomandibular fixation of the left\n angle and right body mandibular fracture.', 'Extraction of teeth #29 and #30.'], 'visit_summary': 'Mr. ___ is a ___ yo M admitted to the Acute Care surgery \nservice on ___ after reportedly being assaulted in the \nface. CT head and neck from outside hospital negative for acute \nintracranial or cervical spine injury. CT face showed multiple \nfractures including: Acute fractures involving the mandible \ninvolves the left mandibular ramus and right mandibular body, \nmildly displaced. The right mandibular body fracture extends \nbetween the lateral most right mandibular teeth with probable \nextension to the apices of these teeth. No definite dental \nfracture though multiple teeth are absent. ___ team consulted \nand recommended surgical repair. The patient was admitted to the \nAcute Care Trauma Surgery Service on ___ for pain \nmanagement and operative intervention.\n\nOn HD3 the patient was taken to the operating room with OMFS for \nopen reduction and internal fixation of left angle and right \nbody mandibular fractures via intraoral approach. Closed \nreduction maxillomandibular fixation of the left angle and right \nbody mandibular fracture. Extraction of teeth #29 and #30. Post \noperatively pain controlled with liquid medications. On POD1 \ndiet was advanced to full liquids which he tolerated well. He \nwas prescribed 7 days of Keflex and chlorhexidine gluconate \ntwice daily per OMFS. \n\nSocial work and case management were involved in creating a safe \ndischarge plan for the patient. \n\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating a diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan. Follow up appointments were \narranged with ___.', 'medications_prescribed': ['Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity', 'Cephalexin 500 mg PO Q6H Duration: 7 Days \nLiquid formulation \nRX *cephalexin 250 mg/5 mL 10 mL by mouth every six (6) hours \nDisp #*300 Milliliter Refills:*0', 'Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID \nRX *chlorhexidine gluconate 0.12 % swish and spit 15 mL twice a \nday Refills:*0', 'Ibuprofen Suspension 600 mg PO Q8H:PRN Pain - Mild \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity\nTake with food/meal.', 'OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate \nRX *oxycodone 5 mg/5 mL ___ mL by mouth every four (4) hours \nRefills:*0', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Senna 8.6 mg PO BID:PRN constipation']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 67, 'gender': 'F', 'symptoms': 'Chest pain/Shortness of breath', 'medical_history': ['- Atrial fibrillation ', '- Non-ischemic cardiomyopathy (EF 20%) ', '- Hypertension', '- Unprovoked DVT (on apixaban, but not reliably taking)', '- Microcytic anemia', '- Untreated HCV', '- GERD', '- Schizoaffective disorder vs. schizophrenia ', '- History of SI/HI', '- Polysubstance abuse (tobacco, marijuana, EtOH, cocaine, \nheroin)'], 'family_history': 'Denies family history of cardiomyopathy, sudden cardiac death, \nor\npremature coronary artery disease.', 'present_illness': '___ with a history of non-ischemic cardiomyopathy (EF 20%),\natrial fibrillation, unprovoked DVT (on apixaban), untreated \nHCV,\nhypertension, schizoaffective disorder vs. schizophrenia, and\nhistory polysubstance abuse, who presented to the ED with chest\npain and tachycardia following crack cocaine use.\n\nPatient was recently admitted ___ for a similar\npresentation of chest pain following crack cocaine use, but\nunfortunately left against medical advice. Work-up notable for\ntroponin-T <0.01 x2, NT-proBNP elevated at 2446, CXR with\nfindings of heart failure, and CTA negative for PE and aortic\ndissection. Ultimately chest pain was felt to be secondary to\ntransient coronary vasospasm in the setting of crack cocaine \nuse.\nHospitalization was complicated by ___ likely pre-renal in\netiology, microcytic anemia without evidence of bleeding, and\nabnormal LFTs. Patient left AMA before his medications could be\ntitrated. He subsequently has been seen on two occasions ___\nand ___ in the ED with recurrence of his chest pain, but left\nagainst medical advice on both occasions.\n\nPatient reports having ongoing chest pain and shortness of \nbreath\nfor the past day, which acutely worsened following smoking crack\ncocaine at 2AM today. Describes the pain as a pressure-like\nsensation across his central chest, non-radiating, worse on\nexertion, and associated with shortness of breath, especially\nwhen lying flat. Denies palpitations, light-headedness,\ndizziness, PND, or new lower extremity edema. Unfortunately he\nhas not been taking his medications since his recent AMA\ndischarge. Last drink was on ___ prior to presentation to the\nED.', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'EPINEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '-9', 'valuenum': -9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 5.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.30', 'valuenum': 1.3, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81.6', 'valuenum': 81.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.1', 'valuenum': 21.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.70', 'valuenum': 2.7, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.10', 'valuenum': 0.1, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.82', 'valuenum': 0.82, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.95', 'valuenum': 9.95, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '71.3', 'valuenum': 71.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.5', 'valuenum': 48.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.6,. Estimated GFR = 18 if non African-American (mL/min/1.73 m2). Estimated GFR = 22 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '426', 'valuenum': 426.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '431', 'valuenum': 431.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 40415.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION. REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.02, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': 'GREATER THAN 2000.'}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP. VERIFIED.'}, {'value': '-11', 'valuenum': -11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 7.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '39', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '53.7', 'valuenum': 53.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '413', 'valuenum': 413.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.7', 'valuenum': 21.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83.9', 'valuenum': 83.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.44', 'valuenum': 2.44, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.70', 'valuenum': 0.7, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.04', 'valuenum': 10.04, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66.9', 'valuenum': 66.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hazy.'}, {'value': 'DKAMB', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ABN COLOR MAY AFFECT DIPSTICK.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '-11', 'valuenum': -11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 8.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 30.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-11', 'valuenum': -11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 11.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'ADMISSION PHYSICAL EXAMINATION:\nVS:\n___ 1530 Temp: 97.2 Axillary BP: 122/74 R Sitting HR: 111\nRR: 20 O2 sat: 96% O2 delivery: RA \nGENERAL: well-appearing middle-aged man, sitting at edge of bed\nHEENT: MMM\nCV: irregular rhythm, tachycardic, no m/g/r\nRESP: CTAB in posterior fields\nABD: soft, nontender\nEXTREMITIES: 1+ pitting edema to mid-calf bilaterally (L \nslightly\nmore than R)\n\nDISCHARGE PHYSICAL EXAMINATION:\n24 HR Data (last updated ___ @ 749)\n Temp: 98.2 (Tm 98.3), BP: 105/72 (100-118/66-78), HR: 108\n(108-175 -SpO2), RR: 17 (___), O2 sat: 96% (94-100), O2\ndelivery: Ra, Wt: 205.03 lb/93 kg \n\nGENERAL: well-appearing, sitting up in bed\nCV: irregular rhythm\nRESP: CTAB in posterior and anterior fields\nEXTREMITIES: trace pitting edema to mid-calves bilaterally', 'diagnoses': [{'icd_code': 'K7201', 'desc': 'Acute and subacute hepatic failure with coma'}, {'icd_code': 'R6521', 'desc': 'Severe sepsis with septic shock'}, {'icd_code': 'K767', 'desc': 'Hepatorenal syndrome'}, {'icd_code': 'R570', 'desc': 'Cardiogenic shock'}, {'icd_code': 'A047', 'desc': 'Enterocolitis due to Clostridium difficile'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'D689', 'desc': 'Coagulation defect, unspecified'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'I8510', 'desc': 'Secondary esophageal varices without bleeding'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'K7031', 'desc': 'Alcoholic cirrhosis of liver with ascites'}, {'icd_code': 'F1021', 'desc': 'Alcohol dependence, in remission'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}], 'summary': 'ADMISSION LABS:\n___ 01:43AM BLOOD WBC-5.4 RBC-4.31* Hgb-10.6* Hct-32.3* \nMCV-75* MCH-24.6* MCHC-32.8 RDW-17.2* RDWSD-45.9 Plt ___\n___ 01:43AM BLOOD Neuts-62.9 ___ Monos-8.6 Eos-1.1 \nBaso-0.9 Im ___ AbsNeut-3.42 AbsLymp-1.43 AbsMono-0.47 \nAbsEos-0.06 AbsBaso-0.05\n___ 01:43AM BLOOD Plt ___\n___ 01:43AM BLOOD Glucose-93 UreaN-24* Creat-1.7* Na-141 \nK-3.5 Cl-104 HCO3-22 AnGap-15\n___ 01:43AM BLOOD proBNP-2973*\n___ 01:43AM BLOOD cTropnT-<0.01\n___ 07:35AM BLOOD cTropnT-<0.01\n\nCXR:\nInterval worsening of now mild to moderate pulmonary vascular \ncongestion and edema. \n\nECG:\nAtrial fibrillation\nRight axis deviation\nDiffuse T wave flattening with T wave inversions in \nanterolateral leads\nWhen compared with ECG of ___\nPVC no longer present, otherwise similar\n\nDISCHARGE LABS:\n___ 05:54AM BLOOD WBC-3.9* RBC-4.68 Hgb-11.6* Hct-36.5* \nMCV-78* MCH-24.8* MCHC-31.8* RDW-18.4* RDWSD-49.8* Plt ___\n___ 05:54AM BLOOD Glucose-123* UreaN-17 Creat-1.2 Na-140 \nK-3.6 Cl-104 HCO___ with a history of non-ischemic cardiomyopathy (EF 20%), \natrial fibrillation, unprovoked DVT (on apixaban), untreated \nHCV, hypertension, schizoaffective disorder vs. schizophrenia, \nand\nhistory polysubstance abuse, who presented to the ED with chest \npain and tachycardia following crack cocaine use.\nACUTE/ACTIVE ISSUES:\n# Chest pain\n# Shortness of breath\nPresented with baseline chest pain and shortness of breath for \nwhich acutely worsened following crack cocaine use, raising \nsuspicion for coronary vasospasm. Troponin negative x2.\n\n# Non-ischemic cardiomyopathy\nReporting shortness of breath at rest, in the setting of a known \nejection fraction of 20% ___ at ___. Multiple admissions \nfor decompensated heart failure to other hospitals in the \nsetting of medication non-compliance and dietary indiscretion. \nNT-proBNP elevated at 2973 (___). Diuretics initially held and \nthen restarted on day prior to discharge at lasix 40mg PO daily. \n\n\n# ___\nBaseline creatinine 1.1-1.4. 1.7 on admission, downtrended to \n1.2 at the time of discharge.\n\n# Atrial fibrillation\n# Tachycardia \nHistory of atrial fibrillation, for which he is rate controlled\nwith digoxin. Was previously on metoprolol and subsequently\ncarvedilol, both of which were discontinued in the setting of\nongoing crack cocaine use. CHADS2VASC of 2. \nRATE CONTROL: continue digoxin 0.0625mg daily\n- ANTICOAGULATION: continue apixaban 5mg daily\n\n# Anemia\nMost recent hemoglobin levels ___ over previous three\npresentations to ___. Hemoglobin stable at 11.6 on ___. \nTrend CBC daily\n\n# Polysubstance abuse\nLong history of abuse of EtOH, marijuana, crack cocaine, and\ntobacco. Prior history of heroin abuse, although no longer using\nsame. Serum tox screen negative on admission. Last drink was\n___ and last crack cocaine use was 2AM ___. Per psychiatry,\nwill need inpatient substance treatment when medically cleared. \nBEST team was screening the patient but he left AMA.\n\nPlease see AMA note:\nThe patient left against medical advice this morning. He was\nmedically cleared for psychiatric/detox placement at the time. \nHe\nwas given his medications that he brought from home which\nincluded furosemide at 40mg daily. He was instructed to continue\nthese medications. He expressed understanding of the risks of\nleaving. \n\n======================\nCHRONIC/STABLE ISSUES:\n======================\n# HTN\nContinue hydralazine 25mg BID\nContinue imdur 30mg daily\n\n# Unprovoked DVT\nContinue apixaban 5mg BID\n\n# GERD\nContinue omeprazole 20mg daily\n\n# Schizoaffective disorder vs. schizophrenia\nContinue topiramate 50mg BID\nIncrease olanzapine to 15mg QHS - he left AMA befor this \nprescription could be adjusted.\n\nDischarge time 20 min'}}
{'final_diagnoses': ['Crack cocaine induced vasospasm', 'Heart failure with reduced ejection fraction', 'Acute kidney injury'], 'procedures': ['None'], 'visit_summary': 'ACUTE/ACTIVE ISSUES:\n# Chest pain\n# Shortness of breath\nPresented with baseline chest pain and shortness of breath for \nwhich acutely worsened following crack cocaine use, raising \nsuspicion for coronary vasospasm. Troponin negative x2.\n\n# Non-ischemic cardiomyopathy\nReporting shortness of breath at rest, in the setting of a known \nejection fraction of 20% ___ at ___. Multiple admissions \nfor decompensated heart failure to other hospitals in the \nsetting of medication non-compliance and dietary indiscretion. \nNT-proBNP elevated at 2973 (___). Diuretics initially held and \nthen restarted on day prior to discharge at lasix 40mg PO daily. \n\n\n# ___\nBaseline creatinine 1.1-1.4. 1.7 on admission, downtrended to \n1.2 at the time of discharge.\n\n# Atrial fibrillation\n# Tachycardia \nHistory of atrial fibrillation, for which he is rate controlled\nwith digoxin. Was previously on metoprolol and subsequently\ncarvedilol, both of which were discontinued in the setting of\nongoing crack cocaine use. CHADS2VASC of 2. \nRATE CONTROL: continue digoxin 0.0625mg daily\n- ANTICOAGULATION: continue apixaban 5mg daily\n\n# Anemia\nMost recent hemoglobin levels ___ over previous three\npresentations to ___. Hemoglobin stable at 11.6 on ___. \nTrend CBC daily\n\n# Polysubstance abuse\nLong history of abuse of EtOH, marijuana, crack cocaine, and\ntobacco. Prior history of heroin abuse, although no longer using\nsame. Serum tox screen negative on admission. Last drink was\n___ and last crack cocaine use was 2AM ___. Per psychiatry,\nwill need inpatient substance treatment when medically cleared. \nBEST team was screening the patient but he left AMA.\n\nPlease see AMA note:\nThe patient left against medical advice this morning. He was\nmedically cleared for psychiatric/detox placement at the time. \nHe\nwas given his medications that he brought from home which\nincluded furosemide at 40mg daily. He was instructed to continue\nthese medications. He expressed understanding of the risks of\nleaving. \n\n======================\nCHRONIC/STABLE ISSUES:\n======================\n# HTN\nContinue hydralazine 25mg BID\nContinue imdur 30mg daily\n\n# Unprovoked DVT\nContinue apixaban 5mg BID\n\n# GERD\nContinue omeprazole 20mg daily\n\n# Schizoaffective disorder vs. schizophrenia\nContinue topiramate 50mg BID\nIncrease olanzapine to 15mg QHS - he left AMA befor this \nprescription could be adjusted.\n\nDischarge time 20 min', 'medications_prescribed': ['Apixaban 5 mg PO BID ', 'Digoxin 0.0625 mg PO DAILY ', 'OLANZapine 10 mg PO QHS ', 'Omeprazole 20 mg PO DAILY ', 'Topiramate (Topamax) 50 mg PO BID ', 'HydrALAZINE 25 mg PO BID ', 'Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY ', 'Furosemide 40 mg PO DAILY ', 'Magnesium Oxide 400 mg PO DAILY ', 'Aspirin 81 mg PO DAILY ', 'Haloperidol 10 mg PO DAILY ', 'CARVedilol 25 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 36, 'gender': 'M', 'symptoms': 'nausea and vomiting', 'medical_history': ['Eye surgery twice on the left eye, and once on the right', 'Hyperlipidemia'], 'family_history': 'No family history of malignancy or heart disease. ', 'present_illness': '___ is a ___ year old woman with a PMH s/f hyperlipidemia who \npresents to to ___ on ___ with nausea, \nvomiting, and lightheadedness.\nShe indicate that she has over the past 2 months lsot about 20 \nlbs from 140 lbs to 120 lbs. She does not have very much of an \nappettie. She says that several months ago she started to have \nnausea, but only within the past week did she have vomiting, \nwhich was non-bloody. She has no appetite for food.\nShe also indicates that starting around a month ago, she began \nto have difficulty urinating; she would have small dribbling of \nurine around 8 times a day, which has been initally attribued to \ndehydration.\nOn her ROS she endores chills for the past week, as well as \nnausea for the past 2 months, and vomiting for the past week. \nShe also endorses intermittent tingling of her hands \nbilaterally, and while she has been in the hospital for the past \nweek she has endorses bilateral leg cramps and spasms.\nShe was seen by Dr. ___ gastroeneterology, who did an EGD \nand a colonsocpy, which shwoed antral gastritis, but no other \nlesions in the EGD or colonsocpy. She was also seen by urology \nfor urinary retention, who placed a foley catheter, and planned \nfor follow-up in 1 week with cystoscopy and urethrogram.\nA CT scan of her abomden showed fullness of the L renal \ncolelcting system and renal pelvis iwhtout dilation of the L \nureter sugesting UPJ stensois. Uorlogy palnned on leaving the \nfoley catheter in for 1 week and then to do a cystoscopy and \nretrograde pyelogram as an outpatient.\nShe was also seen by Cardiology Dr. ___ due to abnormal EKG \nwith TWI. An ECHO was doen that appeared to be WNL, although \nthis report is not in the OSH records.\nBecuase of diazziness, nausea, and gai8t instiablity, a head CT \nwas ordered that was mildly concerning for SAH hemmorhage. An \nMRI was subsequently done that reveraled some hyeprattentuation \nin the mid-brain and cereberllar region, and the patient was \ntehrefor transfered.\nShe also indicates that 7 months ago she had 3 teeth removed, \nand was on a coruse of antibiotics; she says she has never ___ \n___ since that time.\nOn arrival to the floor, through the translator, she appears \nuncomfortable, but in NAD.\nREVIEW OF SYSTEMS:\n(+) As per HPI\n(-) fever, night sweats, headache, vision changes, rhinorrhea, \ncongestion, sore throat, cough, shortness of breath, chest pain, \nabdominal pain, diarrhea, constipation, BRBPR, melena, \nhematochezia, dysuria, hematuria. ', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QIDACHS', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '591', 'valuenum': 591.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.2', 'valuenum': 21.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '573', 'valuenum': 573.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.5', 'valuenum': 20.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam\nVS - Temp 98 BP 126/76 71 RR 18 98% RA\nGENERAL - female in NAD\nappropriate\nHEENT - NC/AT, PERRLA, EOMI, dry MMM\nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use\nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)\nSKIN - no rashes or lesions\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout \n\nDIscharge Physical Exam:\nVS: 99.0 136/86 88 18 99% on RA\nGENERAL - female in NAD, appropriate\nHEENT - NC/AT, PERRLA, EOMI, dry MMM\nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use\nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)\nSKIN - no rashes or lesions\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout ', 'diagnoses': [{'icd_code': '5552', 'desc': 'Regional enteritis of small intestine with large intestine'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '28529', 'desc': 'Anemia of other chronic disease'}], 'summary': 'Admission Labs:\n___ 08:05AM BLOOD WBC-6.4 RBC-5.61* Hgb-14.6 Hct-43.2 \nMCV-77* MCH-26.0* MCHC-33.8 RDW-13.4 Plt ___\n___ 08:05AM BLOOD ___ PTT-33.3 ___\n___ 08:05AM BLOOD Glucose-112* UreaN-14 Creat-0.9 Na-142 \nK-3.9 Cl-107 HCO3-22 AnGap-17\n___ 08:05AM BLOOD ALT-18 AST-17 AlkPhos-116* TotBili-0.5\n___ 08:05AM BLOOD GGT-59*\n___ 08:05AM BLOOD Calcium-9.2 Phos-5.0* Mg-2.0\n___ 06:45AM BLOOD VitB12-424 Folate-13.8\n___ 06:45AM BLOOD TSH-3.2\n___ 06:45AM BLOOD Cortsol-10.8\n\nDischarge Labs\n___ 06:50AM BLOOD WBC-11.0 RBC-5.19 Hgb-13.4 Hct-39.1 \nMCV-75* MCH-25.9* MCHC-34.4 RDW-13.1 Plt ___\n___ 06:50AM BLOOD Glucose-117* UreaN-13 Creat-0.8 Na-139 \nK-4.0 Cl-104 HCO3-24 AnGap-15\n___ 06:50AM BLOOD Calcium-8.9 Phos-4.4 Mg-2.2\n\nUrine studies\n___ 04:00PM URINE Color-Yellow Appear-Clear Sp ___\n___ 04:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG\n___ 04:00PM URINE RBC-1 WBC-18* Bacteri-FEW Yeast-NONE \nEpi-0 TransE-<1 RenalEp-<1\n\nCSF \n___ 05:25PM CEREBROSPINAL FLUID (CSF) WBC-2 RBC-0 Polys-0 \n___ ___ 05:25PM CEREBROSPINAL FLUID (CSF) TotProt-33 Glucose-49\n___ CSF cytology (lumbar puncture): ATYPICAL.Scattered, \ndegenerated large atypical lymphoid cells present.\nFlow cytometry ___: Three color gating is performed (light \nscatter vs. CD45) to optimize lymphocyte yield.Due to \npaucicellular nature of the specimen, a limited panel is \nperformed to determine B-cell clonality.\nCD45 bright, low side scatter lymphoid cells comprise 6% of \ntotal events.\nB cells are scant in number precluding evaluation of clonality\n\nImaging:\nMRI C/T/L spine ___: IMPRESSION: 1. Diffuse spinal cord \nsignal abnormality in the lower cervical and thoracic spine \nwithout enhancement. The differential includes paraneoplastic \nsyndrome, demyelinating process such as ADEM, \ninflammatory/infectious process, and given the presence of areas \nwhere the signal abnormality is H-shaped, ischemia is also in \nthe differential.\n2. Right upper lobe lung mass is highly suspicious for lung \ncancer. Further evaluation with dedicated chest CT is \nrecommended.\n\nCT Chest ___: IMPRESSION:1. Right upper lobe spiculated \nmass approaching 3.5 cm in diameter, highly concerning for lung \ncancer. Mediastinal lymphadenopathy, concerning for metastatic \nspread. Correlation with tissue biopsy and PET-CT might be \nconsidered.\n2. Superior segment of left lower lobe nodule, unclear if \nrepresents\nmetastatic spread or unrelated.\n\nPathology:\n___: Lung mass, right upper lobe, transbronchial biopsy. \nAdenocarcinoma. See note.\nMs ___ is a ___ yo ___ F w/PMH of hyperlipidemia who was \ntransferred from OSH for concerning MRI brain findings and was \nultimately found to have non small cell lung cancer and was \ntreated for her urinary tract infection and urinary retention.\n\n#Non Small Cell Lung Cancer- the lung mass was found \nincidentally on workup for her neurologic deficit symptoms. Pt \nhad been having problems with urinary retention prior to this \nadmission and had been seen by urology at the OSH who had \nplanned on urodynamic studies as an outpatient. While in the \nworkup for a possible subarachnoid bleed the patient underwent a \nhead MRI which showed findings that were nonspecific but \nconcerning for possible paraneoplastic syndrome. Given her \nurinary retention she had an MRI performed of her C/T/Lspine. \nNeurology was consulted and helped to shape the course of the \nworkup. They recommended an LP to rule out infectious etiology \nof her MRI brain findings and to r/o possible leptomeningeal \nencephalitis if it was due to a malignancy. On the MRI of the \nC/T/L spine she had a visible RUL mass that was not well \ncharacterized by this modality. On dedicated CT chest she had a \n3.5 cm spiculated RUL mass and enlarge mediastinal lymph nodes \nand a 5mm subpleural nodule on the left that were concerning for \nmalignancy. IP was consulted an performed a bronch with biopsy \non ___. The results of their biopsy of the mass as well as \nmultiple mediastinal lymph nodes were positive for non small \ncell carcinoma, and adenocarcinoma. A family meeting was held \non ___ to discuss the results and her PCP was informed of the \ndiagnosis. The inpatient team contacted the thoracic oncology \nteam regarding setting her up for outpatient follow-up which was \nbeing done at the time of discharge. \n-pt needs a PET-CT for staging\n-pt needs MRI of brain for staging\n-Pt will be contacted by the thoracic oncology center regarding \nscheduling her workup\n\n#Urinary retention- this was a dx that she carried with her from \nthe OSH. On ___ she failed a voiding trial a trial void was \nfailed and negative. And the Foley was reinserted.\n-she will require are of her Foley\n\n#Urinary tract infection, bacterial- on ___ and ___ she \nspiked temps up to 101. On inspection of her urine it appeared \ncloudy. A UA showed large leuks and urine cultures were still \npending so she was started on Bactrim\n-will need to have final urine culture f/u\n-complete 14 day course of abx (likely Bactrim) for complicated \nUTI with an indwelling Foley.\n\n#Nausea/vomiting- patient originally had nausea and vomiting as \nher presenting complaints. On review of her CT scan from the OSH \nit appeared as though had large amounts of food retained in her \nstomach. During her hospital course at ___ she was \nconstipated. As this could all be due to a demyelinating disease \nin the upper motor neurons leading to decreased gastric transit. \n She was eating solid foods at the time of discharge and \nencouraged to eat small meals.\n\n#Dizziness- this was likely due to being volume depleted as it \nresponded very well to IV fluids, although some of the changes \nfound on the MRI may explain it if there are further areas of \ninflammation.'}}
{'final_diagnoses': ['Non-small cell lung cancer', 'Urinary tract infection', 'Urinary retention'], 'procedures': ['___ Bronchoscopy and biopsy'], 'visit_summary': 'Ms ___ is a ___ yo ___ F w/PMH of hyperlipidemia who was \ntransferred from OSH for concerning MRI brain findings and was \nultimately found to have non small cell lung cancer and was \ntreated for her urinary tract infection and urinary retention.\n\n#Non Small Cell Lung Cancer- the lung mass was found \nincidentally on workup for her neurologic deficit symptoms. Pt \nhad been having problems with urinary retention prior to this \nadmission and had been seen by urology at the OSH who had \nplanned on urodynamic studies as an outpatient. While in the \nworkup for a possible subarachnoid bleed the patient underwent a \nhead MRI which showed findings that were nonspecific but \nconcerning for possible paraneoplastic syndrome. Given her \nurinary retention she had an MRI performed of her C/T/Lspine. \nNeurology was consulted and helped to shape the course of the \nworkup. They recommended an LP to rule out infectious etiology \nof her MRI brain findings and to r/o possible leptomeningeal \nencephalitis if it was due to a malignancy. On the MRI of the \nC/T/L spine she had a visible RUL mass that was not well \ncharacterized by this modality. On dedicated CT chest she had a \n3.5 cm spiculated RUL mass and enlarge mediastinal lymph nodes \nand a 5mm subpleural nodule on the left that were concerning for \nmalignancy. IP was consulted an performed a bronch with biopsy \non ___. The results of their biopsy of the mass as well as \nmultiple mediastinal lymph nodes were positive for non small \ncell carcinoma, and adenocarcinoma. A family meeting was held \non ___ to discuss the results and her PCP was informed of the \ndiagnosis. The inpatient team contacted the thoracic oncology \nteam regarding setting her up for outpatient follow-up which was \nbeing done at the time of discharge. \n-pt needs a PET-CT for staging\n-pt needs MRI of brain for staging\n-Pt will be contacted by the thoracic oncology center regarding \nscheduling her workup\n\n#Urinary retention- this was a dx that she carried with her from \nthe OSH. On ___ she failed a voiding trial a trial void was \nfailed and negative. And the Foley was reinserted.\n-she will require are of her Foley\n\n#Urinary tract infection, bacterial- on ___ and ___ she \nspiked temps up to 101. On inspection of her urine it appeared \ncloudy. A UA showed large leuks and urine cultures were still \npending so she was started on Bactrim\n-will need to have final urine culture f/u\n-complete 14 day course of abx (likely Bactrim) for complicated \nUTI with an indwelling Foley.\n\n#Nausea/vomiting- patient originally had nausea and vomiting as \nher presenting complaints. On review of her CT scan from the OSH \nit appeared as though had large amounts of food retained in her \nstomach. During her hospital course at ___ she was \nconstipated. As this could all be due to a demyelinating disease \nin the upper motor neurons leading to decreased gastric transit. \n She was eating solid foods at the time of discharge and \nencouraged to eat small meals.\n\n#Dizziness- this was likely due to being volume depleted as it \nresponded very well to IV fluids, although some of the changes \nfound on the MRI may explain it if there are further areas of \ninflammation.', 'medications_prescribed': ['Mirtazapine 15 mg PO HS ', 'Omeprazole 20 mg PO BID ', 'Simvastatin 20 mg PO DAILY ', 'Docusate Sodium 100 mg PO BID ', 'Ondansetron 4 mg IV Q8H:PRN nausea ', 'Calcium 500 + D *NF* (calcium carbonate-vitamin D3) 500 \nmg(1,250mg) -400 unit Oral Daily ', 'Sulfameth/Trimethoprim DS 1 TAB PO BID ', 'Senna 1 TAB PO BID:PRN constipation ', 'Polyethylene Glycol ___ g PO DAILY:PRN constipation ', 'Acetaminophen 325-650 mg PO Q6H:PRN pain ', 'Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN wheezing ', 'Meclizine 12.5 mg PO Q8H:PRN nausea ', 'Lorazepam 0.5 mg PO Q4H:PRN nausea ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 85, 'gender': 'F', 'symptoms': 'Myoclonus.', 'medical_history': ['PAST ONCOLOGIC HISTORY:\n___ Confusion and somnolence started \n___ ED visit \n___ CT head showed corpus callosum mass\n___ Brain MRI showed mass in the splenium of the corpus\ncallosum\n___ Brain biopsy by Dr. ___ \n___: Glioblastoma\n___ Seizure\n___ Port placed \n___ - ___ IMRT/TMZ to 6000 cGy over 30 fractions\n___ Port clotted\n___ Left port replacement\n___ C1D1 Bevacizumab 10 mg/kg \n___ C1D15 Bevacizumab 10 mg/kg \n___ C2D1 Bevacizumab 10 mg/kg \n___ Syncope \n___ CT Head showed decrease in size of mass lesion \n___ Urine Protein > 600\n___ 24hr Protein/Creatinine Ratio 12.4 (0 - 2 mg)\n___ Brain MRI: increase in the non-enhancing necrotic\ncomponent and decrease in the enhancing nodular component. \nDecrease in the size of the cavum vergae \n___ Renal U/S: No hydronephrosis\n___ Started Diltiazem ER 120mg daily as per renal recs\n___ to ___ Completed cycle 1 adjuvant temozolomide at 125\nmg/m2/day x 5 days\n___ Noted to have purulent drainage at the incision site in\nrehab facility \n___ admitted to neurosurgery service at ___ for wound\ndebridement and washout\n___ MRI: mass lesion decreased in size and enhancement from\nthe MRI ___\n___ admitted to ___ for wound dehiscence. Had wound\nwashout, wound exploration\n___ Return home from ___ nursing facility on ___ \nwith services\n___ to ___ Admission to ___ Hospitalist Service for\nweakness and altered mental status\n___ to ___ Completed cycle 2 adjuvant temozolomide at\n150 mg/m2/day x 5 days\n___ to ___ Completed cycle 3 adjuvant temozolomide at\n150 mg/m2/day x 5 days\n___ Port flushed at ___ per protocol with\ngood blood return \n___ ED at ___ for hypertension.\n___ ED at ___ for weakness\nand electrolyte imbalance. \n___ to ___ Completed cycle 4 adjuvant temozolomide at\n175 mg/m2/day x 5 days\n___ Infectious disease evaluation for scalp wound drainage.', 'PAST MEDICAL HISTORY:\n- hepatitis C cirrhosis complicated by renal failure status post\nliver-kidney transplant, ___, with a redo liver\ntransplant on ___ for hepatic arterial thrombosis\n- Salmonella gastroenteritis\n- Nephrolithiasis, s/p lithotripsy in ___\n- Diabetes mellitus\n- Hypertension, on antihypertensives\n- ITP, s/p splenectomy in ___\n- Asthma\n- Laparoscopic incisional hernia repair with mesh on ___ with hemoperitoneum requiring evacuation\n- Genotype 1A hepatitis C with recurrent fibrosis stage I-II on \nliver biopsy ___ s/p 12 weeks Harvoni and ribavirin\n- ID history: surgical site wound: MRSA cranial osteomyelitis:\nAfter stereotactic brain biopsy ___ he developed surgical \nsite infection with wound dehiscence requiring washout and \nremoval of cranial hardware ___ swab grew MRSA. He had \nadditional washout with flap closure performed on ___. He \nwas\ntreated initially with vancomycin and was transitioned to \nlinezolid on ___ for convenience. He completed 8 weeks of \ntreatment on ___ and was transitioned to indefinite \ndoxycycline suppression. He had complete healing of his scalp \nwound and was doing well at his transplant ID evaluation ___.'], 'family_history': 'His family history is significant for an aunt and uncle with \ndiabetes.', 'present_illness': 'This is a ___ year old man with a history of HCV cirrhosis s/p \nrenal and liver transplant in ___ with re-do liver transplant \nin ___ (on tacrolimus and prednisone 5 mg daily), subsequently \ndiagnosed with glioblastoma multiforme now s/p bavacizumab \n(stopped due to proteinuria), temozolamide (___), \nand radiation therapy (ending ___, course c/b MRSA surgical \nsite infection (cranium osteomyelitis for which he is on chronic \ndoxy suppression) now admitted with worsening shaking/tremors, \ntransferred to the FICU for monitoring after a seizure-like \nepisode and subsequent obtundation.\n\nThe patient was admitted to the OMED service the evening of \n___, reporting that about 1 week ago he started having shaking \nof the left arm which progressed to shaking tremors of the left \nand right arms. He did not have any lower extremity symptoms. He \nhas had intermittent mild headaches but none on admission, as \nwell as no fevers or visual changes. He denied trauma or LOC. \n\nHe had initially presented to his neuro-oncologist yesterday, \nDr. ___ evaluation of these shaking episodes. These were \noccurring in the setting of a recent MRI <1 week ago showing \nprogression of his corpus collosum GBM (no evidence of cranial \nosteo or dural empyema). Per Dr. ___ decision was made \nto focus on comfort/symptoms given his progressive disease, \nthough he did not think the jerking movements were seizure \nactivity. Note was made of a new gait disturbance. The patient \nwas referred to the ED for further evaluation, whereupon head CT \nrevealed new hypodensity within the GBM mass consistent with \nintralesional hemorrhage. Neurosurgery recommended admission to \n___. While in the ED the patient received 50 mg methadone, as \nwell as labetalol to break BPs down from 180s systolic. He also \nreceived 1L NS and 500 mg valproate (level was slightly \nsubtherapeutic at 47).\n\n___ hours after arrival to the floor the patient was noted to \nhave rhythmic jerking movements of his hands and feet for an \nunclear amount of time (one RN reported 5 min, one reported 30 \nmin) followed by obtundation. A trigger and ICU consult were \ncalled. Upon evaluation by the ICU team the patient the patient \nwas ordered for 0.04mg IV narcan with immediate improvement in \nhis mental status (confused but awake), with ongoing mycoclonic \nmovements of his extremities. He denied any headache, neck \npain/stiffness, or other acute symptoms. The floor team \nconfirmed his code status of DNR/DNI with his HCP, though the \nICU team was unable to reach her upon transfer.\n\nOf note, after stereotactic brain biopsy ___ he developed \nMRSA surgical site infection. Seen in ___ clinic ___ where it \nwas suggested he have MRI to r/o recurring osteo of head \nsurgical site infection. As above, MRI showed progression of \ncorpus callosum GBM, per Dr. ___ was no fluid collection \nor suggestion of worsening infection on report of that MRI (done \nat OSH).', 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77.7', 'valuenum': 77.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.72', 'valuenum': 4.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2512', 'valuenum': 2512.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 43 if non African-American (mL/min/1.73 m2). Estimated GFR = 52 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.07, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.07, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2295', 'valuenum': 2295.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '377', 'valuenum': 377.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2156', 'valuenum': 2156.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '331', 'valuenum': 331.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '57', 'valuenum': 57.0, 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105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '380', 'valuenum': 380.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.3', 'valuenum': 24.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': "ADMISSION PHYSICAL EXAM \n=======================\nVITAL SIGNS: Temperature 98.2 F, blood pressure 160/70, pulse \n74, respiration 20 and oxygen saturation 97% in room air\nGeneral: NAD but speaks slowly, has word finding difficulty\nHEENT: MMM, no OP lesions, scar appears fairly well healed with \nsome thick crust though but no exudate/drainage/erythema. no \ncervical, supraclavicular, or\naxillary adenopathy, no thyromegaly\nCARDIOVASCULAR: RRR, NL S1S2 no MRG\nPULMONARY: CTAB\nGASTROENTEROLOGY: BS+, soft, NTND, no masses or \nhepatosplenomegaly. Midline scar from prior liver transplant\nLIMBS: No edema, clubbing, + bilateral UE tremor, no asterixis; \nno inguinal adenopathy\nSKIN: No rashes or skin breakdown\nNEUROLOGICAL EXAMINATION: Oriented to place and year, self. \nDoesn't recall details of his history and admits his memory is \npoor. Cranial nerves II-XII are within normal limits excluding \nvisual acuity which was not assessed, no nystagmus; strength is \n___ of the proximal and distal upper and lower extremities; \nEOMI, PERRLA, tremor noted of right and left UE \n\nDISCHARGE PHYSICAL EXAM \n=======================\nVITAL SIGNS: Temperature 99.2 F, blood pressure 160s/80s, pulse \n___, respiration 18, and oxygen saturation 97-100% in room air\nGENERAL: Middle-aged gentleman, laying in bed, pleasant, \ninattentive\nHEENT: MMM. no JVD. scalp with well-healed scar.\nCARDIOVASCULAR: RRR. S1/S2 normal. no murmurs/gallops/rubs. \nPULMONARY: CTAB, normal work of breathing on room air, no \ncrackles or wheezes\nABDOMEN: BS+, soft, flat, no suprapubic tenderness, no \nrebound/guarding, no HSM, no CVAT\nLIMBS: WWP, no edema, no midline back tenderness; Right shoulder \nnontender but with limited range of motion at the right shoulder\nSKIN: no rashes or bruising, tattoo over left and right forearms\nNEUROLOGICAL EXAMINATION: AOx3, CNs II-XII grossly intact. \nSpeech slow by fluent. Strength slightly reduced in LLE in \ncomparison to overall global weakness. Increased muscle tone in \nLUE and LLE. Resting left sided tremor worsened when closing \neyes.", 'diagnoses': [{'icd_code': '7213', 'desc': 'Lumbosacral spondylosis without myelopathy'}, {'icd_code': '7210', 'desc': 'Cervical spondylosis without myelopathy'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': 'V103'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '7823', 'desc': 'Edema'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'E9320', 'desc': 'Adrenal cortical steroids causing adverse effects in therapeutic use'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': '7197', 'desc': 'Difficulty in walking'}], 'summary': "ADMISSION LABS\n==============\n___ 11:14PM ___ PTT-31.6 ___\n___ 07:10PM URINE HOURS-RANDOM UREA N-754 CREAT-119 \nSODIUM-51 POTASSIUM-65 CHLORIDE-42\n___ 07:10PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 07:10PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 07:10PM URINE RBC-<1 WBC-1 BACTERIA-NONE YEAST-NONE \nEPI-<1\n___ 07:10PM URINE HYALINE-5*\n___ 07:10PM URINE MUCOUS-RARE\n___ 06:30PM URINE HOURS-RANDOM UREA N-771 CREAT-119 \nSODIUM-51 POTASSIUM-65 CHLORIDE-45\n___ 06:30PM URINE HOURS-RANDOM\n___ 06:30PM URINE GR HOLD-HOLD\n___ 06:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 06:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-100 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 06:30PM URINE RBC-0 WBC-<1 BACTERIA-NONE YEAST-NONE \nEPI-1\n___ 06:30PM URINE MUCOUS-RARE\n___ 12:45PM LACTATE-1.7\n___ 12:38PM GLUCOSE-201* UREA N-48* CREAT-2.3* SODIUM-138 \nPOTASSIUM-4.5 CHLORIDE-97 TOTAL CO2-30 ANION GAP-16\n___ 12:38PM ALT(SGPT)-18 AST(SGOT)-17 ALK PHOS-94 TOT \nBILI-0.3\n___ 12:38PM CALCIUM-9.6 PHOSPHATE-4.1 MAGNESIUM-1.7\n___ 12:38PM VALPROATE-47*\n___ 12:38PM WBC-12.7* RBC-4.74 HGB-14.2 HCT-43.6 MCV-92 \nMCH-30.0 MCHC-32.6 RDW-16.8* RDWSD-56.0*\n___ 12:38PM NEUTS-60.5 ___ MONOS-9.0 EOS-1.9 \nBASOS-0.2 IM ___ AbsNeut-7.69* AbsLymp-3.51 AbsMono-1.15* \nAbsEos-0.24 AbsBaso-0.03\n___ 12:38PM PLT COUNT-173\n___ 12:38PM ___ PTT-60.9* ___\n\nIMAGING STUDIES\n===============\nCXR ___\nIMPRESSION: \nNo acute cardiopulmonary process. \n\nHead CT ___\nIMPRESSION: 1. Unchanged size of the central ill-defined \nhypodense mass consistent known glioblastoma measuring 2.3 x 3.6 \ncm. \n2. New central hyperdense region within the mass suggestive of \nintralesional hemorrhage without MR evidence of hemorrhage in \nsimilar regions on recent MRI. \n3. No acute fractures or other sites of hemorrhage identified. \n\nCT NECK ___\nIMPRESSION: \nNo acute fracture or malalignment.\n\n___ EEG\nIMPRESSION: This is an abnormal continuous ICU EEG monitoring \nstudy because of a slow and disorganized background, indicative \nof a severe encephalopathy which is nonspecific with regards to \netiology. Compared to the previous day's recording, the record \nis unchanged. There are no epileptiform discharges or \nelectrographic seizures.\n\n___ SHOULDER (AP, NEUTRAL AND AXILLARY) TRAUMA RIGHT\nIMPRESSION: \nNo evidence of acute fracture or dislocation. Moderate \ndegenerative changes seen in the AC joint, with the glenohumeral \njoint essentially within normal limits and no abnormal \ncalcification soft tissues. \n\n___ ABDOMEN (SUPINE ONLY)\nFINDINGS:\nThere are no abnormally dilated loops of large or small bowel. \nThere are multiple small radiopaque foreign bodies seen \nprojecting over the mid-abdomen, compatible with mesh clips from \nprior ventral hernia repair. The bladder is opacified with \ncontrast material, likely from a recent cross sectional exam.\nThere is no free intraperitoneal air. Moderate degenerative \nchanges are seen in the bilateral hips. There are no unexplained \nsoft tissue calcifications.\nIMPRESSION:\nNo evidence of obstruction or perforation.\n \nNOTABLE LABS\n============\n___ 05:21AM BLOOD Valproa-63\n___ 05:30AM BLOOD Valproa-55\n___ 04:22AM BLOOD Valproa-68\n___ 05:01AM BLOOD Valproa-56\n___ 01:00AM BLOOD tacroFK-3.5*\n___ 07:44AM BLOOD tacroFK-5.7\n___ 05:41AM BLOOD tacroFK-7.7\n___ 05:30AM BLOOD tacroFK-7.7\n___ 05:50AM BLOOD tacroFK-9.6\n___ 05:22AM BLOOD tacroFK-6.2\n___ 05:44AM BLOOD tacroFK-5.1\n___ 04:22AM BLOOD tacroFK-4.6*\n___ 05:01AM BLOOD tacroFK-4.6*\n___ 09:24AM BLOOD tacroFK-3.4*\n___ 09:00AM BLOOD tacroFK-3.4*\n___ 09:41AM BLOOD tacroFK-3.8*\n___ 09:07AM BLOOD tacroFK-5.1\n___ 09:14AM BLOOD tacroFK-4.7*\n___ 09:44AM BLOOD tacroFK-4.3*\n\nMICROBIOLOGY\n============\n___ 6:45 pm URINE Source: ___. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n PROTEUS MIRABILIS. >100,000 ORGANISMS/ML.. \n PRESUMPTIVE IDENTIFICATION. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n PROTEUS MIRABILIS\n | \nAMPICILLIN------------ <=2 S\nAMPICILLIN/SULBACTAM-- <=2 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN--------- =>4 R\nGENTAMICIN------------ 2 S\nMEROPENEM-------------<=0.25 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ 2 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\nDISCHARGE LABS\n==============\n___ 05:26AM BLOOD WBC-13.7* RBC-4.17* Hgb-12.6* Hct-36.9* \nMCV-89 MCH-30.2 MCHC-34.1 RDW-17.0* RDWSD-54.7* Plt ___\n___ 05:26AM BLOOD Glucose-151* UreaN-22* Creat-1.2 Na-137 \nK-4.5 Cl-102 HCO3-26 AnGap-14\n___ 05:07AM BLOOD ALT-25 AST-18 LD(LDH)-211 AlkPhos-112 \nTotBili-0.2\n___ 05:26AM BLOOD Calcium-9.0 Phos-2.7 Mg-2.0\n___ 08:55AM BLOOD tacroFK-4.1*\nMr. ___ is a ___ year old man with a history of HCV cirrhosis \ns/p renal and liver transplant in ___ with re-do liver \ntransplant in ___ (on tacrolimus and prednisone 5 mg daily), \nsubsequently diagnosed with glioblastoma multiforme admitted \nwith worsening shaking/tremors and obtundation upon arrival to \nthe inpatient floor.\n\n1. Seizure-like Activity and Obtundation: Patient was at high \nrisk for seizures given progressive GBM with intralesional \nhemorrhage, and intermittent rhythmic jerking movements and now \nobtundation could be c/w partial complex or generalized seizures \nwith post-ictal state. His response to Narcan on the floor \nraises concern for co-existent opiate overdose from methadone, \nthough several hours passed after methadone prior to his event \non the floor. No evidence clinically for meningitis and recent \nMRI reassuring for absence of recurrent cranial osteomyelitis. \nPatient was given Depakote load with 750 mg IV and then 750 mg \nBID. He was monitored closely and his mental status improved. He \nhad an EEG which did not show any evidence of seizures. For the \nrest of his hospitalization, he had no more episodes of \nobtundation or seizure-like activity. His Depakote was reduced \nback to home dose of 500 mg BID after the development of \nthrombocytopenia.\n\n2. Progressive Glioblastoma: He presented with new intralesional \nhemorrhage that did not require surgical intervention. Given \nthat he had a recent MRI in ___ that showed a new left \ntentorium lesion, he had an LP to determine if he had any \nleptomeningeal spread, which was negative. His temozolomide was \nheld on admission and will be restarted at the discretion of his \noutpatient oncologist. Given that the patient lives in ___ and has difficulty commuting for treatment, he remained \nin patient to receive CyberKnife to the new left tentorium \nlesion. He was unable to receive a planned session on ___ due to \nmovement. He had a repeat session on ___, which he was able to \ntolerate with pre-medication.\n\n3. Chronic Pain and History of IV Drug Abuse: The patient \npresented on methadone 50 mg PO BID, which was confirmed with \nhis outpatient methadone provider, ___ in ___. He \nwas given 50 mg in the ED, and on arrival to the floor, he was \nfound to be very somnolent. He was given naloxone with quick \nimprovement in his mental status. After monitoring in the ICU \nfor a short duration, he was transferred back to the floor. In \nthe ICU, he was maintained on methadone 5 mg TID. After several \ndays without any signs of withdrawal, a decision was made to try \nweaning the patient from methadone due to the patient's request \nand by the patient's sister (HCP). His pain was controlled with \nhydromorphone ___ mg PO as needed.\n\n4. Acute Kidney Injury: His creatinine has been as high as 2.0 \nin ___ but had downtrended to 1.6 on ___ and then was up \nto 2.3 on admission. FeNa 0.7% suggested prerenal cause though \nurine Na not terribly low at only 51. After receiving IV fluids, \nhis Cr improved to 1.1-1.2. The Cr rose to 1.3 then 1.2 after \nstarting lisinopril.\n\n5. Urinary Tract Infection: The patient was found to have a \nurinary tract infection and started on broad spectrum \nantibiotics on ___ with cefepime. Cultures and sensitivities \neventually showed >100,000 Proteus mirabilis that is resistant \nto only ciprofloxacin. He was transitioned to PO amoxicillin 500 \nmg Q8H to complete a course of 14 days that ends on ___ given \nhis renal transplant status.\n\n6. Hypertension: The patient was treated with labetalol 300 mg \nPO TID and diltiazem extended release 120 mg PO daily prior to \nadmission. On arrival, he had SBP to 160s and 170s during his \nadmission that required IV medications with concern for \nintralesional bleeding. On the floor, he was uptitrated on \ndiltiazem to 240 mg PO daily and started on lisinopril with \nuptitration to 20 mg daily.\n\n7. Kidney and Liver Transplant Status: LFTs normal with no \nsignificant synthetic dysfunction. Kidney function improved \nduring hospitalization. He was continued on tacrolimus and home \nsteroid of prednisone 5 mg daily. He had a renal transplant \nultrasound which showed mild parenchymal changes, but no changes \nin resistive indices. His tacrolimus was adjusted to 1.5 mg BID, \nlikely due an increased diltiazem dose.\n\n8. Thrombocytopenia: During his hospitalization, his platelet \ncount dropped to a low 98, which was thought to be due to \nDepakote. His Depakote dose was reduced from 750 mg BID to ___ \nmg BID, and his platelet counts recovered to 233 on discharge.\n\n9. Wound Infection and MRSA Osteomyelitis: He was seen by Dr. \n___ from infectious disease on ___ for a chronic \nwound infection from his craniotomy incision site. In the ICU \nhis scalp looks uninfected. His head MRI from ___ dated \n___ did not show subgaleal or subdural empyema. He is s/p 8 \nweeks of antibiotics and now on indefinite suppression with doxy \nas of ___ which was continued.\n\n10. Diabetes: He was continued on insulin, which was titrated. \nAt discharge, he was on glargine 10 units at night.\n\n11. Depression: His home dose of Seroquel, alprazolam, \ntrazodone, and sertraline were held on admission due to altered \nmental status. Of these medications, only sertraline was \nrestarted given concern for withdrawal and low likelihood of \ncausing over-sedation."}}
{'final_diagnoses': ['Glioblastoma multiforme', 'Toxic-metabolic encephalopathy', 'Hypertension', 'Chronic pain', 'Liver transplant status', 'Renal transplant status'], 'procedures': ['___: CyberKnife treatment to left tentorium mass.'], 'visit_summary': "Mr. ___ is a ___ year old man with a history of HCV cirrhosis \ns/p renal and liver transplant in ___ with re-do liver \ntransplant in ___ (on tacrolimus and prednisone 5 mg daily), \nsubsequently diagnosed with glioblastoma multiforme admitted \nwith worsening shaking/tremors and obtundation upon arrival to \nthe inpatient floor.\n\n1. Seizure-like Activity and Obtundation: Patient was at high \nrisk for seizures given progressive GBM with intralesional \nhemorrhage, and intermittent rhythmic jerking movements and now \nobtundation could be c/w partial complex or generalized seizures \nwith post-ictal state. His response to Narcan on the floor \nraises concern for co-existent opiate overdose from methadone, \nthough several hours passed after methadone prior to his event \non the floor. No evidence clinically for meningitis and recent \nMRI reassuring for absence of recurrent cranial osteomyelitis. \nPatient was given Depakote load with 750 mg IV and then 750 mg \nBID. He was monitored closely and his mental status improved. He \nhad an EEG which did not show any evidence of seizures. For the \nrest of his hospitalization, he had no more episodes of \nobtundation or seizure-like activity. His Depakote was reduced \nback to home dose of 500 mg BID after the development of \nthrombocytopenia.\n\n2. Progressive Glioblastoma: He presented with new intralesional \nhemorrhage that did not require surgical intervention. Given \nthat he had a recent MRI in ___ that showed a new left \ntentorium lesion, he had an LP to determine if he had any \nleptomeningeal spread, which was negative. His temozolomide was \nheld on admission and will be restarted at the discretion of his \noutpatient oncologist. Given that the patient lives in ___ and has difficulty commuting for treatment, he remained \nin patient to receive CyberKnife to the new left tentorium \nlesion. He was unable to receive a planned session on ___ due to \nmovement. He had a repeat session on ___, which he was able to \ntolerate with pre-medication.\n\n3. Chronic Pain and History of IV Drug Abuse: The patient \npresented on methadone 50 mg PO BID, which was confirmed with \nhis outpatient methadone provider, ___ in ___. He \nwas given 50 mg in the ED, and on arrival to the floor, he was \nfound to be very somnolent. He was given naloxone with quick \nimprovement in his mental status. After monitoring in the ICU \nfor a short duration, he was transferred back to the floor. In \nthe ICU, he was maintained on methadone 5 mg TID. After several \ndays without any signs of withdrawal, a decision was made to try \nweaning the patient from methadone due to the patient's request \nand by the patient's sister (HCP). His pain was controlled with \nhydromorphone ___ mg PO as needed.\n\n4. Acute Kidney Injury: His creatinine has been as high as 2.0 \nin ___ but had downtrended to 1.6 on ___ and then was up \nto 2.3 on admission. FeNa 0.7% suggested prerenal cause though \nurine Na not terribly low at only 51. After receiving IV fluids, \nhis Cr improved to 1.1-1.2. The Cr rose to 1.3 then 1.2 after \nstarting lisinopril.\n\n5. Urinary Tract Infection: The patient was found to have a \nurinary tract infection and started on broad spectrum \nantibiotics on ___ with cefepime. Cultures and sensitivities \neventually showed >100,000 Proteus mirabilis that is resistant \nto only ciprofloxacin. He was transitioned to PO amoxicillin 500 \nmg Q8H to complete a course of 14 days that ends on ___ given \nhis renal transplant status.\n\n6. Hypertension: The patient was treated with labetalol 300 mg \nPO TID and diltiazem extended release 120 mg PO daily prior to \nadmission. On arrival, he had SBP to 160s and 170s during his \nadmission that required IV medications with concern for \nintralesional bleeding. On the floor, he was uptitrated on \ndiltiazem to 240 mg PO daily and started on lisinopril with \nuptitration to 20 mg daily.\n\n7. Kidney and Liver Transplant Status: LFTs normal with no \nsignificant synthetic dysfunction. Kidney function improved \nduring hospitalization. He was continued on tacrolimus and home \nsteroid of prednisone 5 mg daily. He had a renal transplant \nultrasound which showed mild parenchymal changes, but no changes \nin resistive indices. His tacrolimus was adjusted to 1.5 mg BID, \nlikely due an increased diltiazem dose.\n\n8. Thrombocytopenia: During his hospitalization, his platelet \ncount dropped to a low 98, which was thought to be due to \nDepakote. His Depakote dose was reduced from 750 mg BID to ___ \nmg BID, and his platelet counts recovered to 233 on discharge.\n\n9. Wound Infection and MRSA Osteomyelitis: He was seen by Dr. \n___ from infectious disease on ___ for a chronic \nwound infection from his craniotomy incision site. In the ICU \nhis scalp looks uninfected. His head MRI from ___ dated \n___ did not show subgaleal or subdural empyema. He is s/p 8 \nweeks of antibiotics and now on indefinite suppression with doxy \nas of ___ which was continued.\n\n10. Diabetes: He was continued on insulin, which was titrated. \nAt discharge, he was on glargine 10 units at night.\n\n11. Depression: His home dose of Seroquel, alprazolam, \ntrazodone, and sertraline were held on admission due to altered \nmental status. Of these medications, only sertraline was \nrestarted given concern for withdrawal and low likelihood of \ncausing over-sedation.", 'medications_prescribed': ['1. Bisacodyl 10 mg PO/PR DAILY:PRN constipation', '2. Docusate Sodium 100 mg PO BID', '3. Labetalol 300 mg PO TID', '4. Doxycycline Hyclate 100 mg PO Q12H', '5. Ondansetron 8 mg PO Q8H:PRN nausea', '6. PredniSONE 5 mg PO DAILY', '7. Sertraline 50 mg PO QHS', '8. Tamsulosin 0.4 mg PO QHS', '9. Famotidine 20 mg PO Q12H', '10. nystatin 100,000 unit/gram topical BID groin', '11. Acetaminophen 650 mg PO Q6H pain', '12. Divalproex (DELayed Release) 500 mg PO BID', '13. Diltiazem Extended-Release 240 mg PO DAILY', '14. Tacrolimus 1.5 mg PO Q12H', '15. Senna 8.6 mg PO BID:PRN constipation', '16. Amoxicillin 500 mg PO Q8H Duration: 12 Days \nFinishes total course after doses on ___. Glargine 10 Units Bedtime', '18. Lisinopril 20 mg PO DAILY', '19. HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nRX *hydromorphone 2 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*10 Tablet Refills:*0', '20. Outpatient Lab Work\nICD 10: Z94.0 Kidney Transplant Status\nPlease draw tacrolimus level and fax results to Dr. ___ \n___, Fax: ___, Phone: ___.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 79, 'gender': 'F', 'symptoms': 'abdominal pain', 'medical_history': ['hypertension', 'breast cancer s/p lumpectomy and radiation', '___ ___ s/p ablation'], 'family_history': 'non-contributory', 'present_illness': '___ year old female who presents with 2 episodes of mid-abdominal \npain over the past week that was first mid-epigastric and then \nbandlike across the abdomen. She has pain now that is constant \nfor the past 2 days. She had a\ncheeseburger one day before the second episode. The first \nepisode\nfollowed a fatty meal. No N/V/D No F/C/S Abdomen felt distended\nand gassy.. Her brother had gallstone pancreatitis.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Labetalol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CHECKED & REPEATED.'}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 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'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 16.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYZED, MODERATELY.'}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES Mg.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K.'}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.50', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.3', 'valuenum': 24.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical examination upon admission: ___\n\nVital Signs sheet entries for ___: \nBP: 118/64. Heart Rate: 97. O2 Saturation%: 98. Weight: 174.\nHeight: 69.5. BMI: 25.3. Temperature: 98.5. \n Examination: \n General Examination: \n GENERAL APPEARANCE: alert and oriented, no acute \ndistress,\npleasant. HEENT: unremarkable, atraumatic, normocephalic,clear\nconjuctiva, Extra Ocular Muscles Intact (EOMI) bilaterally,\nPupils Equal, Round, Reactive to Light (PERRL), Oropharynx clear\nwith moist mucous membranes . NECK: no lymphadenopathy, supple. \n\nCARDIOVASCULAR: no murmurs, click or rubs, normal S1S2, regular\nrate and rhythm.. CHEST: clear to auscultation. \nGASTROINTESTINAL: bowel sounds normoactive She is tender to\npalpation at the right upper quadrant. no mass, no\nhepatosplenomegaly.. EXTREMETIES: no clubbing, no edema.\n\nPhysical examination upon discharge: ___:\n\nGENERAL: NAD\n\nCV: ns1,s2, no murmurs\nLUNGS: clear\nABDOMEN: Hypoactive BS, soft, generalized tenderness, no \nguarding/rebount\nEXT: no pedal edema bil., no calf tenderness bil\nNEURO: alert and oriented x 3 speech clear, no tremors', 'diagnoses': [{'icd_code': '85180', 'desc': 'Other and unspecified cerebral laceration and contusion, without mention of open intracranial wound, unspecified state of consciousness'}, {'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'E8889'}, {'icd_code': 'E8496', 'desc': 'Accidents occurring in public building'}], 'summary': '___ 04:00AM BLOOD WBC-6.4 RBC-3.84* Hgb-11.9 Hct-35.2 \nMCV-92 MCH-31.0 MCHC-33.8 RDW-12.0 RDWSD-40.3 Plt ___\n___ 04:10AM BLOOD WBC-7.9 RBC-3.89* Hgb-12.0 Hct-35.8 \nMCV-92 MCH-30.8 MCHC-33.5 RDW-12.0 RDWSD-40.3 Plt ___\n___ 12:10PM BLOOD WBC-12.2*# RBC-4.61 Hgb-14.0 Hct-40.9 \nMCV-89 MCH-30.4 MCHC-34.2 RDW-12.0 RDWSD-38.9 Plt ___\n___ 12:10PM BLOOD Neuts-84.0* Lymphs-10.7* Monos-4.5* \nEos-0.2* Baso-0.3 Im ___ AbsNeut-10.26*# AbsLymp-1.31 \nAbsMono-0.55 AbsEos-0.03* AbsBaso-0.04\n___ 04:00AM BLOOD Plt ___\n___ 04:00AM BLOOD ___\n___ 04:00AM BLOOD Glucose-98 UreaN-6 Creat-0.7 Na-139 K-3.4 \nCl-102 HCO3-29 AnGap-11\n___ 12:10PM BLOOD ALT-19 AST-19 AlkPhos-44 Amylase-54 \nTotBili-0.4\n___ 04:00AM BLOOD Calcium-8.7 Phos-3.1 Mg-2.1\n\n___: ABD. US:\n\nCholelithiasis with a distended gallbladder demonstrating wall \nedema, \nsonographic features which are concerning for acute \ncholecystitis.\n\n___: cat scan abdomen and pelvis:\n\n. Acute calculus cholecystitis. The gallbladder contains a \nlarge stone. \nThere is gallbladder wall thickening up to 7 mm, and \npericholecystic fat \nstranding.\n___ year old female admitted to the hospital with right upper \nquadrant pain for 9 days. Upon admission, the patient was made \nNPO, given intravenous fluids, and underwent imaging. Initial \nUS imaging showed cholelithiasis with a distended gallbladder \nwall. The patient underwent cat scan imaging which showed acute \ncalculus cholecystitis with a large stone in the gallbladder as \nwell as gallbladder wall thickening and edema. The patient was \nplaced on bowel rest and her white blood cell count and liver \nfunction tests were monitored.\n\nAfter her abdominal pain decreased in severity, the patient was \nstarted on clear liquids and advanced to a regular diet. Her \nvital signs were stable with a normal white blood cell count and \nliver function tests. The patient progressed to a regular diet \nwith reports of "achiness" in the abdomen. She was ambulatory \nand voiding without difficulty. Because of the lengthy \npresentation of symptoms, the decision was made for the patient \nto be discharged and follow-up for an interval cholecystectomy. \nAn appointment was made in the the Acute care clinic with Dr. \n___ ___. Discharge instructions were reviewed and \nquestions answered. The patient resumed her home medications \nand instructed to complete her course of ciprofloxacin and \nflagyl. She was discharged home in stable condition on HD #4.'}}
{'final_diagnoses': ['acute cholecystitis'], 'procedures': ['none'], 'visit_summary': '___ year old female admitted to the hospital with right upper \nquadrant pain for 9 days. Upon admission, the patient was made \nNPO, given intravenous fluids, and underwent imaging. Initial \nUS imaging showed cholelithiasis with a distended gallbladder \nwall. The patient underwent cat scan imaging which showed acute \ncalculus cholecystitis with a large stone in the gallbladder as \nwell as gallbladder wall thickening and edema. The patient was \nplaced on bowel rest and her white blood cell count and liver \nfunction tests were monitored.\n\nAfter her abdominal pain decreased in severity, the patient was \nstarted on clear liquids and advanced to a regular diet. Her \nvital signs were stable with a normal white blood cell count and \nliver function tests. The patient progressed to a regular diet \nwith reports of "achiness" in the abdomen. She was ambulatory \nand voiding without difficulty. Because of the lengthy \npresentation of symptoms, the decision was made for the patient \nto be discharged and follow-up for an interval cholecystectomy. \nAn appointment was made in the the Acute care clinic with Dr. \n___ ___. Discharge instructions were reviewed and \nquestions answered. The patient resumed her home medications \nand instructed to complete her course of ciprofloxacin and \nflagyl. She was discharged home in stable condition on HD #4.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Ciprofloxacin HCl 500 mg PO Q12H \nlast dose ___ \nRX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth every \ntwelve (12) hours Disp #*20 Tablet Refills:*0', 'MetroNIDAZOLE 500 mg PO Q8H \nlast dose ___ \nRX *metronidazole 500 mg 1 tablet(s) by mouth every eight (8) \nhours Disp #*30 Tablet Refills:*0', 'Metoprolol Succinate XL 25 mg PO DAILY', 'Hydrochlorothiazide 25 mg PO DAILY', 'LORazepam 0.5 mg PO QHS:PRN anxiety', 'Tamoxifen Citrate 20 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 69, 'gender': 'M', 'symptoms': 'respiratory distress', 'medical_history': ['___ disease', 'Paranoid schizophrenia', 'COPD', 'Asthma', 'Hyperlipidemia', 'GI Bleeding'], 'family_history': 'FAMILY HISTORY: Unknown. ', 'present_illness': ' Conducted with telephone interpreter, patient is very limited \nhistorian and answers mostly yes or no. \n___ ___-speaking male with history of \nschizophrenia, who presents with acute onset difficulty \nbreathing. Patient vomited a large amount of undigested food the \nevening of ___. The following day, chest x-ray was \nunremarkable and KUB showed slightly distended transverse colon \nbut no small bowel obstruction. The large bowel was full of \nstool. On ___ (day of admission), he was noted to have \nincreased respiratory distress, characterized by wheezing, \ncongestion, tachypnea to RR of 32 and diaphoresis. He was \nsatting 94-96% on 2L. \nPatient mostly moans incoherently with interpreter. He denies \ndifficulty breathing, cough, chest pain, abdominal pain, nausea, \nvomiting, diarrhea, constipation. \nIn the ED initial vitals were: 93 153/70 18 96% 2L \n- Labs were significant for lactate: 2.2, creat 1.3 (up from \nbaseline 0.9) \n- Patient was given vancomycin, levofloxacin, metronidazole in \nthe ED \nVitals prior to transfer were: 100.4 88 182/81 22 96-100% NC \nReview of Systems: Unable to reliably obtain ', 'medications': [{'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Alteplase 1mg/5mL ( Clearance ie. Indwelling port )', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.3', 'valuenum': 43.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': '<5.'}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.71', 'valuenum': 0.71, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.6, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.75', 'valuenum': 4.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.73', 'valuenum': 4.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56.2', 'valuenum': 56.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 110.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '47.3', 'valuenum': 47.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.6', 'valuenum': 52.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.67', 'valuenum': 4.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58.1', 'valuenum': 58.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66.1', 'valuenum': 66.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 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{'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '70.0', 'valuenum': 70.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 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14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.7', 'valuenum': 44.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92.1', 'valuenum': 92.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 157.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55.8', 'valuenum': 55.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72.9', 'valuenum': 72.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79.8', 'valuenum': 79.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '72.0', 'valuenum': 72.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66.7', 'valuenum': 66.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '177', 'valuenum': 177.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.75', 'valuenum': 4.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81.3', 'valuenum': 81.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71.1', 'valuenum': 71.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.92', 'valuenum': 4.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.7', 'valuenum': 48.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73.7', 'valuenum': 73.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.70', 'valuenum': 4.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '66.1', 'valuenum': 66.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 103.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '55.2', 'valuenum': 55.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.68', 'valuenum': 4.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.0', 'valuenum': 51.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PE:\n\nVitals - T: 98.4 BP: 180/89 HR: 86 RR: 22 02 sat: 100% on 3L \nGENERAL: Awake, answers questions inconsistently, intermittent \nmoaning \nHEENT: NCAT, PERRL, anicteric sclera \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: Wet crackles bilaterally, coarse wet upper airway noises, \nno wheezes. \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, +G tube c/d/i \nEXTREMITIES: Hypertonic, contracted bilateral upper and lower \nextremities, left > right \nNEURO: Limited cooperation. +Fine resting tremor, increased tone \nthroughout. +Clonus left > right. Mute Babinksi sign \n\nDISCHARGE PE:\n\nVitals - 97.8 122/71 73 21 98% on open mist \nGENERAL: Waxing/Waning LOC cannot comprehend\nHEENT: NCAT, PERRL, anicteric sclera \nCARDIAC: RRR, but unable to eval for murmur as patient \nconstantly moaning with exhalation\nLUNG: can confirm air movement but exam significantly limited by \npatient cooperation and monaing; slightly course BS with wet \ncrackles. \nABDOMEN: distended but softer since admission, +BS, +G tube \nc/d/i, but not secured. \nEXTREMITIES: Hypertonic, contracted bilateral upper and lower \nextremities, left > right \nNEURO: Limited cooperation. +Fine resting tremor, increased tone \nthroughout. ', 'diagnoses': [{'icd_code': 'I6340', 'desc': 'Cerebral infarction due to embolism of unspecified cerebral artery'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'I513', 'desc': 'Intracardiac thrombosis, not elsewhere classified'}, {'icd_code': 'R29810', 'desc': 'Facial weakness'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'R200', 'desc': 'Anesthesia of skin'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E7800', 'desc': 'Pure hypercholesterolemia, unspecified'}, {'icd_code': 'Z85118', 'desc': 'Personal history of other malignant neoplasm of bronchus and lung'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'Z951', 'desc': 'Presence of aortocoronary bypass graft'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'I6523', 'desc': 'Occlusion and stenosis of bilateral carotid arteries'}], 'summary': "ADMISSION LABS:\n\n___ 06:39PM BLOOD WBC-9.8# RBC-3.96* Hgb-12.1* Hct-38.4* \nMCV-97# MCH-30.4 MCHC-31.5 RDW-16.3* Plt ___\n___ 06:39PM BLOOD Neuts-47* Bands-10* ___ Monos-13* \nEos-2 Baso-0 ___ Myelos-0\n___ 06:39PM BLOOD ___ PTT-28.2 ___\n___ 03:00PM BLOOD Glucose-142* UreaN-51* Creat-1.3* Na-140 \nK-5.5* Cl-101 HCO3-29 AnGap-16\n___ 03:00PM BLOOD ALT-30 AST-60* AlkPhos-79 TotBili-0.5\n___ 03:00PM BLOOD Lipase-15\n___ 03:00PM BLOOD Albumin-4.1\n___ 02:41PM BLOOD Lactate-2.2*\n___ 03:40PM URINE Color-Yellow Appear-Hazy Sp ___\n___ 03:40PM URINE Blood-NEG Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n___ 03:40PM URINE RBC-2 WBC-3 Bacteri-NONE Yeast-NONE Epi-0\n___ 03:40PM URINE CastGr-1* CastHy-12*\n___ 03:40PM URINE Mucous-RARE\n\nRECENT LABS:\n\nMICRO: Blood cultures\n\nSTUDIES/IMAGING:\n\n___ CT ABDOMEN \n1. No evidence of bowel obstruction. Fecal packing throughout \nthe large bowel. \n2. Small right and trace left pleural effusions with \nconsolidative lower lobe opacities consistent with infection or \naspiration. \n3. 2.5 cm focal aneurysmal dilatation of the infrarenal \nabdominal aorta. \n4. Cholelithiasis without cholecystitis. \n___ CHEST X-RAY \nLow lung volumes. Patchy right basilar opacity could be due to \npneumonia. \n\nCXR ___:\n\nThere are patchy opacities in both lungs, more pronounced at the \nbases, but \nextending superiorly from there. For the most part, these appear \nalveolar. The \nextent appears slightly increased compared with the prior film. \nThe most \nlikely differential includes changes due to aspiration, \ninfection, and, in the \nappropriate setting, evolving ARDS. An atypical distribution of \nCHF could also \nhave a similar appearance. No obvious effusion identified on \nthis radiograph, \nthough the CT scan from ___, the show a small right and \ntrace left \neffusion \n\nECG ___\nSinus rhythm. Left axis deviation. Minor non-specific \nrepolarization \nabnormalities. Compared to the previous tracing of ___ \nfindings are \nunchanged. \nRead by: ___. \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n82 184 80 390/428 44 -33 50 \n \n___ KUB\nIMPRESSION: \n \nNonspecific mild gaseous dilatation of the small bowel. No free \nair. \n\n___\nIMPRESSION: \n \nHeart size and mediastinum are unchanged with cardiomegaly still \npresent. \nThere is overall slight improvement of widespread parenchymal \nconsolidations. \nBibasal opacities are still more prominent. \n\n___ 12:50PM BLOOD WBC-5.1 RBC-4.50* Hgb-14.0 Hct-43.9 \nMCV-97 MCH-31.0 MCHC-31.9 RDW-15.9* Plt ___\n___ 12:50PM BLOOD Glucose-76 UreaN-20 Creat-1.0 Na-141 \nK-3.7 Cl-99 HCO3-27 AnGap-___ yo male with history of schizophrenia and ___ disease \nwho presents from SNF with acute respiratory distress. \nACUTE ISSUES THIS ADMISSION:\n\n# RESPIRATORY DISTRESS/INTERMITTENT RESPIRATORY FAILURE: This \nadmission, respiratory distress felt to be due to aspiration \npneumonia given recent aspiration history and unchanged findings \nof chest xray (would have expected resolution if only \npneumonitis). The pateint was started on levofloxacin for \npresumed HCAP which was continued for a 7 day course. His \ndementia has progressed to being unable to protect his airway. \nHe needs to be on constant airway precautions with excellent \noral care to keep bacterial loads down. He had intermittent \nresiratory failure with desaturations to the low 80's, which \nimproved with deep suctioning. His intermittent respiratory \nfailure was contributed to by abdominal bloating secondary to \nconstipation, which improved with an aggressive bowel regimen. \nLater in his hospitalization he was thought to be fluid \noverloaded and diuresed to improve respiratory function. The \npatient was also maintained on standing nebulizer treatments and \noxygen. Oxygen was weaned to open mist, and then to room air on \nday of discharge. \n\n# ACUTE KIDNEY INJURY: Creat 1.3 on admission elevated from \nbaseline 0.9. Patient responded to 1L fluid challege and \ncreatinine quickly corrected to baseline and was stable for the \nremainder of the admission. Likely d/t vomiting and poor intake.\n\n# HYPERTENSION: He was started on HCTZ on ___. \n\n# CONSTIPATION: CT notable for significant stool in the colon. \nPatient given a liberalized bowel regimen and fleet enema. KUB \nsuggestive of illeus and not obstuction on ___. On ___ had \nlarge bowel movemement. The following bowel regimen was used:\nLactulose 30 mL PO/NG DAILY \nStart: ___\nBisacodyl ___ID constipation \nStart: ___\nPolyethylene Glycol 17 g PO/NG QID \nStart: ___\nSenna 8.6 mg PO/NG QID constipation \nStart: ___\nDocusate Sodium (Liquid) 100 mg PO/NG BID \nStart: ___ \n\n# GOALS OF CARE: Goals of care discussions were held with the \nPatient's daughter and the ___ Team and Palliative Care. \nHis family's wishes were that he remain full code.\n\nCHRONIC ISSUES THIS ADMISSION:\n\n# ___ disease: Continued home carbidopa/levodopa, \nropinirole, trihexyphenidyl \n\n# Schizophrenia: continued depot haldol (every 2 weeks) due \n___ and administered this admission.\n\n He presented with an ileus He initially presented with ___, \nwhich resolved.. Goals of care discussions were held with his \nfamily, who decided he should continue to be full code. "}}
{'final_diagnoses': ['Aspiration Pneumonia', 'Acute Kidney Injury', 'Constipation', 'Paranoid Schizophrenia', 'Parkinsons'], 'procedures': ['none'], 'visit_summary': "ACUTE ISSUES THIS ADMISSION:\n\n# RESPIRATORY DISTRESS/INTERMITTENT RESPIRATORY FAILURE: This \nadmission, respiratory distress felt to be due to aspiration \npneumonia given recent aspiration history and unchanged findings \nof chest xray (would have expected resolution if only \npneumonitis). The pateint was started on levofloxacin for \npresumed HCAP which was continued for a 7 day course. His \ndementia has progressed to being unable to protect his airway. \nHe needs to be on constant airway precautions with excellent \noral care to keep bacterial loads down. He had intermittent \nresiratory failure with desaturations to the low 80's, which \nimproved with deep suctioning. His intermittent respiratory \nfailure was contributed to by abdominal bloating secondary to \nconstipation, which improved with an aggressive bowel regimen. \nLater in his hospitalization he was thought to be fluid \noverloaded and diuresed to improve respiratory function. The \npatient was also maintained on standing nebulizer treatments and \noxygen. Oxygen was weaned to open mist, and then to room air on \nday of discharge. \n\n# ACUTE KIDNEY INJURY: Creat 1.3 on admission elevated from \nbaseline 0.9. Patient responded to 1L fluid challege and \ncreatinine quickly corrected to baseline and was stable for the \nremainder of the admission. Likely d/t vomiting and poor intake.\n\n# HYPERTENSION: He was started on HCTZ on ___. \n\n# CONSTIPATION: CT notable for significant stool in the colon. \nPatient given a liberalized bowel regimen and fleet enema. KUB \nsuggestive of illeus and not obstuction on ___. On ___ had \nlarge bowel movemement. The following bowel regimen was used:\nLactulose 30 mL PO/NG DAILY \nStart: ___\nBisacodyl ___ID constipation \nStart: ___\nPolyethylene Glycol 17 g PO/NG QID \nStart: ___\nSenna 8.6 mg PO/NG QID constipation \nStart: ___\nDocusate Sodium (Liquid) 100 mg PO/NG BID \nStart: ___ \n\n# GOALS OF CARE: Goals of care discussions were held with the \nPatient's daughter and the ___ Team and Palliative Care. \nHis family's wishes were that he remain full code.\n\nCHRONIC ISSUES THIS ADMISSION:\n\n# ___ disease: Continued home carbidopa/levodopa, \nropinirole, trihexyphenidyl \n\n# Schizophrenia: continued depot haldol (every 2 weeks) due \n___ and administered this admission.\n\n He presented with an ileus He initially presented with ___, \nwhich resolved.. Goals of care discussions were held with his \nfamily, who decided he should continue to be full code. ", 'medications_prescribed': ['Bisacodyl ___AILY:PRN constipation', 'Carbidopa-Levodopa (___) 1 TAB PO QID', 'Hydrocodone-Acetaminophen (5mg-325mg) 1 TAB PO Q8H:PRN pain', 'Ipratropium-Albuterol Neb 1 NEB NEB Q4H:PRN wheeze', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Pantoprazole 20 mg PO Q24H', 'Ropinirole 1 mg PO QHS', 'Senna 8.6 mg PO BID:PRN constipation', 'Simvastatin 40 mg PO DAILY', 'Trihexyphenidyl 2 mg PO BID', 'Docusate Sodium (Liquid) 100 mg PO BID', 'Ascorbic Acid (Liquid) 500 mg PO BID', 'Juven (arginine-glutamine-calcium Hmb) ___ gram oral BID', 'Lorazepam 0.5 mg PO Q4H:PRN agitation', 'Potassium Chloride (Powder) 30 mEq PO DAILY', 'Haloperidol Decanoate 50 mg IM EVERY 2 WEEKS', 'QUEtiapine Fumarate 175 mg PO TID', 'Polyethylene Glycol 17 g PO DAILY \nhold for loose stools \nRX *polyethylene glycol 3350 17 gram/dose 17 g powder(s) by \nmouth daily Refills:*0', 'Hydrochlorothiazide 25 mg PO DAILY \nRX *hydrochlorothiazide 25 mg 1 tablet(s) by mouth twice a day \nDisp #*30 Tablet Refills:*0', 'Ropinirole 1.5 mg PO QAM', 'Acetaminophen 650 mg PO Q6H:PRN pain', 'Lactulose 30 mL PO DAILY PRN constipation \nHold for loose stools']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'L4-5 HNP, LSS', 'medical_history': ['L4-L5 right-sided hemilaminectomy ___ years ago'], 'family_history': 'None', 'present_illness': '___ female who previously underwent dorsal spinal \ndecompression on the right side at L4-L5. Unfortunately, she had \nrecurrence of her stenosis, with severe leg pain, requiring \nhospitalization for adequate reduction in pain. She had \nundergone a prolonged and multimodal course of conservative care \nwithout significant or lasting relief. In the setting of severe \nneurologic compression, severe symptoms refractory to outpatient \nmanagement, she has elected to undergo surgical treatment.', 'medications': [{'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '293', 'valuenum': 293.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Sensory ___ R L \nL2(Groin) Intact Intact \nL3 (Leg) Intact Intact \nL4 (Knee) Intact Intact \nL5(Grt Toe) Diminished Intact \nS1(Sm toe) Intact Intact \nS2 (Post Thigh) Intact Intact \nMotor ___- exam limited due to pain \nR L \nQuad (L3) 4+/5 4+/5 \nTib Ant (L4) ___ \n___ (L5) ___ \nPeroneal (S1) ___ \nG/S (S1) ___ \nReflexes R L \nPatellar (L3-4) 2+ 2+ \nAchilles (L5-S1) 1 1 \nStraight leg raise: Positive right side \nBabinski: downgoing bilaterally \nClonus: no clonus BLE', 'diagnoses': [{'icd_code': '8208', 'desc': 'Closed fracture of unspecified part of neck of femur'}, {'icd_code': '80126', 'desc': 'Closed fracture of base of skull with subarachnoid, subdural, and extradural hemorrhage, with loss of consciousness of unspecified duration'}, {'icd_code': '8026', 'desc': 'Closed fracture of orbital floor (blow-out)'}, {'icd_code': 'E8889'}, {'icd_code': '36960', 'desc': 'Profound impairment, one eye, impairment level not further specified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '1420', 'desc': 'Malignant neoplasm of parotid gland'}, {'icd_code': '37923', 'desc': 'Vitreous hemorrhage'}], 'summary': '___ 06:00AM BLOOD WBC-10.1 RBC-3.50* Hgb-8.8* Hct-28.7* \nMCV-82 MCH-25.2* MCHC-30.8* RDW-15.3 Plt ___\n___ 06:00AM BLOOD Plt ___\n___ 06:00AM BLOOD Glucose-99 UreaN-17 Creat-0.6 Na-137 \nK-4.0 Cl-103 HCO3-25 AnGap-13\n___ 06:00AM BLOOD Calcium-8.1* Phos-3.8 Mg-1.9\nPatient was admitted to the ___ Spine Surgery Service and \ntaken to the Operating Room for the above procedure. Refer to \nthe dictated operative note for further details. The surgery was \nwithout complication and the patient was transferred to the PACU \nin a stable condition. TEDs/pnemoboots were used for \npostoperative DVT prophylaxis. Intravenous antibiotics were \ncontinued for 24hrs postop per standard protocol. Initial postop \npain was controlled IV/PO meications. Diet was advanced as \ntolerated. The patient was transitioned to oral pain medication \nwhen tolerating PO diet. Physical therapy was consulted for \nmobilization OOB to ambulate. This patient has contact \ndermatitis blisters located near her incision site. Most likely \nfrom her incisional dressing tape. The blisters do not appear \ninfected. They are intact and filled with clear fluid and no \nerrythema surrounding blisters. She will call if the blisters \nburst and show signs of infection. Hospital course was otherwise \nunremarkable. On the day of discharge the patient was afebrile \nwith stable vital signs, comfortable on oral pain control and \ntolerating a regular diet.'}}
{'final_diagnoses': ['Prior right L4-5 hemilaminotomy.', 'Recurrent right L4-L5 stenosis, lateral recess and\n foramen.', 'Spinal stenosis.', 'Radiculopathy.'], 'procedures': ['Bilateral decompression, L4-5.', 'Interbody reconstruction with biomechanical device.', 'Interbody fusion, posterior, L4-L5.', 'Posterior instrumentation L4-L5.', 'Posterior arthrodesis at L4, L5.', 'Autograft, same incision.', 'Allograft.'], 'visit_summary': 'Patient was admitted to the ___ Spine Surgery Service and \ntaken to the Operating Room for the above procedure. Refer to \nthe dictated operative note for further details. The surgery was \nwithout complication and the patient was transferred to the PACU \nin a stable condition. TEDs/pnemoboots were used for \npostoperative DVT prophylaxis. Intravenous antibiotics were \ncontinued for 24hrs postop per standard protocol. Initial postop \npain was controlled IV/PO meications. Diet was advanced as \ntolerated. The patient was transitioned to oral pain medication \nwhen tolerating PO diet. Physical therapy was consulted for \nmobilization OOB to ambulate. This patient has contact \ndermatitis blisters located near her incision site. Most likely \nfrom her incisional dressing tape. The blisters do not appear \ninfected. They are intact and filled with clear fluid and no \nerrythema surrounding blisters. She will call if the blisters \nburst and show signs of infection. Hospital course was otherwise \nunremarkable. On the day of discharge the patient was afebrile \nwith stable vital signs, comfortable on oral pain control and \ntolerating a regular diet.', 'medications_prescribed': ['HydrALAzine 100 mg PO DAILY', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain \nPlease do not operate heavy machinery,drink alcohol or drive \nRX *hydromorphone [Dilaudid] 2 mg ___ tablet(s) by mouth every \nfour (4) hours Disp #*85 Tablet Refills:*0', 'Labetalol 200 mg PO BID', 'Gabapentin 300 mg PO TID', 'Diazepam 5 mg PO Q6H:PRN spasms', 'Acetaminophen 1000 mg PO Q6H:PRN pain', 'Cyclobenzaprine 10 mg PO TID:PRN spasms', 'Docusate Sodium 100 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Weakness', 'medical_history': ['Gallstone pancreatitis status post cholecystectomy ___', 'Seizures in the setting of the above gallstone pancreatitis', 'Hypertension due to renal artery stenosis, difficult to control', 'Prior history of upper GI bleed from a likely AVM', 'Prior history of DVT no longer on anticoagulation'], 'family_history': '___ and found to be not relevant to this\nillness/reason for hospitalization. She specifically denies any\nfamily history of seizures or strokes.', 'present_illness': 'Ms. ___ is a ___ female with past medical\nhistory notable for hypertension, prior small intestinal bleed\n(sounds like distal upper AVM), recent hospitalization for\nseizures in the setting of gallstone pancreatitis status post\ncholecystectomy who was discharged on ___ who presents to\nthe hospital with several days of weakness. She reports that\ninitially following discharge she was feeling well. She reports\nthat after several days at home she started to feel increasingly\nfatigued. She reports that she felt similar to when she was\nbleeding in ___ and required the upper GI which found a\nlikely AVM. She reports the records from that hospitalization \nor\nat ___ in ___. She reports that at that \ntime\nher bowel movements were normal. She reports that on the \nevening\nprior to admission she developed diarrhea with black stools. \nShe\nreports that this is the exact same happened last time she had\nthe upper GI bleed. She reports that she continue to feel\nfurther fatigue. She touch base with her primary care doctor \nwho\nreferred her into the emergency department for further\nevaluation. She also reports that while at home she had a\ndecreased appetite. Per her daughter she started to look\nincreasingly pale. She became lightheaded and dizzy in the\nshower on several occasions. She also reports that she had\nurinary symptoms from around the time she got home. She reports\nthat over the last 6 days she has had increased lower abdominal\npain, burning on urination, pressure. She reports that she \nfeels\nlike it got so bad she decreased her p.o. intake to reduce the\namount that she would have to urinate. She also reports that \nshe\nhad some blood in the urine.\n\nIn the emergency department she was seen and evaluated. Her\ninitial vital signs were unremarkable. She was afebrile with a\nheart rate of 81, blood pressure 157/94, respiratory rate of 18. \n\nHer H&H was notable for 11.3/35.3 which is up from her discharge\nhemoglobin and hematocrit of 8.7/26.8. She had a UA that was\nchecked which unfortunately contained 9 epithelial cells. It \ndid\nhave positive nitrates, large leukocyte esterase, greater than\n184 white blood cells as well as few bacteria. She received 1 g\nof IV ceftriaxone, 2 L of normal saline, and was admitted to the\nmedical service for further evaluation and management. She was\nalso evaluated by the surgery service while in the emergency\ndepartment he felt like if she had anything was likely a slow GI\nbleed and would not require acute surgical intervention and \nwould\nrecommend admission to medicine for a GI workup.\n\nROS: Pertinent positives and negatives as noted in the HPI. All\nother systems were reviewed and are negative.', 'medications': [{'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxybutynin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '43.0', 'valuenum': 43.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.01, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': 'CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '362', 'valuenum': 362.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.4', 'valuenum': 69.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70.5', 'valuenum': 70.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '360', 'valuenum': 360.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '335', 'valuenum': 335.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '318', 'valuenum': 318.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\n--------------\nVITALS: 98.4 PO 147 / 72 60 18 100 RA \nGENERAL: Alert and in no apparent distress, laying in bed\nEYES: Anicteric, pupils equally round\nENT: Ears and nose without visible erythema, masses, or trauma. \nOropharynx without visible lesion, erythema or exudate\nCV: Heart regular, no murmur. No JVD.\nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, tender to palpation over the\nsuprapubic region. Laparoscopic cholecystectomy incisions\nhealing well. Bowel sounds present. No HSM. No CVA tenderness\nGU: No suprapubic fullness but significant tenderness to\npalpation\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent, moves all limbs, sensation to light touch grossly\nintact throughout\nPSYCH: pleasant, appropriate affect\n\nDISCHARGE EXAM\n--------------\nVS: Reviewed\nGENERAL: Alert and in no apparent distress, laying in bed\nEYES: Anicteric, pupils equally round\nCV: Heart regular, no murmur. \nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, tender to palpation over the\nsuprapubic region. Laparoscopic cholecystectomy incisions\nhealing well. Bowel sounds present. \nGU: No suprapubic fullness but significant tenderness to\npalpation\nPSYCH: pleasant, appropriate affect ', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '49320', 'desc': 'Chronic obstructive asthma, unspecified'}, {'icd_code': '78492', 'desc': 'Jaw pain'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '25200', 'desc': 'Hyperparathyroidism, unspecified'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'V4364'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V1255', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'V5863', 'desc': 'Long-term (current) use of antiplatelet/antithrombotic'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': 'ADMISSION LABS\n--------------\n___ 03:46PM BLOOD WBC-10.6*# RBC-3.78*# Hgb-11.5# Hct-35.3# \nMCV-93 MCH-30.4 MCHC-32.6 RDW-14.0 RDWSD-47.6* Plt ___\n___ 03:46PM BLOOD Neuts-71.9* Lymphs-17.5* Monos-6.9 \nEos-2.6 Baso-0.7 Im ___ AbsNeut-7.65* AbsLymp-1.86 \nAbsMono-0.73 AbsEos-0.28 AbsBaso-0.07\n___ 02:22PM BLOOD Glucose-108* UreaN-12 Creat-1.0 Na-145 \nK-4.8 Cl-104 HCO3-24 AnGap-17\n___ 02:22PM BLOOD ALT-18 AST-17 AlkPhos-121* TotBili-0.5\n\nMICROBIOLOGY\n------------\n___ 4:55 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT \nWITH SKIN\n AND/OR GENITAL CONTAMINATION. \n ESCHERICHIA COLI. >100,000 CFU/mL. PRESUMPTIVE \nIDENTIFICATION. \n PREDOMINATING ORGANISM. INTERPRET RESULTS WITH \nCAUTION. \n Cefazolin interpretative criteria are based on a dosage \nregimen of\n 2g every 8h. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ <=2 S\nAMPICILLIN/SULBACTAM-- <=2 S\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\nDISCHARGE LABS\n--------------\n___ 08:10AM BLOOD WBC-5.6 RBC-2.92* Hgb-8.9* Hct-27.2* \nMCV-93 MCH-30.5 MCHC-32.7 RDW-13.3 RDWSD-45.4 Plt ___\n___ 08:10AM BLOOD Glucose-101* UreaN-11 Creat-1.0 Na-142 \nK-4.6 Cl-101 HCO3-30 AnGap-11\n___ 07:10AM BLOOD ALT-16 AST-17 AlkPhos-91 TotBili-0.4\n___ 07:45AM BLOOD Calcium-9.7 Phos-3.8 Mg-1.7\n___ 03:46PM BLOOD calTIBC-411 Ferritn-___-___\n___ 02:35PM BLOOD Lactate-1.8\n\nKUB: \nIMPRESSION: \nNormal bowel gas pattern.\n___ female with past medical history notable for \nhypertension, prior small intestinal bleed (sounds like distal \nupper AVM), recent hospitalization for seizures in the setting \nof gallstone pancreatitis status post cholecystectomy who was \ndischarged on ___ who presents to the hospital with \nseveral days of weakness. \n\n# Possible upper GI bleed\n# Gastritis: Patient reported several episodes of black stools, \nbut none during admission. Hemoglobin downtrended over the \ncourse of admission. Awaiting records from ___ \nin ___. GI following patient, but did not plan on \nEGD/colonoscopy. H. pylori antigen was sent. She was placed on \nPO pantoprazole, as well as home famotidine and simethicone, \ngiven complaints of indigestion, as well as antiemetics.\n\n# Urinary tract infection: Patient reported approximately five \ndays of urinary tract symptoms with pain on urination, burning \non urination, and suprapubic fullness. Pan-sensitive E.coli on \nurine specimen, placed on ceftriaxone and switched to \nciprofloxacin for 7-day course. She was also placed on three \nday course of pyridium.\n\n# Weakness: suspect related to UTI and possible slow GI bleed, \nsee above. ___ consulted. She progressed and was able to be \ndischarged home. \n\n#Constipation\nPatient noted to constipated likely ___ to opioids and decreased \nmobility. KUB without obstruction. She received bowel regimen. \nShe had a bowel movement prior to discharge.\n\n# HTN due to\n# RAS: Patient has renal artery stenosis as documented on her \nprior admission. She has difficult to control blood pressures. \nShe was stabilized on a regimen during her prior \nhospitalization. Continued home antihypertensive regimen of \namlodipine, labetalol, lisinopril.\n\n# Seizure Disorder: Patient had generalized tonic-clonic seizure \nduring her prior hospitalization in the setting of her gallstone \npancreatitis. She was seen by neurology during her prior \nhospitalization and is now on antiseizure medication with \noutpatient follow-up. She was continued on her home Keppra.\n\n# GERD: continued on home famotidine and added PO pantoprazole.\n\nI updated her son and daughter with the plan of care.'}}
{'final_diagnoses': ['Urinary tract infection', 'Gastritis/peptic ulcer'], 'procedures': ['None'], 'visit_summary': '___ female with past medical history notable for \nhypertension, prior small intestinal bleed (sounds like distal \nupper AVM), recent hospitalization for seizures in the setting \nof gallstone pancreatitis status post cholecystectomy who was \ndischarged on ___ who presents to the hospital with \nseveral days of weakness. \n\n# Possible upper GI bleed\n# Gastritis: Patient reported several episodes of black stools, \nbut none during admission. Hemoglobin downtrended over the \ncourse of admission. Awaiting records from ___ \nin ___. GI following patient, but did not plan on \nEGD/colonoscopy. H. pylori antigen was sent. She was placed on \nPO pantoprazole, as well as home famotidine and simethicone, \ngiven complaints of indigestion, as well as antiemetics.\n\n# Urinary tract infection: Patient reported approximately five \ndays of urinary tract symptoms with pain on urination, burning \non urination, and suprapubic fullness. Pan-sensitive E.coli on \nurine specimen, placed on ceftriaxone and switched to \nciprofloxacin for 7-day course. She was also placed on three \nday course of pyridium.\n\n# Weakness: suspect related to UTI and possible slow GI bleed, \nsee above. ___ consulted. She progressed and was able to be \ndischarged home. \n\n#Constipation\nPatient noted to constipated likely ___ to opioids and decreased \nmobility. KUB without obstruction. She received bowel regimen. \nShe had a bowel movement prior to discharge.\n\n# HTN due to\n# RAS: Patient has renal artery stenosis as documented on her \nprior admission. She has difficult to control blood pressures. \nShe was stabilized on a regimen during her prior \nhospitalization. Continued home antihypertensive regimen of \namlodipine, labetalol, lisinopril.\n\n# Seizure Disorder: Patient had generalized tonic-clonic seizure \nduring her prior hospitalization in the setting of her gallstone \npancreatitis. She was seen by neurology during her prior \nhospitalization and is now on antiseizure medication with \noutpatient follow-up. She was continued on her home Keppra.\n\n# GERD: continued on home famotidine and added PO pantoprazole.\n\nI updated her son and daughter with the plan of care.', 'medications_prescribed': ['Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice \na day Disp #*30 Capsule Refills:*0 ', 'Ondansetron 4 mg PO Q8H \nRX *ondansetron 4 mg 1 tablet(s) by mouth every eight (8) hours \nDisp #*30 Tablet Refills:*0 ', 'OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - Severe \n\nRX *oxycodone 5 mg 1 capsule(s) by mouth every eight (8) hours \nDisp #*6 Capsule Refills:*0 ', 'Pantoprazole 40 mg PO Q12H \nRX *pantoprazole 40 mg 1 tablet(s) by mouth twice a day Disp \n#*60 Tablet Refills:*0 ', 'Polyethylene Glycol 17 g PO DAILY \nRX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by \nmouth once a day Disp #*30 Packet Refills:*0 ', 'Acetaminophen 650 mg PO Q6H:PRN Pain - Mild ', 'amLODIPine 10 mg PO DAILY hypertension ', 'Aspirin 81 mg PO DAILY ', 'Atorvastatin 40 mg PO QPM ', 'Famotidine 20 mg PO BID ', 'Labetalol 400 mg PO BID Hypertension ', 'LevETIRAcetam 1500 mg PO Q12H ', 'Lisinopril 40 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'morbid obesity', 'medical_history': ['Borderline type 2 diabetes', 'back pain'], 'family_history': 'Family History: Brother status post ___ gastric bypass \nand wife supportive and is a ___.', 'present_illness': '___ male complaining of obesity for ___ years. He has a \nhistory of multiple supervised diets with a maximum weight loss \nof 27 pounds with weight regain.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.76', 'valuenum': 3.76, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.8', 'valuenum': 47.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '99.2 78 148/94 18 96 RA\n\nGen: NAD\nCV: RRR, no m/r/g, clear s1, s2\nPulm: CTAB\nGI: abdomen obese, soft, appropriately tender to palpation, \nincisions well-healed, no erythema or discharge, drain removed\nExtrem: no peripheral edema, feet wwp', 'diagnoses': [{'icd_code': 'D150', 'desc': 'Benign neoplasm of thymus'}, {'icd_code': 'E559', 'desc': 'Vitamin D deficiency, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'Z6833', 'desc': 'Body mass index [BMI] 33.0-33.9, adult'}], 'summary': "___ 06:55PM HCT-41.2\n\nUGI ___ IMPRESSION: No evidence of leak. Contrast material is \nnot seen beyond the gastrojejunostomy site, which may be due to \nedema, a normal post-surgical finding. Followup radiograph may \nbe obtained to document passage of the contrast material.\nMr. ___ went to the operating room on ___ for \nuncomplicated laparoscopic roux en y gastric bypass. Please see \noperative note for details. Post-operatively Mr. ___ \nremained in the PACU overnight for monitoring given intermittent \ndesaturations into the 80's. His repsiratory and hemodynamic \nstatus was stable overnight and he did not require CPAP. He was \nthen transferred to the floor where he remained comfortable but \nwas persistently tachycardic (sinus) to the 115's and \nhypertensive. He was given IVF and CXR was obtained which \nshowed LLL atelectasis but was otherwise unremarkable. EKG was \nalso not concerning for ischemia or arrhythmia. Given concern \nfor possible leak he underwent UGI series on ___ which failed \nto reveal evidence of a leak though the contrast did not pass \nthe GJ anastomosis. Hypertension and tachycardia persisted and \nhe was started on lopressor twice daily. His NGT was removed and \nhe tolerated a stage I diet which was carefully titrated up to \nstage III. The JP remained serosanguinous throughout the \nhospitalization and was removed prior to discharge. On discharge \nthe patient was comfortable, tolerating a stage III diet which \nhe was instructed to continue until follow-up. An email was sent \nto the patient's PCP regarding blood pressure management. He \nwill continue lopressor 25mg PO BID for now until he follows up \nwith his primary care doctor. The patient was also discharged on \nstandard bariatric post-operative medications including zantac, \nactigall, colace, roxicet and multivitamins."}}
{'final_diagnoses': ['morbid obesity', 'sinus tachycardia', 'obstructive sleep apnea'], 'procedures': ['laparoscopic ___ gastric bypass'], 'visit_summary': "Mr. ___ went to the operating room on ___ for \nuncomplicated laparoscopic roux en y gastric bypass. Please see \noperative note for details. Post-operatively Mr. ___ \nremained in the PACU overnight for monitoring given intermittent \ndesaturations into the 80's. His repsiratory and hemodynamic \nstatus was stable overnight and he did not require CPAP. He was \nthen transferred to the floor where he remained comfortable but \nwas persistently tachycardic (sinus) to the 115's and \nhypertensive. He was given IVF and CXR was obtained which \nshowed LLL atelectasis but was otherwise unremarkable. EKG was \nalso not concerning for ischemia or arrhythmia. Given concern \nfor possible leak he underwent UGI series on ___ which failed \nto reveal evidence of a leak though the contrast did not pass \nthe GJ anastomosis. Hypertension and tachycardia persisted and \nhe was started on lopressor twice daily. His NGT was removed and \nhe tolerated a stage I diet which was carefully titrated up to \nstage III. The JP remained serosanguinous throughout the \nhospitalization and was removed prior to discharge. On discharge \nthe patient was comfortable, tolerating a stage III diet which \nhe was instructed to continue until follow-up. An email was sent \nto the patient's PCP regarding blood pressure management. He \nwill continue lopressor 25mg PO BID for now until he follows up \nwith his primary care doctor. The patient was also discharged on \nstandard bariatric post-operative medications including zantac, \nactigall, colace, roxicet and multivitamins.", 'medications_prescribed': ['Actigall 300 mg Capsule Sig: One (1) Capsule PO twice a day \nfor 6 months.\nDisp:*360 Capsule(s)* Refills:*0*', 'Zantac 15 mg/mL Syrup Sig: Ten (10) mL PO twice a day for 1 \nmonths.\nDisp:*600 mL* Refills:*0*', 'oxycodone-acetaminophen ___ mg/5 mL Solution Sig: ___ MLs \nPO Q4H (every 4 hours) as needed for pain for 10 days.\nDisp:*500 ML(s)* Refills:*1*', 'metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*2*', 'Colace 60 mg/15 mL Syrup Sig: Twenty (20) mL PO every twelve \n(12) hours for 10 days.\nDisp:*500 mL* Refills:*1*', 'Multi-Vitamin W/Minerals Capsule Sig: One (1) Capsule PO \nonce a day: chewable vitamins.\nDisp:*30 Capsule(s)* Refills:*2*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 33, 'gender': 'M', 'symptoms': 'CC: ___', 'medical_history': ['depression'], 'family_history': 'Paternal GM with urinary CA. Maternal GF with melanoma. No FHx \nof GI or pancreatic malignancies.', 'present_illness': "Pt is a ___ y/o F who initially developed mid back pain \napproximately 1.5 weeks ago. Saw her PCP, who ___ naprosyn and \ncyclobenzaprine. 1 week after starting these medications, pt's \nmother noted that she looked jaundiced. Pt presented to urgent \ncare yesterday and was then referred to ER after labs were \nnotable for cholestasis.\n\nShe initially presented to ___, where CT scan showed \nmass in the pancreas. She was referred here for ERCP.", 'medications': [{'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '2.82', 'valuenum': 2.82, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.9', 'valuenum': 43.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '64.1', 'valuenum': 64.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.87', 'valuenum': 4.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.48', 'valuenum': 1.48, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.00', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98.9', 'valuenum': 98.9, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.1, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS - 99.2 158/95 77 16 99%RA\nGEN - Alert, NAD\nHEENT - NC/AT, scleral icterus\nNECK - Supple, no cervical or supraclavicular LAD noted\nCV - RRR, no m/r/g\nRESP - CTA B\nABD - S/NT/ND, BS present\nBACK - no spinal tenderness\nEXT - No ___ edema or calf tenderness\nSKIN - Jaundice, some excoriations across chest\nNEURO - Non-focal\nPSYCH - Calm, appropriate', 'diagnoses': [{'icd_code': 'M7022', 'desc': 'Olecranon bursitis, left elbow'}], 'summary': '___ 06:30PM BLOOD WBC-5.5 RBC-4.47 Hgb-13.4 Hct-43.2 MCV-97 \nMCH-30.0 MCHC-31.0 RDW-17.0* Plt ___\n___ 06:30PM BLOOD Neuts-68 Bands-0 ___ Monos-2 Eos-2 \nBaso-0 Atyps-1* ___ Myelos-0 Other-1*\n___ 06:30PM BLOOD Hypochr-1+ Anisocy-OCCASIONAL \nPoiklo-NORMAL Macrocy-OCCASIONAL Microcy-NORMAL Polychr-NORMAL\n___ 06:44PM BLOOD ___ PTT-35.7 ___\n___ 06:30PM BLOOD Plt Smr-NORMAL Plt ___\n___ 06:30PM BLOOD Glucose-112* UreaN-9 Creat-0.6 Na-136 \nK-3.4 Cl-105 HCO3-22 AnGap-12\n___ 06:30PM BLOOD ALT-637* AST-331* AlkPhos-181* \nTotBili-9.6*\n___ 06:30PM BLOOD Lipase-18\n___ 06:30PM BLOOD Albumin-4.1\n___ 06:40PM BLOOD Lactate-1.___\nSSESSMENT & PLAN: ___ y/o F with PMHx of depression, referred \nhere with biliary obstruction and concern for pancreatic mass on \nCT scan.\n\n# Bile Duct Obstruction: Given reported CT findings at BI-N, \nthis is highly concern for obstruction ___ pancreatic mass. Labs \nconsistent with cholestasis; however, pt felt well otherwise. No \nfevers. ERCP with stenting performed:\n\nThe ___ film was normal. \nNormal major papilla. \nThe bile duct was deeply cannulated with the sphincterotome. \nContrast was injected and there was brisk flow through the \nducts. Contrast extended to the entire biliary tree. \nThere was a 2cm stricture in the mid-CBD with mild \npost-obstructive dilation. \nThe CBD was 12mm in diameter proximally. \nNo other filling defects identified. \nOpacification of the gallbladder was incomplete. \nA biliary sphincterotomy was made with a sphincterotome. \nThere was no post-sphincterotomy bleeding. \nCytology samples were obtained for histology using a brush in \nthe middle third of the common bile duct and lower third of the \ncommon bile duct. \nTo facilitate decompression, a 9cm by ___ Cotton ___ biliary \nstent was placed successfully. \nExcellent bile and contrast drainage was seen endoscopically and \nfluoroscopically \nOverall successful biliary decompression in the setting of \npossible malignant obstruction.\n\nAnd the following was recommended: \n\nRepeat ERCP in 6 weeks for stent pull and consideration of metal \nstent insertion.\nWill consider EUS if further pathology needed.\nConsult ___ surgery\nReturn to ward under ongoing care.\nNPO overnight with aggressive IV hydration with LR at 200 cc/hr\nFollow for response and complications. If any abdominal pain, \nfever, jaundice, gastrointestinal bleeding please call ERCP \nfellow on call ___\nIf no abdominal pain in the morning, advance diet to clear \nliquids and then advance as tolerated\nNo aspirin, Plavix, NSAIDS, Coumadin for 5 days.\nContinue with antibiotics - Ciprofloxacin 500mg BID x 5 days.\nFollow up with cytology reports. Please call Dr. ___ \n___ ___ in 7 days for the pathology results.\n\nA CTA was performed and revealed:\n\n1. Partially necrotic pancreatic head/neck mass with associated \npancreatic \nductal dilatation. \n2. Abnormal appearing peripancreatic lymph nodes measuring up to \n1.5 cm. In \naddition there is an abnormal appearing lymph node along the \nmesenteric root \njust beyond the takeoff of the right colic vessels measuring 1 \ncm, and 12 mm \nGDA lymph node is noted. \n3. Tumor abutment of the portal splenic confluence, and SMV \ninvolvement over a \n180 degree circumference, with encasement/narrowing of the GDA. \n4. Interval placement of CBD stent, with resolution of \nintrahepatic biliary \ndilatation. \n5. Right adrenal lesion low in attenuation on non-contrast \nimaging, likely \nrepresenting a benign adrenal adenoma. \n\nPt. was evaluated by surgery, and outpatient follow up is \nplanned. Subsequent to ercp she did well, and her diet was \nadvanced without difficulty and her labs improved. On the day \nof discharge she was tolerating a regular diet and had no \ncomplaints. \n\n# Depression\n- zoloft 200 mg daiy (confirmed) but had not taken in weeks - \nwill hold until follow up with primary MD for repeat LFT check.'}}
{'final_diagnoses': ['Pancreatic mass', 'Bile duct obstruction'], 'procedures': ['ERCP'], 'visit_summary': 'SSESSMENT & PLAN: ___ y/o F with PMHx of depression, referred \nhere with biliary obstruction and concern for pancreatic mass on \nCT scan.\n\n# Bile Duct Obstruction: Given reported CT findings at BI-N, \nthis is highly concern for obstruction ___ pancreatic mass. Labs \nconsistent with cholestasis; however, pt felt well otherwise. No \nfevers. ERCP with stenting performed:\n\nThe ___ film was normal. \nNormal major papilla. \nThe bile duct was deeply cannulated with the sphincterotome. \nContrast was injected and there was brisk flow through the \nducts. Contrast extended to the entire biliary tree. \nThere was a 2cm stricture in the mid-CBD with mild \npost-obstructive dilation. \nThe CBD was 12mm in diameter proximally. \nNo other filling defects identified. \nOpacification of the gallbladder was incomplete. \nA biliary sphincterotomy was made with a sphincterotome. \nThere was no post-sphincterotomy bleeding. \nCytology samples were obtained for histology using a brush in \nthe middle third of the common bile duct and lower third of the \ncommon bile duct. \nTo facilitate decompression, a 9cm by ___ Cotton ___ biliary \nstent was placed successfully. \nExcellent bile and contrast drainage was seen endoscopically and \nfluoroscopically \nOverall successful biliary decompression in the setting of \npossible malignant obstruction.\n\nAnd the following was recommended: \n\nRepeat ERCP in 6 weeks for stent pull and consideration of metal \nstent insertion.\nWill consider EUS if further pathology needed.\nConsult ___ surgery\nReturn to ward under ongoing care.\nNPO overnight with aggressive IV hydration with LR at 200 cc/hr\nFollow for response and complications. If any abdominal pain, \nfever, jaundice, gastrointestinal bleeding please call ERCP \nfellow on call ___\nIf no abdominal pain in the morning, advance diet to clear \nliquids and then advance as tolerated\nNo aspirin, Plavix, NSAIDS, Coumadin for 5 days.\nContinue with antibiotics - Ciprofloxacin 500mg BID x 5 days.\nFollow up with cytology reports. Please call Dr. ___ \n___ ___ in 7 days for the pathology results.\n\nA CTA was performed and revealed:\n\n1. Partially necrotic pancreatic head/neck mass with associated \npancreatic \nductal dilatation. \n2. Abnormal appearing peripancreatic lymph nodes measuring up to \n1.5 cm. In \naddition there is an abnormal appearing lymph node along the \nmesenteric root \njust beyond the takeoff of the right colic vessels measuring 1 \ncm, and 12 mm \nGDA lymph node is noted. \n3. Tumor abutment of the portal splenic confluence, and SMV \ninvolvement over a \n180 degree circumference, with encasement/narrowing of the GDA. \n4. Interval placement of CBD stent, with resolution of \nintrahepatic biliary \ndilatation. \n5. Right adrenal lesion low in attenuation on non-contrast \nimaging, likely \nrepresenting a benign adrenal adenoma. \n\nPt. was evaluated by surgery, and outpatient follow up is \nplanned. Subsequent to ercp she did well, and her diet was \nadvanced without difficulty and her labs improved. On the day \nof discharge she was tolerating a regular diet and had no \ncomplaints. \n\n# Depression\n- zoloft 200 mg daiy (confirmed) but had not taken in weeks - \nwill hold until follow up with primary MD for repeat LFT check.', 'medications_prescribed': ['Ciprofloxacin HCl 500 mg PO Q12H Duration: 2 Days \nRX *ciprofloxacin 500 mg 1 tablet(s) by mouth twice a day Disp \n#*7 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'osteomyelitis and cellulitis of the left lower extremity', 'medical_history': ['Coronary artery disease, recent NSTEMI ___ managed medically', 'Recent transurethral resection of a 3cm bladder tumor \n(___)', 'Recurrent cellulitis', 'Foot ulcers (17 wounds, 2 probe to bone - followed by Dr \n___', 'Atrial fibrillation (s/p DCCV ___, not currently on \nanticoagulation because of thrombocytopenia - only on ASA 325mg)', 'AAA s/p EVAR ___', 'PAD s/p L fem-AT bypass (___), R profunda-BK pop bypass \n(___), L pop and L AT angioplasties (___)', 'Hypertension', 'Hyperlipidemia', 'Rheumatoid arthritis (on chronic steroids)', 'Prostate cancer s/p XRT in ___ now in complete remission, \ncomplicated by radiation cystitis', 'Lumbar spinal stenosis', 'DJD with L2 vertebral compression fracture s/p L1/L2 \ndiscectomy and laminectomy with kyphoplasty in ___', 'Hx of ocular migraines (none for years)', 'neuropathy', 'rosacea', 'Cholelithiasis', 'Chronic Thrombocytopenia due to possible myelodysplastic sx vs \nITP'], 'family_history': 'Mother passed away at age ___ of lung cancer.\nFather died at ___ of lung cancer.\nUncle died of bladder CA\nOne sister is ___ - with bladder CA, former smoker,\nOne daughter ___ and one son ___; healthy.\nHe denies any neurological conditions running in his family. No \nfamily history of recurrent skin infections, premature CAD, SCD, \nrecurrent blood clots or strokes.', 'present_illness': 'Mr ___ is a ___ year old man with a history of CAD, A-fib not \non anticoagulation secondary to chronic thrombocytopenia, AAA \ns/p EVAR \n(___), HTN, HLD, RA on chronic steroids, prostate cancer s/p \nXRT with chronic foley, multilevel lumbar stenosis and \ncompression fractures s/p L1-2 discectomy and L2 kyphoplasty, \nrecurrent cellulitis of left lower extremity, recurrent C.Diff \nand peripheral arterial disease, status post left fem-AT bypass \n(___), right profunda-BK pop bypass (___), left \npopliteal and AT angioplasties (___) who presents to our ED at \nthe referral of his home care NP with lower extremity cellulitis \nwith left toe ulcers. These ulcers have been followed by Dr. \n___ podiatry. \n\nHe has had multiple recent admissions since ___ including for \nCellulitis of the left leg in setting of neuropathic and \narterial lower extremity ulcers and chronic osteomyelitis of the \nleft ___ toe, NSTEMI, hematuria ___ radiation cystitis c/b \nurosepsis, c diff, bilateral ___ numbness and weakness \n(self-limited), and again for diarrhea from C diff with \ngabapentin contribution. \n\nPatient has Chronic indwelling foley and Ambulates with cane at \nbaseline\n\nIn the ED, initial vitals: 100.4 94 101/63 99% RA \n- Labs were notable for WBC 8.3, Hgb 8.2, plt 84, lactate 1.5. \n- Imaging showed Unchanged mild cardiomegaly and central \npulmonary vascular congestion on CXR\n- IV vanc 1g and 500mg flagyl, 1L NS bolus, morphine were given\n- Exam showed: Left foot diffusely tender. 1cm area of purulent \ndischarge on medial aspect of foot at first tarsal head.\n\nOn arrival to the MICU, patient is sleepy but arousable. He is \nnot oriented to situation. On ROS, he denies f/c, N/V, SOB, \ndizziness, chest pain, abd pain, constipation/diarrhea, or leg \npain. He is not aware of any problems with his feet.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glycerin Supps', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = 67 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': '>1.050*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90.1', 'valuenum': 90.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '236', 'valuenum': 236.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSON PHYSICAL EXAM: \n=======================\nVitals: AF 73 113/67 23 97%RA\nGENERAL: Sleeping but arousable, NAD, pale\nHEENT: Sclera anicteric, EOMI, oropharynx clear, edentulous \nNECK: supple \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Irregular rate + murmur \nABD: soft, diffusely tender, non-distende, no rebound tenderness \nor guarding, no organomegaly \nEXT: Bandages on L & R feet. Poor pulses. Eschar on toe. \nSKIN: Erythematous patch on LLE (marked) that is warm and \ntender. \nNEURO: Oriented to "hospital" and month but not year or \nsituation. Moving all extremities with purpose. \nGU: Foley in place. Dirty. \nACCESS: R IJ\n\nDSCHARGE PHYSICAL EXAM: \n=======================\n98.4po, 97.9po, 63, 142/72, 18, 95% RA.\nGENERAL: Mr. ___ is a well developed, well nourished male in \nno acute distress.\nHEENT: Head is atraumatic, normocephalic. Sclera anicteric\nNECK: Supple. No JVD.\nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Irregular rate. Extremities warm with brisk capillary \nrefill.\nABD: soft, no tenderness, non-distende, no guarding, no \norganomegaly \nLOWER EXTREMITIES: Bilateral lower extremities are warm. Gross \ndeformity of left hallux. Dry ulceration to right first \nmetatarsal head, third and fourth toes. Kissing ulcers of third \nand fourth toes are dry. The fourth toe is cyanotic. There is \nno surrounding erythema. No drainage or foul odor. There is no \ncellulitis of the left lower extremity. There is no tenderness. \n There is a dry ulcer of the right fifth metatarsal head. There \nis a dry scab of the head of the right hallux. Pedal pulses \ncannot be appreciated.\nNEURO: Oriented to "hospital" vaguely to situation and month \nbut not year. Moving all extremities. Following one step \ncommands. \nGU: Foley in place. Draining sufficient amounts of clear yellow \nurine.', 'diagnoses': [{'icd_code': '5589', 'desc': 'Other and unspecified noninfectious gastroenteritis and colitis'}], 'summary': '___ 06:30PM BLOOD WBC-8.3 RBC-3.01* Hgb-8.2* Hct-27.2* \nMCV-90 MCH-27.2 MCHC-30.1* RDW-18.7* RDWSD-61.8* Plt Ct-84*\n___ 06:30PM BLOOD Neuts-86.4* Lymphs-3.7* Monos-7.3 \nEos-0.7* Baso-0.2 Im ___ AbsNeut-7.16* AbsLymp-0.31* \nAbsMono-0.61 AbsEos-0.06 AbsBaso-0.02\n___ 06:30PM BLOOD ___ PTT-27.8 ___\n___ 06:30PM BLOOD Glucose-93 UreaN-16 Creat-0.9 Na-135 \nK-4.3 Cl-98 HCO3-26 AnGap-15\n___ 06:30PM BLOOD Lactate-1.5\n___ 02:47AM BLOOD Lactate-0.7\n\nNOTABLE LABS:\n=============\n___: Digoxin: 0.7\n___: CRP: 64.9\n___: ESR: 46\n\nDISCHARGE LABS:\n===============\n\nMICROBIOLOGY: \n===============\n___ STOOL C. difficile - NEGATIVE\n___ MRSA SCREEN MRSA SCREEN - NEGATIVE\n___ Inpatient UCx - Final: MBF/fecal contamination\n___ BCx - NGTD\n___ ED UCx - Final: MBF/fecal contamination \n___ BCx - NGTD\n\nIMAGING: \n===============\n-___ CXR PA and LAT (PRELIM)\nFINDINGS:\nStable mild cardiomegaly and central pulmonary vascular \ncongestion. No\nevidence for focal consolidation, pleural effusion, or \npneumothorax.\n \nIMPRESSION: Unchanged mild cardiomegaly and central pulmonary \nvascular congestion.\n\n-___ portable CXR central line placement \nFINDINGS: Portable semi-upright radiograph of the chest \ndemonstrates the interval\nplacement of a right internal jugular venous catheter. The tip \nterminates in\nthe region of the upper SVC. The remainder of the examination \nis stable.\n \nIMPRESSION: Right internal jugular venous catheter with tip \nterminating in the region of\nthe upper SVC.\n \n-___: X-ray of feet:\nOn the left, there is concern for osteomyelitis of the first\ndigit. Evaluation of the second and third digits is limited. \nMRI can be considered for further evaluation.\n\n___ Duplex: \nOn the right side, the common femoral Doppler waveform is \ntriphasic. The \npopliteal is biphasic. Tibial waveforms are monophasic. The \nankle vessels \nare noncompressible. \n \n \nOn the left side, the femoral waveform is triphasic. Popliteal \nwaveform is \nbiphasic. The tibial waveforms are monophasic. The \nankle-brachial index is \n0.68. \n \n \nPulse volume recordings are pulsatile at the left thigh and calf \nbut \ndimished at the ankle and monophasic at the metatarsal level. \nOn the right, \nthere are diminished at the thigh calf and ankle levels and \nbarely phasic at \nthe metatarsal level. \n \nIMPRESSION: \n \nEvidence of bilateral femoral popliteal and tibial disease with \nmoderate to \nsevere ischemia at rest. \n\nANGIOGRAPHIC FINDINGS (___):\n1. Patent EVAR graft and patent left iliac limb.\n2. Stenotic outflow via the left external iliac artery.\n3. Patent left common femoral, profunda femoris.\n4. Patent left SFA to anterior tibial artery bypass graft\n with good outflow into the proximal AT.\n5. Occluded distal AT with filling of the foot via\n collaterals, which filled the posterior tibial artery.\n\n___ 07:00AM BLOOD WBC-6.0 RBC-2.81* Hgb-7.3* Hct-25.8* \nMCV-92 MCH-26.0 MCHC-28.3* RDW-18.1* RDWSD-61.0* Plt ___\n___ 06:30PM BLOOD Neuts-86.4* Lymphs-3.7* Monos-7.3 \nEos-0.7* Baso-0.2 Im ___ AbsNeut-7.16* AbsLymp-0.31* \nAbsMono-0.61 AbsEos-0.06 AbsBaso-0.02\n___ 07:00AM BLOOD Glucose-87 UreaN-13 Creat-0.8 Na-137 \nK-4.1 Cl-104 HCO3-29 AnGap-8\n___ 07:00AM BLOOD Calcium-7.9* Phos-3.8 Mg-1.9\nOn presentation to the ED, notable for temp 100.4 HR 94 with \nsoft BP 101/63. Labs were notable for WBC 8.3, Hgb 8.2, plt 84, \nlactate 1.5. Exam was notable for diffusely tender left foot \nwith 1 cm area of purulent discharge on medial aspect of foot at \nfirst tarsal head. Imaging showed unchanged mild cardiomegaly \nand central pulmonary vascular congestion on CXR. In the ED was \nstarted on vanc and flagyl for cellulitis and given IVF, \nadmitted to ___ due to soft blood pressures and concern for \nbacteremia. Vancomycin was continued and started on \nciprofloxacin. Podiatry was consulted with concern for \nosteomyelitis, recommended bilateral lower extremity xrays which \nwas suggested osteomyelitis of the left first digit, with \nlimited exam of the ___ and ___ digits. Podiatry deferred \nsurgical intervention due to concern for poor blood supply, and \nrecommended vascular surgery evaluation. Vascular surgery \nrecommended performing an angiogram for further evaluation. \nAngiogram was performed on ___ and demonstrated sufficient flow \nto the level of the ankle and severe ischemia below the level of \nthe ankle.\n\nDiscussed his case with ID, who recommended discontinuation of \nantibiotics pending bone biopsy with tissue culture and decision \nfor 1) amputation or 2) revascularization and treatment, while \nmaintaining a low threshold to resume empiric abx if he showed \nsigns of sepsis or evidence of worsening cellulitis. Vanc/cipro \ndiscontinued on ___. At this point, his care was transferred to \nvascular surgery. He was hemodynamically stable and was \ntransferred out of the ICU. After discussion with ID and a plan \nwas made for left transmetatarsal amputation, broad spectrum \nantibiotics were restarted.\n\n#History of recurrent cdiff/diarrhea: Pt has had recurrent C \ndiff infection (finished course of PO vanc ___ per one \ndocument. Per another document, ___. Gabapentin has \ncontributed to his diarrhea in the past. Restarted PO vancomycin \nin the setting of treating with broad spectrum antibiotics. C. \ndiff was sent and was negative. Diarrhea resolved.\n\nCHRONIC ISSUES:\n\n#Lumbar Radiculopathy in setting of L3 Compression Fracture: \nInitially held home oxycodone given concern for altered mental \nstatus thought to be from morphine in the ED. \n\n#CHRONIC URINARY RETENTION: Continued on home finasteride and \ntamsulosin. Foley was replaced on ___. Of note, his UA on \nadmission showed pyuria, 3+ leuks, +nitrites. UCx x2 grew MBF \nconsistent with fecal contamination. These urine studies were \nless concerning for acute UTI given presence of chronic \nindwelling foley catheter and similar past UA results. At this \ntime, patient was on broad spectrum antibiotics. Discharged on \nPO Bactrim.\n\n#Paroxysmal Atrial fibrillation: Not on anticoagulation due to \nthrombocytopenia and hx of bleeds requiring transfusion. \nContinued home metop, digoxin. \n\n#CAD: Continued on home aspirin, metoprolol, atorvastatin, and \nlisinopril.\n\n#PAD: H/o ___ PAD, AAA, chronic osteomyelitis of his left ___ \ntoe. Amputation had been recommended in the past, but he has \nbeen resistant. Wound care was consulted. \n\n#THROMBOCYTOPENIA: Per OMR, this has been attributed to ITP vs \nmyelodysplastic syndrome. Platelets were in the ___ on \nadmission, with nadir at 68, but rebounded to the ___ and were \nstable/improving at the time of transfer to vascular surgery.\n\n#RHEUMATOID ARTHRITIS: Continued home methylprednisone.\n\n#HYPERTENSION: continued home lisinopril and metoprolol. \n\n#Diastolic CHF: continued Lasix 80 mg PO daily until ___, when \nhe was found to have moderately severe asymptomatic orthostatic \nhypotension. On ___, he was given a bolus of 500 cc IVNS and \nlasix was held. His home dose of lasix was resumed at time of \ndischarge, when he appeared euvolemic. At time of DC, he was \nhemodynamically stable and without signs of cellulitis. There \nis no urgent need for amputation at this moment. Left \ntransmetatarsal amputation is discussed with his sister, ___, \nhis HCP. She is in agreement with this plan. The case is booked \nfor ___. He should remain on his PO Bactrim until procedure. \nHe will be readmitted on ___ for medical optimization/cardiac \nclearance and IV antibiotics prior to surgery.'}}
{'final_diagnoses': ['Peripheral arterial disease with critical ischemia of the left \nlower extremity', 'recurrent cellulitis or left lower extremity', 'osteomyelitis of left forefoot', 'diarrhea', 'delirium'], 'procedures': ['Left lower extremity angiogram on ___.'], 'visit_summary': 'On presentation to the ED, notable for temp 100.4 HR 94 with \nsoft BP 101/63. Labs were notable for WBC 8.3, Hgb 8.2, plt 84, \nlactate 1.5. Exam was notable for diffusely tender left foot \nwith 1 cm area of purulent discharge on medial aspect of foot at \nfirst tarsal head. Imaging showed unchanged mild cardiomegaly \nand central pulmonary vascular congestion on CXR. In the ED was \nstarted on vanc and flagyl for cellulitis and given IVF, \nadmitted to ___ due to soft blood pressures and concern for \nbacteremia. Vancomycin was continued and started on \nciprofloxacin. Podiatry was consulted with concern for \nosteomyelitis, recommended bilateral lower extremity xrays which \nwas suggested osteomyelitis of the left first digit, with \nlimited exam of the ___ and ___ digits. Podiatry deferred \nsurgical intervention due to concern for poor blood supply, and \nrecommended vascular surgery evaluation. Vascular surgery \nrecommended performing an angiogram for further evaluation. \nAngiogram was performed on ___ and demonstrated sufficient flow \nto the level of the ankle and severe ischemia below the level of \nthe ankle.\n\nDiscussed his case with ID, who recommended discontinuation of \nantibiotics pending bone biopsy with tissue culture and decision \nfor 1) amputation or 2) revascularization and treatment, while \nmaintaining a low threshold to resume empiric abx if he showed \nsigns of sepsis or evidence of worsening cellulitis. Vanc/cipro \ndiscontinued on ___. At this point, his care was transferred to \nvascular surgery. He was hemodynamically stable and was \ntransferred out of the ICU. After discussion with ID and a plan \nwas made for left transmetatarsal amputation, broad spectrum \nantibiotics were restarted.\n\n#History of recurrent cdiff/diarrhea: Pt has had recurrent C \ndiff infection (finished course of PO vanc ___ per one \ndocument. Per another document, ___. Gabapentin has \ncontributed to his diarrhea in the past. Restarted PO vancomycin \nin the setting of treating with broad spectrum antibiotics. C. \ndiff was sent and was negative. Diarrhea resolved.\n\nCHRONIC ISSUES:\n\n#Lumbar Radiculopathy in setting of L3 Compression Fracture: \nInitially held home oxycodone given concern for altered mental \nstatus thought to be from morphine in the ED. \n\n#CHRONIC URINARY RETENTION: Continued on home finasteride and \ntamsulosin. Foley was replaced on ___. Of note, his UA on \nadmission showed pyuria, 3+ leuks, +nitrites. UCx x2 grew MBF \nconsistent with fecal contamination. These urine studies were \nless concerning for acute UTI given presence of chronic \nindwelling foley catheter and similar past UA results. At this \ntime, patient was on broad spectrum antibiotics. Discharged on \nPO Bactrim.\n\n#Paroxysmal Atrial fibrillation: Not on anticoagulation due to \nthrombocytopenia and hx of bleeds requiring transfusion. \nContinued home metop, digoxin. \n\n#CAD: Continued on home aspirin, metoprolol, atorvastatin, and \nlisinopril.\n\n#PAD: H/o ___ PAD, AAA, chronic osteomyelitis of his left ___ \ntoe. Amputation had been recommended in the past, but he has \nbeen resistant. Wound care was consulted. \n\n#THROMBOCYTOPENIA: Per OMR, this has been attributed to ITP vs \nmyelodysplastic syndrome. Platelets were in the ___ on \nadmission, with nadir at 68, but rebounded to the ___ and were \nstable/improving at the time of transfer to vascular surgery.\n\n#RHEUMATOID ARTHRITIS: Continued home methylprednisone.\n\n#HYPERTENSION: continued home lisinopril and metoprolol. \n\n#Diastolic CHF: continued Lasix 80 mg PO daily until ___, when \nhe was found to have moderately severe asymptomatic orthostatic \nhypotension. On ___, he was given a bolus of 500 cc IVNS and \nlasix was held. His home dose of lasix was resumed at time of \ndischarge, when he appeared euvolemic. At time of DC, he was \nhemodynamically stable and without signs of cellulitis. There \nis no urgent need for amputation at this moment. Left \ntransmetatarsal amputation is discussed with his sister, ___, \nhis HCP. She is in agreement with this plan. The case is booked \nfor ___. He should remain on his PO Bactrim until procedure. \nHe will be readmitted on ___ for medical optimization/cardiac \nclearance and IV antibiotics prior to surgery.', 'medications_prescribed': ['Aspirin 325 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Calcium Carbonate 500 mg PO QID:PRN heart burn', 'Digoxin 0.125 mg PO DAILY', 'Finasteride 5 mg PO DAILY', 'Furosemide 80 mg PO DAILY', 'Lisinopril 2.5 mg PO DAILY', 'LOPERamide 2 mg PO QID:PRN diarrhea', 'Methylprednisolone 4 mg PO DAILY', 'Metoprolol Succinate XL 100 mg PO DAILY', 'Tamsulosin 0.4 mg PO QHS', 'Florastor (Saccharomyces boulardii) 250 mg oral BID', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Oxycodone-Acetaminophen (5mg-325mg) 1 TAB PO Q8H:PRN pain', 'Sulfameth/Trimethoprim DS 1 TAB PO BID\nRX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by \nmouth twice a day Disp #*14 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 43, 'gender': 'M', 'symptoms': 'Post-ERCP observation', 'medical_history': ['Atrial fibrillation', 'Acoustic neuroma on R w/ hearing loss', 'COPD', 's/p CCY', 's/p hysterectomy'], 'family_history': 'Pt comes from ___ family.', 'present_illness': 'HISTORY OF THE PRESENTING ILLNESS: ___ year old female with \nhistory of COPD, atrial fibrillation on Coumadin and dofetilide, \nwho was admitted from ___ for acute on chronic \nabdominal pain, who is admitted following \nERCP/stent/sphincterotomy/stone extraction on ___.\n\nDuring last hospitalization, patient was transferred with CT \nsigns concerning for choledocholithiasis. She was transferred to \n___ with MRCP showed dilated intra and extrahepatic bile ducts \nwithout definitive stone. An ERCP was performed which revealed a \nfilling defect in the mid CBD consistent with \ncholedocholithiasis. At that time, INR was 3.4 so \nsphincterotomty was not performed and a 10 ___ plastic stent \nwas placed. Post-procedure course was complicated by post-ERCP \npancreatitis which was managed with IV hydormorphone and IVF. \n\nShe presented on ___ for elective ERCP. Her Coumadin as \nstopped on ___. During procedure, the prior 10 ___ plastic \nstent was removed. A filling defect was noted in the mid CBD \nconsistent with a stone. A biliary spincterotomy was made with a \nspincterotome with mild post-sphincterotomy bleeding. A stone \nand stone fragments were removed. A final occlusion \ncholangiogram showed no evidence of filling defects in the CBD. \n\nPlan was to admit overnight for IV hydration at 150 cc/hour, \nadvancing diet in AM if no abdominal pain, resuming Coumadin in \n2 days. \n\nOn the floor, she denies any fevers, chills, night sweats, \nnausea, vomiting. Denies any abdominal pain.', 'medications': [{'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Colchicine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.25', 'valuenum': 4.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.1', 'valuenum': 87.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n=======================\nVital Signs: 98.0, 136/67, 71, 18, 91% on 2L. \nGeneral: Alert, oriented, no acute distress, resting comfortably \nin bed. \nHEENT: Sclerae anicteric, MMM, oropharynx clear, neck supple, no \nJVD. \nCV: Regular rate and rhythm, S1 and S2 present. \nLungs: Bibasilar crackles appreciated. \nAbdomen: soft, non-tender, non-distended, no rebound or \nguarding. no epigastric abdominal pain appreciated. \nExt: no lower extremity edema. \n\nDISCHARGE PHYSICAL EXAM\n=======================\nVital Signs: 98.5PO 137 / 71 82 18 94 RA \nGeneral: Alert, oriented, no acute distress, resting comfortably \nin bed. \nHEENT: Sclerae anicteric, MMM, oropharynx clear, neck supple, no \nJVD. \nCV: Regular rate and rhythm, S1 and S2 present. \nLungs: CTAB, no rales or wheezes \nAbdomen: Soft, non-tender, non-distended, no rebound or \nguarding. no epigastric abdominal pain appreciated. \nExt: No lower extremity edema.', 'diagnoses': [{'icd_code': 'I309', 'desc': 'Acute pericarditis, unspecified'}, {'icd_code': 'Q211', 'desc': 'Atrial septal defect'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'Z981', 'desc': 'Arthrodesis status'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}], 'summary': "ADMISSION LABS\n==============\n___ 11:39AM BLOOD WBC-6.5 RBC-4.60 Hgb-14.0 Hct-43.6 MCV-95 \nMCH-30.4 MCHC-32.1 RDW-13.5 RDWSD-47.4* Plt ___\n___ 11:39AM BLOOD ___ PTT-31.5 ___\n___ 11:39AM BLOOD Plt ___\n___ 11:39AM BLOOD UreaN-9 Creat-0.5 Na-140 K-4.1 Cl-96 \nHCO3-30 AnGap-18\n___ 11:39AM BLOOD ALT-17 AST-21 AlkPhos-107* Amylase-56 \nTotBili-0.5 DirBili-<0.2 IndBili-0.5\n\nMICRO\n=====\nNone\n\nIMAGING/PROCEDURES\n==================\n___ ERCP\nProcedures:A sphincterotomy was performed in the 12 o'clock \nposition using a sphincterotome over an existing guidewire.\n8ml of 1:10,000 epinephrine injection was applied for hemostasis \nsuccessfully. \n\nImpression:\nThe scout film revealed previous stent in place.\nAfter stent removal, the bile duct was deeply cannulated with \nthe Sphincterotome.\nContrast was injected and there was brisk flow through the \nducts. Contrast extended to the entire biliary tree.\nThe CBD and CHD were 12-13 mm in diameter.\nThere was a filling defect in the mid CBD consistent with a \nstone.\nA biliary sphincterotomy was made with a sphincterotome. There \nwas mild post-sphincterotomy bleeding.\nThe biliary tree was swept with a 9-12mm balloon starting at the \nbifurcation.\nA stone and stone fragments were removed. The CBD and CHD were \nswept repeatedly.\nThe final occlusion cholangiogram showed no evidence of filling \ndefects in the CBD.\n8ml of 1:10,000 epinephrine injection was applied for hemostasis \nsuccessfully\nExcellent bile and contrast drainage was seen endoscopically and \nfluoroscopically.\nOtherwise normal ercp to third part of the duodenum\n\n___ CHEST PA AND LAT\nIMPRESSION:\n1. Left peribronchial opacification lateral to left heart border \ncould\nrepresent bronchial inflammation or pneumonia. Recommend \nroutine oblique\nviews to clarify this finding. Background emphysema.\n2. Enlarged hilar pulmonary vasculature with normal cardiac \nsilhouette is\nlikely due to isolated pulmonary hypertension.\n\n___ CHEST XR OBLIQUE\nIMPRESSION: \nLeft basilar peribronchial inflammation. No evidence of \nconsolidation. If\nthere is clinical suspicion for pneumonia, follow-up radiograph \nin ___ hr\nrecommended.\n\nDISCHARGE LABS\n==============\n___ 11:10AM BLOOD WBC-5.8 RBC-3.76* Hgb-11.7 Hct-36.9 \nMCV-98 MCH-31.1 MCHC-31.7* RDW-13.7 RDWSD-49.8* Plt ___\n___ 11:10AM BLOOD Plt ___\n___ 11:10AM BLOOD Glucose-127* UreaN-14 Creat-0.4 Na-138 \nK-3.5 Cl-96 HCO3-31 AnGap-15\n___ 11:10AM BLOOD Calcium-8.9 Phos-3.3 Mg-1.8\nHOSPITAL COURSE\n===============\n___ year old female with history of COPD, atrial fibrillation on \nCoumadin and dofetilide, who was admitted from \n___ for acute on chronic abdominal pain, who \nis admitted following ERCP/stent/sphincterotomy/stone extraction \non ___. ERCP went well with no complications. However, \npatient was found to be hypoxic to high 70's saturation with \nambulation. Concern for worsening COPD vs. pulmonary \nhypertension vs. ILD, low suspicion for infectious cause. CXR \nnotable for left peribronchial inflammation, background \nemphysema and enlarged hilar pulmonary vasculature possibly due \nto pulmonary hypertension. Patient was started on \nFluticasone-Salmeterol Diskus and Tiotropium Bromide with \nimprovement in ambulatory sat to 84%. Prescribed home oxygen \nwith ___ services. Discharged stably with plan for outpatient \npulmonary workup. Recommend formal ___ to evaluate severity of \nCOPD. Recommend TTE and/or CT Chest to evaluate for pulmonary \nHTN or lung disease if ___ do not explain hypoxia. Patient \nagreed to further workup in the outpatient setting. Patient \ndeveloped RVR to 140's on ___ in setting of not having \ntaken metoprolol in several days. Patient stable and completely \nasymptomatic, re-started on metoprolol and discharged stably \nwith SBP in 110's and heart rate in 110's."}}
{'final_diagnoses': ['Choledocholeithiasis', 'Atrial fibrillation', 'Asthma / COPD', 'Hypoxia'], 'procedures': ['ERCP with sphincterotomy ___'], 'visit_summary': "HOSPITAL COURSE\n===============\n___ year old female with history of COPD, atrial fibrillation on \nCoumadin and dofetilide, who was admitted from \n___ for acute on chronic abdominal pain, who \nis admitted following ERCP/stent/sphincterotomy/stone extraction \non ___. ERCP went well with no complications. However, \npatient was found to be hypoxic to high 70's saturation with \nambulation. Concern for worsening COPD vs. pulmonary \nhypertension vs. ILD, low suspicion for infectious cause. CXR \nnotable for left peribronchial inflammation, background \nemphysema and enlarged hilar pulmonary vasculature possibly due \nto pulmonary hypertension. Patient was started on \nFluticasone-Salmeterol Diskus and Tiotropium Bromide with \nimprovement in ambulatory sat to 84%. Prescribed home oxygen \nwith ___ services. Discharged stably with plan for outpatient \npulmonary workup. Recommend formal ___ to evaluate severity of \nCOPD. Recommend TTE and/or CT Chest to evaluate for pulmonary \nHTN or lung disease if ___ do not explain hypoxia. Patient \nagreed to further workup in the outpatient setting. Patient \ndeveloped RVR to 140's on ___ in setting of not having \ntaken metoprolol in several days. Patient stable and completely \nasymptomatic, re-started on metoprolol and discharged stably \nwith SBP in 110's and heart rate in 110's.", 'medications_prescribed': ['Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath \nRX *albuterol sulfate [Ventolin HFA] 90 mcg 2 puffs orally every \nsix (6) hours Disp #*1 Inhaler Refills:*0 ', 'Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID \nRX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/dose 1 \ninhalation twice a day Disp #*1 Disk Refills:*0 ', 'Tiotropium Bromide 1 CAP IH DAILY \nRX *umeclidinium [Incruse Ellipta] 62.5 mcg/actuation 1 \ninhalation once a day Disp #*1 Disk Refills:*0 ', 'Diltiazem Extended-Release 240 mg PO DAILY ', 'dofetilide 500 mcg oral BID ', 'Metoprolol Succinate XL 50 mg PO DAILY \nRX *metoprolol succinate 50 mg 1 tablet(s) by mouth Daily Disp \n#*30 Tablet Refills:*3 ', 'Warfarin 5 mg PO 5X/WEEK (___) ', 'Warfarin 7.5 mg PO 2X/WEEK (___) ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': '"I\'ve had my ups and downs... it kinda just came over me I felt \nanxious and my mind was ruminating... I was throwing chairs and \nbreaking furniture."', 'medical_history': ['* PCP ___, ___ (___)', '* GERD', '* Obesity', '* Hyperlipidemia', '* Chronic headaches', '* H/o Amenorrhea likely result of haldol and thorazine\n per discharge summary from ___ ___', '* H/o dry eyes'], 'family_history': 'Family psychiatric history:\n* Mother with anxiety\n* ___ uncle committed suicide\n* First cousin committed suicide', 'present_illness': 'The patient is a ___ yo cauc. female with hx of Schizoaffective \ndo, Bipolar Type, Intermittent explosive do, Borderline \nPersonality do with cluster B and C traits sent from ___ DBT \npartial hospital program with increasingly disruptive and \naggressive behaviors over the last 24 hours.\n\nThe patient was discharged from the ___, \nintermediate care on ___ to a ___ group home in ___ \nand has had a difficult transition and has continued to have \nepisodes of extremely dysregulated behaviors. Today she was in \nthe DBT PHP and she abruptly w/o a clear precipitant, picked up \na chair and threw it and tried to punch a staff member who was \nable to protect herself with a clipboard. Her psychiatrist took \nher into her office and the patient threw a planter through a \nwindow.\n\nHer psychiatrist reports that the patient has had ___ weeks of \nout of control behavior with aggression towards herself {cutting \nand puncturing herself a fork} and throwing and breaking \nfurniture.\n\nThe patient reports that last night in her group home she tried \nto puncture herself with a fork. She said "I get anxious, I \nmissed my mother." \n\nThe patient visited her parents over the weekend and wanted to \nspent another day but was it was not feasible. She also had \nwanted to spend ___ with her parents but was told by \nher team and her parents they thought it would be "too \noverwhelming" for her.\n\nThe patient said she tries to use her DBT skils but said "I try \nbut they don\'t work."\n\nWhen the patient first arrived at triage by ambulance she \nattempted to leave the ED but security intervened and was \noffered and took Klonopin 1mg po.', 'medications': [{'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.64', 'valuenum': 3.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.4,. Estimated GFR = 35 if non African-American (mL/min/1.73 m2). Estimated GFR = 43 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T: 97.5 P: 100 BP: 121/82 RR: 16 SpO2: 100% (RA)\n height: 5\'6" weight: 217.4 lbs BMI: 35.1\nGeneral: Well-nourished, well-developed, in no apparent \ndistress. Appears stated age. Fair hygiene, dressed in hospital \ngown.\nHEENT: Normocephalic. PERRL, EOMI. Oropharynx clear. Mucous \nmembranes moist.\nNeck: Supple, trachea midline. No adenopathy or thyromegaly.\nBack: No significant deformity, no focal tenderness.\nLungs: Clear to auscultation; no crackles or wheezes.\nCV: Regular rate and rhythm; no murmurs/rubs/gallops; 2+ pedal \npulses.\nAbdomen: Soft, nontender, nondistended; no masses or \norganomegaly.\nExtremities: No clubbing, cyanosis, or edema.\nSkin: Acne on face, especially around mouth. Scars visible on \nbilateral arms, both transverse on forearm and longitudinal on \nwrists. Well-healing punctate scabs puncture wounds on L-dorsal \nforearm and hand with mild surrounding ecchymosis. Warm and dry, \nno rashes or bruising.\nNeurological:\n *Cranial Nerves-\n I: Not tested\n II: Pupils equally round and reactive to light \nbilaterally. Visual fields are full to confrontation.\n III, IV, VI: Extraocular movements intact bilaterally \nwithout nystagmus.\n V, VII: Facial strength and sensation intact and \nsymmetric.\n VIII: Hearing intact to voice.\n IX, X: Palatal elevation symmetrical.\n XI: Sternocleidomastoid and trapezius normal bilaterally.\n XII: Tongue midline without fasciculations.\n *Motor- Normal bulk and tone bilaterally. No abnormal\nmovements, tremors. Strength full ___ ___ throughout. No gross\nfocal motor or sensory deficits, normal gait.\n *Coordination- Normal on finger-nose-finger, rapid alternating\nmovements, heel to shin.\n *Deep tendon Reflexes- 2+ and symmetrical, toes downgoing\n *Sensation- intact to light touch, position sense intact\n *Gait- steady, no truncal ataxia, normal stance and posture\n *Romberg- negative\n\nNeuropsychiatric Examination:\n Appearance: no apparent distress, appears stated age, fair \nhygiene, appropriately dressed in hospital gown\n Behavior: calm, cooperative, engaged, friendly, pleasant, \nappropriate eye contact, orients to interviewer, no abnormal \nposturing, no psychomotor agitation or retardation\n Mood: "okay, I guess"\n Affect: euthymic, full range, normal intensity, appropriate to \nsituation, congruent with mood\n Thought Process: linear, coherent, goal-oriented towards \ngetting back to group home, no loose associations\n Thought Content: denies SI/HI/AH/VH, delusions and paranoia \nabsent\n Impulse Control: poor (brought in for throwing chairs and \nassaulting staff)\n Judgment: poor\n Insight: poor\n Speech: fluent, normal rate, tone, volume, and prosody, no \nparaphasic errors\n\nCognition:\n Memory: ___ registration, ___ recall at 5 min; remote intact\n Concentration: good (MOYB without error)\n Calculation: $2.25 = 9 quarters\n Abstraction: apple/orange = "fruit"\n Proverb: The apple doesn\'t fall far from the tree = "you\'re \nrelated"\n Fund of information: average\n Attention span: normal\n Language: normal\n Vocabulary: normal\n Intelligence: average', 'diagnoses': [{'icd_code': '7802', 'desc': 'Syncope and collapse'}, {'icd_code': '7840', 'desc': 'Headache'}, {'icd_code': '34830', 'desc': 'Encephalopathy, unspecified'}, {'icd_code': '78060', 'desc': 'Fever, unspecified'}, {'icd_code': 'E9479', 'desc': 'Unspecified drug or medicinal substance causing adverse effects in therapeutic use'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': 'V4561', 'desc': 'Cataract extraction status'}, {'icd_code': '4264', 'desc': 'Right bundle branch block'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': '___ 10:45AM GLUCOSE-84 UREA N-11 CREAT-0.8 SODIUM-141 \nPOTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-29 ANION GAP-12\n___ 10:45AM WBC-9.0 RBC-4.78 HGB-12.6 HCT-39.4 MCV-82 \nMCH-26.4* MCHC-32.1 RDW-14.4\n___ 10:45AM PLT COUNT-287\n___ 10:45AM NEUTS-64.8 ___ MONOS-5.9 EOS-6.8* \nBASOS-1.3\n___ 10:35AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n___ 10:35AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 10:45AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\nPSYCHIATRIC\n#) INTERMITTENT EXPLOSIVE DISORDER, CLUSTER B & C TRAITS\nUpon arrival to the unit, the pt was calm and cooperative at \nfirst. She met with the team and acknowledged her aggressive \nand dangerous behaviors at ___ and asked for prompt d/c to her \nDBT group home.\nOn the first evening of her admission, the patient threw a table \nat staff and required the seclusion room. \n\nShe was restarted on her home medications; however, her \nchloropromazine was changed from 75 mg at night to 75 mg each \nmorning and 175 mg each evening with 25 mg dose as needed for \nagitation with minimal increased ability to regulate emotional \ncontrol. Additionally, her home lorazepam 1 mg daily, was made \nas needed for anxiety, but she utilized this regularly. \n\nThe patient continued to have frequent episodes of verbal and \nphysical outbursts in the setting of anxiety and frustration, \ndescribing these episodes as being precipitated by "cloudy \nthoughts," which occurred approximately every other day, \nincluding throwing tables and chairs and occasionally making \nefforts to swing at staff members. She was typically able to \nreflect on these episodes after the fact, but demonstrated \nlittle control in identifying episodes as they began and \nutilizing coping skills to abort an episode. She was placed on a \nroom program to increase safety for the patient and others on \nthe unit, which she tolerated well despite near daily once a day \noutbursts.\n\nA transfer to an intermediate care facility through ___ was \narranged for the patient and she signed a section 3 to \nfacilitate expedited transfer. \n\n#) PSYCHOSIS\nThe pt presented to us with a dx of possible schizoaffective vs. \npsychosis nos. She did not have any hallucinations/ideas of \nreference on the unit. We continued her neuroleptic medication \nas she had apparently done fairly well on this in the past and \ntolerated it well. We did notice that she had ruminating \nthoughts of her family being in danger which triggered odd and \naggressive behaviors such as throwing things on the unit. \n\nGENERAL MEDICAL CONDITIONS\n1. GERD\nWe continued the patient\'s home Omeprazole 20 mg PO DAILY.\n\n2. Hyperlipidemia\nWe continued the patient\'s home Simvastatin 20 mg PO HS.\n\n3. Chronic headaches\nWe continued the patient\'s home Ibuprofen 400 mg PO Q8H:PRN and \nAcetaminophen 650 mg PO Q6H:PRN.\n\n4. Constipation\nWe continued the patient\'s home Milk of Magnesia, Docusate \nSodium, Polyethylene Glycol, and Senna.\n\n5. Nicotine dependence\nThe patient reported smoking 1 PPD. We offered her Nicotine \nLozenge 4 mg PO Q1H:PRN for nicotine withdrawal and encouraged \nthe pt to consider smoking cessation.\n\n6. Tachycardia\n- Q8hr vital signs\n- Continue to monitor\n\n7. Health maintenance\nWe continued the patient\'s home Calcium Carbonate 500 mg PO \nDAILY.\n\nPSYCHOSOCIAL\n#) COLLATERAL\nWe spoke with the patient\'s outpatient treatment team from the \n___ Mental ___ program who reported that she \nhad had multiple unprovoked outbursts at the ___ \n___ program she was attending at ___ \n___. On the day of transfer to ___ the patient threw \na chair at her treating physician, attempted to punch a staff \nmember, and threw a planter through a window. In addition to \naggressive and assaultive behavior towards others, Ms. ___ \ndemonstrated increasing ___ behavior in the days and \nweeks leading up to this admission; she engaged in self-cutting \nand stabbed herself in the hand and forearm with a fork.\n\n#) GROUPS/MILIEU\nThe patient spent her first night on the unit in a multi-person \nroom without incident. On hospital day #1 the patient threw over \na table, attempted to punch a mental health worker, and banged \nher head against a wall. She required medication to calm her \ndown, and had to be placed in the seclusion room with constant \nobservation by a security guard given her volatility. After \ntitrating her medications the pt was able to come off of \nsecurity CO and was placed on a day program but continued to \nsleep in the seclusion room and was kept out of groups.\n\nLEGAL STATUS\nThe patient was admitted on a CV and signed a 3-day notice on \n___, which was retracted on ___. The patient signed a \nSection 3 notice of transfer to an ___ facility on \n___. \n\nRISK ASSESSMENT\nMs. ___ has been aggressive and highly assaultive on our \nunit, and is considered acute risk to others.\n\nShe is at further risk for harm due to a number of static \nfactors, including a history of prior suicide attempt (Tylenol \noverdose), history of ___ behavior, family history of \nsuicide, chronic and severe mental illness, and a history of \nimpulsive/aggressive tendencies. She is also at chronic risk of \ndanger towards others given her young age, history of \nimpulsivity, history of loss of control, history of prior \nviolent acts, young age at first offense, low education level, \nand major mental illness. Ms. ___ also has a number of \nmodifiable risk factors for self-harm including hopelessness, \nlimited social support, lack of coping skills, and financial \nstressors.\n\nWe recommend mitigating her risks by providing continued \ninpatient hospitalization, psychiatric medication, \npsychoeducation, and individual, group, and milieu therapy.\n\nThe patient also has some protective factors against self-harm \nwhich include the presence of current outpatient providers and \ntreatment, willingness to accept treatment and utilize groups, \nand strong connections to a supportive family. \n\nPROGNOSIS\nDue to the patient\'s young age, history of drug use, chronic \npersonality problems, lengthy ___ \nadmissions, and failure to thrive in the community, in addition \nto polypharmacy with little change in dangerous behavior, Ms. \n___ has an overall poor prognosis. '}}
{'final_diagnoses': ['AXIS I', 'Intermittent explosive disorder;', 'H/o polysubstance abuse;', 'Reported h/o Schizoaffective disorder, bipolar type', 'AXIS II', 'Cluster B & C traits', 'AXIS III', 'GERD, obesity, hyperlipidemia', 'AXIS IV', 'Chronic mental illness, limited finances, lack of social \nsupports'], 'procedures': ['None.'], 'visit_summary': 'PSYCHIATRIC\n#) INTERMITTENT EXPLOSIVE DISORDER, CLUSTER B & C TRAITS\nUpon arrival to the unit, the pt was calm and cooperative at \nfirst. She met with the team and acknowledged her aggressive \nand dangerous behaviors at ___ and asked for prompt d/c to her \nDBT group home.\nOn the first evening of her admission, the patient threw a table \nat staff and required the seclusion room. \n\nShe was restarted on her home medications; however, her \nchloropromazine was changed from 75 mg at night to 75 mg each \nmorning and 175 mg each evening with 25 mg dose as needed for \nagitation with minimal increased ability to regulate emotional \ncontrol. Additionally, her home lorazepam 1 mg daily, was made \nas needed for anxiety, but she utilized this regularly. \n\nThe patient continued to have frequent episodes of verbal and \nphysical outbursts in the setting of anxiety and frustration, \ndescribing these episodes as being precipitated by "cloudy \nthoughts," which occurred approximately every other day, \nincluding throwing tables and chairs and occasionally making \nefforts to swing at staff members. She was typically able to \nreflect on these episodes after the fact, but demonstrated \nlittle control in identifying episodes as they began and \nutilizing coping skills to abort an episode. She was placed on a \nroom program to increase safety for the patient and others on \nthe unit, which she tolerated well despite near daily once a day \noutbursts.\n\nA transfer to an intermediate care facility through ___ was \narranged for the patient and she signed a section 3 to \nfacilitate expedited transfer. \n\n#) PSYCHOSIS\nThe pt presented to us with a dx of possible schizoaffective vs. \npsychosis nos. She did not have any hallucinations/ideas of \nreference on the unit. We continued her neuroleptic medication \nas she had apparently done fairly well on this in the past and \ntolerated it well. We did notice that she had ruminating \nthoughts of her family being in danger which triggered odd and \naggressive behaviors such as throwing things on the unit. \n\nGENERAL MEDICAL CONDITIONS\n1. GERD\nWe continued the patient\'s home Omeprazole 20 mg PO DAILY.\n\n2. Hyperlipidemia\nWe continued the patient\'s home Simvastatin 20 mg PO HS.\n\n3. Chronic headaches\nWe continued the patient\'s home Ibuprofen 400 mg PO Q8H:PRN and \nAcetaminophen 650 mg PO Q6H:PRN.\n\n4. Constipation\nWe continued the patient\'s home Milk of Magnesia, Docusate \nSodium, Polyethylene Glycol, and Senna.\n\n5. Nicotine dependence\nThe patient reported smoking 1 PPD. We offered her Nicotine \nLozenge 4 mg PO Q1H:PRN for nicotine withdrawal and encouraged \nthe pt to consider smoking cessation.\n\n6. Tachycardia\n- Q8hr vital signs\n- Continue to monitor\n\n7. Health maintenance\nWe continued the patient\'s home Calcium Carbonate 500 mg PO \nDAILY.\n\nPSYCHOSOCIAL\n#) COLLATERAL\nWe spoke with the patient\'s outpatient treatment team from the \n___ Mental ___ program who reported that she \nhad had multiple unprovoked outbursts at the ___ \n___ program she was attending at ___ \n___. On the day of transfer to ___ the patient threw \na chair at her treating physician, attempted to punch a staff \nmember, and threw a planter through a window. In addition to \naggressive and assaultive behavior towards others, Ms. ___ \ndemonstrated increasing ___ behavior in the days and \nweeks leading up to this admission; she engaged in self-cutting \nand stabbed herself in the hand and forearm with a fork.\n\n#) GROUPS/MILIEU\nThe patient spent her first night on the unit in a multi-person \nroom without incident. On hospital day #1 the patient threw over \na table, attempted to punch a mental health worker, and banged \nher head against a wall. She required medication to calm her \ndown, and had to be placed in the seclusion room with constant \nobservation by a security guard given her volatility. After \ntitrating her medications the pt was able to come off of \nsecurity CO and was placed on a day program but continued to \nsleep in the seclusion room and was kept out of groups.\n\nLEGAL STATUS\nThe patient was admitted on a CV and signed a 3-day notice on \n___, which was retracted on ___. The patient signed a \nSection 3 notice of transfer to an ___ facility on \n___. \n\nRISK ASSESSMENT\nMs. ___ has been aggressive and highly assaultive on our \nunit, and is considered acute risk to others.\n\nShe is at further risk for harm due to a number of static \nfactors, including a history of prior suicide attempt (Tylenol \noverdose), history of ___ behavior, family history of \nsuicide, chronic and severe mental illness, and a history of \nimpulsive/aggressive tendencies. She is also at chronic risk of \ndanger towards others given her young age, history of \nimpulsivity, history of loss of control, history of prior \nviolent acts, young age at first offense, low education level, \nand major mental illness. Ms. ___ also has a number of \nmodifiable risk factors for self-harm including hopelessness, \nlimited social support, lack of coping skills, and financial \nstressors.\n\nWe recommend mitigating her risks by providing continued \ninpatient hospitalization, psychiatric medication, \npsychoeducation, and individual, group, and milieu therapy.\n\nThe patient also has some protective factors against self-harm \nwhich include the presence of current outpatient providers and \ntreatment, willingness to accept treatment and utilize groups, \nand strong connections to a supportive family. \n\nPROGNOSIS\nDue to the patient\'s young age, history of drug use, chronic \npersonality problems, lengthy ___ \nadmissions, and failure to thrive in the community, in addition \nto polypharmacy with little change in dangerous behavior, Ms. \n___ has an overall poor prognosis. ', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN pain', '2. Benztropine Mesylate 0.5 mg PO HS', '3. Calcium Carbonate 500 mg PO DAILY', '4. ClonazePAM 0.5 mg PO DAILY:PRN agitation', '5. Simvastatin 20 mg PO HS', '6. Senna 2 TAB PO HS', '7. ChlorproMAZINE 25 mg PO BID:PRN agitation', '8. ChlorproMAZINE 75 mg PO QAM', '9. ChlorproMAZINE 175 mg PO HS', '10. ClonazePAM 0.5 mg PO BID', '11. Clozapine 300 mg PO DAILY AT 17:00', '12. Docusate Sodium 100 mg PO BID', '13. Gabapentin 200 mg PO TID', '14. Ibuprofen 400 mg PO Q8H:PRN pain', '15. Lorazepam 1 mg PO DAILY:PRN anxiety', '16. lurasidone 80 mg oral HS', '17. Milk of Magnesia 30 mL PO BID:PRN constipation', '18. Nicotine Lozenge 4 mg PO Q1H:PRN nicotine withdrawal', '19. Omeprazole 20 mg PO DAILY', '20. Polyethylene Glycol 17 g PO DAILY', '21. Propranolol 10 mg PO HS']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'Diarrhea, weakness, ___ pain', 'medical_history': ['Bronchiectasis, followed by pulm - Dr. ___ in \n___,\ndiagnosed approx. ___, diagnosed after recurrent episodes of\npneumonia (pt reports 9 times in ___ years)'], 'family_history': "Mother died from breast cancer at age ___, no other medical\nproblems. Father had massive MI in ___, died of dementia at ___. \nShe has two sisters and a brother. ___ (sister) with\nfibromyalgia. ___ has arthritis of both knees, is obese. She\nhas two kids, ___ (___) and ___ (___), both in good health.\n___ has thyroid cysts, and takes thyroid medicine. A baby,\n___, died at age ___ months in ___ with polycystic kidney\ndisease. Pt's husband also has ___.", 'present_illness': '___ with hx of bronchiectasis presenting with diarrhea,\nprogressive weakness, weight loss, and bilateral ___ pain x6\nweeks.\n\nPt reports that just after ___, she developed diarrhea,\nwithout hematochezia, abdominal pain, nausea or vomiting. \nInitial\nevaluation was done at ___. She then presented \nto\n___ on ___ for further evaluation, where\nlabs and CT abd/pelvis were apparently unrevealing. Her symptoms\nhave since progressed, with BMs ___ per day, with associated\nrectal pain in setting of frequent wiping. She also described\noral ulcers, and painful red bumps over arms, back, abdomen, and\n___. Per ___, an outpatient colonoscopy revealed: "the \ncecum,\nascending colon, transverse colon, descending colon, sigmoid\ncolon all had patches of deep ulcerations with inflamed tissue \nat\nthe margins. There are also patches of erythema. The rectum had\nerythema and friability, but none of these deeper ulcerations.\nMultiple biopsies were taken from the cecum, ascending colon,\ntransverse colon, descending colon, sigmoid colon, and rectum.\nThis may be developing ulcerative or Crohn\'s colitis, or \npossibly\nthe remnants of a prior infectious colitis. We will need to\nfollow-up on pathology." (___. Her symptoms were apparently\nrefractory to oral steroids. \n\nShe recalls that the prep for colonoscopy was miserable. She has\nbeen using topical nitroglycerin for anal fissure, and topical\nlidocaine. \n\nThe only relief has come from probiotic, which has improved her\noral ulcers. She denies genital ulcers. The worst day was\n___, with progressive bilateral ___ discomfort. She spent \nmost\nof that day in bed. She pushed herself to return to work on\n___, was at work 8:30 am-1 pm, and then had to rest in bed.\nOn ___, her ___ weakness had progressed to the point that she\nagain had to call out of work. She ultimately felt that she\nneeded further evaluation, and presented to ___ ED. \n\nBefore bowel movements, she passes flatus. She endorses \nbilateral\nankle pain, although describes pain in "muscles and tendons from\nthe knee down, on both sides." She has not noticed any \nerythema.\nIn ___ she started going to Weight Watchers, and lost 20 lbs.\nSince ___, she has lost an additional 14 lbs \nunintentionally.\nDenies night sweats, cough. She does recall a recent episode of\nredness of her R eye, with some discharge. \n\nIn the ___ ED:\nVS 98.1, 76, 135/76, 99% RA\nExam notable for fatigued appearing, oral aphthous ulcers, \nhands,\nforearms, R bra line and extremities with multiple erythematous\ntender nodules\nLabs notable for WBC 9.7, Hb 11.8, plt 389, BUN 7, Cr 0.6, CK \n17,\nALT 105, AST 77, Alk phos 176, Tbili 0.3, albumin 3.4, lipase \n34,\nTSH 3.5, CRP 108.1\nUA negative\nVit D, RF, ___ pending\n\nReceived:\nIVF\n\nOn arrival to the floor, she endorses rectal and ___ pain, denies\nchest pain, SOB. \n\nROS: 10 point review of system reviewed and negative except as\notherwise described in HPI', 'medications': [{'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\n\nVS: 98.0 PO 122 / 73 91 18 97 Ra \nGEN: alert and interactive, appears uncomfortable with movement,\ntired, NAD\nHEENT: PERRL, anicteric, conjunctiva pink, oropharynx with\nscattered aphthous ulcers over buccal mucosa and lateral aspects\nof tongue, moist mucus membranes\nbilateral submandibular mobile nontender adenopathy\nCARDIOVASCULAR: Regular rate and rhythm without murmurs, rubs, \nor\ngallops\nLUNGS: clear to auscultation bilaterally without rhonchi,\nwheezes, or crackles\nGI: soft, nontender, without rebounding or guarding, \nnondistended\nwith normal active bowel sounds, no hepatomegaly\nEXTREMITIES: no clubbing, cyanosis, or edema. Skin tags and anal\nTTP.\nGU: no foley\nSKIN: ulcers and erythematous papules at various stages over\nextensor surfaces of UEs, perianal, and anterior thighs. No\nvulvar ulcers. \nNEURO: Strength is ___ in UE and ___\nPSYCH: normal mood and affect, appears tired\n\nDISCHARGE PHYSICAL EXAM:\n========================\n97.8 PO 133 / 62 L Lying 60 18 95 Ra \nGeneral: in NAD, sitting in room with clothes on\nHEENT: OP moist, no LAD, aphthous ulcer on right upper lip\nResp CTA B, no rales, wheezes\nCV RRR without murmurs\nGI soft, NT, ND, NABS\nMS: Decreasing edema in bilateral ankles\nNeuro: alert/oriented X3, moving all extremities.\nSkin: Multiple moles and some erythematous macules, resolving.', 'diagnoses': [{'icd_code': '1749', 'desc': 'Malignant neoplasm of breast (female), unspecified'}, {'icd_code': '73390', 'desc': 'Disorder of bone and cartilage, unspecified'}, {'icd_code': 'V8389', 'desc': 'Other genetic carrier status'}, {'icd_code': 'V103'}, {'icd_code': 'V1641', 'desc': 'Family history of malignant neoplasm of ovary'}, {'icd_code': 'V153'}, {'icd_code': 'V8741', 'desc': 'Personal history of antineoplastic chemotherapy'}], 'summary': "___ 06:40PM BLOOD WBC-9.7 RBC-4.15 Hgb-11.8 Hct-36.5 MCV-88 \nMCH-28.4 MCHC-32.3 RDW-13.7 RDWSD-44.0 Plt ___\n___ 06:40PM BLOOD Neuts-71.6* ___ Monos-6.8 Eos-1.1 \nBaso-0.3 Im ___ AbsNeut-6.94* AbsLymp-1.93 AbsMono-0.66 \nAbsEos-0.11 AbsBaso-0.03\n___ 06:40PM BLOOD Glucose-86 UreaN-7 Creat-0.6 Na-138 K-4.0 \nCl-102 HCO3-21* AnGap-15\n___ 06:40PM BLOOD ALT-105* AST-77* CK(CPK)-17* AlkPhos-176* \nTotBili-0.3\n___ 06:40PM BLOOD Lipase-34\n___ 06:40PM BLOOD Albumin-3.4* Calcium-9.1 Phos-3.1 Mg-2.0\n___ 06:40PM BLOOD TSH-3.5\n___ 06:40PM BLOOD 25VitD-39\n___ 06:40PM BLOOD RheuFac-<10 ___ Titer-1:40* \nCRP-108.1*\n\nPERTINENT LABS:\n===============\n\n___ 06:40PM BLOOD TSH-3.5\n___ 06:40PM BLOOD 25VitD-39\n___ 07:40AM BLOOD HBsAg-NEG HBsAb-NEG HBcAb-NEG HAV Ab-NEG\n___ 06:40PM BLOOD RheuFac-<10 ___ Titer-1:40* \nCRP-108.1*\n___ 08:00AM BLOOD CRP-150.8*\n___ 07:40AM BLOOD HIV Ab-NEG\n___ 07:40AM BLOOD HCV Ab-NEG\n___ 05:59PM URINE Color-Straw Appear-Clear Sp ___\n___ 05:59PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n\nPERTINENT IMAGING:\n==================\n\nOSH Colonoscopy (___):\nThe endoscope was passed with ease through the anus under direct\nvisualization; it was advanced to the terminal ileum. The scope\nwas withdrawn and the mucosa was carefully examined. The quality\nof the preparation was excellent. The views were excellent. \nThere\nwas evidence of moderately severe colitis throughout the colon.\nThe cecum, ascending colon, transverse colon, descending colon,\nsigmoid colon all had patches of deep ulcerations with inflamed\ntissue at the margins. There were also patches of erythema. The\nrectum had erythema and friability, but none of these deeper\nulcerations. Multiple biopsies were taken from the cecum,\nascending colon, transverse colon, descending colon, sigmoid\ncolon, and rectum. Otherwise, the colon appeared to be normal. \n\nOSH PATHOLOGY: \nA. Colon, cecum, cecum, ascending, biopsy: Active cryptitis and\ncrypt abscesses with surface erosion and increased chronic\ninflammatory cells. No dysplasia and no carcinoma seen.\nB. Colon, transverse biopsy:\nActive cryptitis and crypt abscesses with surface erosion and\nincreased chronic inflammation.\nC. Colon, Descending, Descending, Sigmoid, Biopsy:\nActive cryptitis and crypt abscesses with increased chronic\ninflammatory cells. \nD. Focal active colitis and surface hyperplastic change. No\ndysplasia and no carcinoma seen.\n\n___ ___ L\nIMPRESSION: \nNo evidence of deep venous thrombosis in the left lower \nextremity veins. \n\n___ MRE\nFindings likely reflective of descending colitis/proctitis. \nSmall bowel \nappears unremarkable. Constellation of findings may reflect an \ninfectious \ncolitis or inflammatory colitis. No perianal fistulas \nidentified. \n\n___ Right anterior thigh skin biopsy\nSections show dermal areas of necrobiosis with surrounding \nhistiocytes consistent with palisading granulomas and foci \nshowing interstitial histiocytes. There are separate areas \nshowing numerous neutrophils. The combination of findings are \nbest classified as a palisaded and neutrophilic granulomatous \ndermatitis (PNGD). Some authors include this diagnosis under the \nterm interstitial granulomatous dermatitis. This histopathologic \npattern may be associated with a number of underlying systemic \nprocesses including collagen vascular, infections, and tumors. \nWhile rheumatoid arthritis and lupus erythematosus are the more \ncommon associations; there are rare reports of PNGD associated \nwith Crohn's disease. Special stains ___, AFB, Gram, GMS, and \nPAS) are negative for organisms. There is minimal increased \nmucin with alcian blue stain.\n##Likely Crohn's disease \nPresenting with diarrhea, joint pain, and weight loss over the \npast 6 months most consistent with a new diagnosis of colonic \nCrohn's disease with extraintestinal manifestations. GI followed \nthroughout admission. Symptoms improved on IV steroids and CRP \ndowntrended. Transitioning to PO prednisone for discharge today. \nWill need to be initiated on anti-TNF as an outpatient for \nmaintenance therapy. Also treated with empiric cipro/flagyl \nduring admission. Quant gold pending.\n\n##Transaminitis\nLFTs have been persistently elevated during her hospitalization \nwith ALT/AST in the 100-200s and AP around 170s. Tbili normal. \nUnclear etiology, although given association of PSC with \ninflammatory bowel disease will plan for further imaging with \nMRCP as outpatient. Hepatitis serologies negative. Elevated \nprior to initiation of steroids. Possibly with underlying NAFLD. \nSent full workup of labs prior to discharge ___, IgG, \nAMA, IgM, ferritin, Fe, TIBC, Vit D), results pending.\n\n##LLE swelling \nLeft lower extremity ultrasound negative for DVT. Improved on \nsteroids.\n\n## Skin rash \nDermatology followed during admission, thought to be \nextraintestinal manifestation of Crohn's. Improved on oral \nsteroids. Skin biopsy showing palisaded and neutrophilic \ngranulomatous dermatitis. Outpatient dermatology follow up \nscheduled."}}
{'final_diagnoses': ["PRIMARY: \nCrohn's disease with extraintestinal manifestations", 'SECONDARY: \nBronchiolitis', 'Asthma'], 'procedures': ['None'], 'visit_summary': "##Likely Crohn's disease \nPresenting with diarrhea, joint pain, and weight loss over the \npast 6 months most consistent with a new diagnosis of colonic \nCrohn's disease with extraintestinal manifestations. GI followed \nthroughout admission. Symptoms improved on IV steroids and CRP \ndowntrended. Transitioning to PO prednisone for discharge today. \nWill need to be initiated on anti-TNF as an outpatient for \nmaintenance therapy. Also treated with empiric cipro/flagyl \nduring admission. Quant gold pending.\n\n##Transaminitis\nLFTs have been persistently elevated during her hospitalization \nwith ALT/AST in the 100-200s and AP around 170s. Tbili normal. \nUnclear etiology, although given association of PSC with \ninflammatory bowel disease will plan for further imaging with \nMRCP as outpatient. Hepatitis serologies negative. Elevated \nprior to initiation of steroids. Possibly with underlying NAFLD. \nSent full workup of labs prior to discharge ___, IgG, \nAMA, IgM, ferritin, Fe, TIBC, Vit D), results pending.\n\n##LLE swelling \nLeft lower extremity ultrasound negative for DVT. Improved on \nsteroids.\n\n## Skin rash \nDermatology followed during admission, thought to be \nextraintestinal manifestation of Crohn's. Improved on oral \nsteroids. Skin biopsy showing palisaded and neutrophilic \ngranulomatous dermatitis. Outpatient dermatology follow up \nscheduled.", 'medications_prescribed': ['PredniSONE 40 mg PO DAILY \n40 mg x1 week, 30 mg x1 week, 20 mg until GI appointment \nTapered dose - DOWN \nRX *prednisone 10 mg 4 tablet(s) by mouth daily Disp #*120 \nTablet Refills:*0', 'Ibuprofen 800 mg PO Q8H:PRN Pain - Moderate', 'Lidocaine Jelly 2% 1 Appl TP ASDIR', 'Montelukast 10 mg PO DAILY', 'Pirmella (norethin-e.estradiol \ntriphasic;<br>norethindrone-ethin estradiol) 0.5/0.75/1 mg- 35 \nmcg oral DAILY', 'ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation \nBID', 'Qvar (beclomethasone dipropionate) 80 mcg/actuation \ninhalation BID', 'Vesicare (solifenacin) 5 mg oral DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 62, 'gender': 'M', 'symptoms': 'hematuria', 'medical_history': ['CAD, pacemaker', 's/p aortic aneurysm wrap-around repair and 2-vessel CABG', 'aortic aneurysm', 'Aortic dissection', 'prostate cancer', 'stress incontinence s/p artifical urinary sphincter', 'bladder neck contractures s/p multiple dilations', 'depression', 'anxiety', 'Radiation cystitis', 'Arthritis', 'Hearing aids bilateraly', 'Macular degeneration'], 'family_history': 'noncontributory', 'present_illness': 'Mr. ___ is a pleasant ___ y/o male with complex urologic \nhistory of prostate cancer s/p radiation complicated by \nradiation cystitis, bladder neck contractures and stress \nincontinence now controlled with an artificial urinary \nsphincter. He is unable to empty his bladder fully and therefore \nself-catheterizes each time\nhe deactivates his sphincter. He has had issues with recurrent \ngross hematuria for quite some time. These episodes are often \nmanaged with an indwelling Foley catheter for a period of time.\n\nHe now presents with recurrent gross hematuria x ___ days, \nreportedly requiring hand-irrigation by the nurse at his \nassisted living facility. There does not seem to have been any \nspecific inciting event and he has no localizing symptoms; in \nparticular he denies fevers, chills, sweats, dysuria. He was \nseen in the ED\nat ___ where he was hand-irrigated to clear via a \nstraight catheter; he was then transferred to ___ for further \nevaluation. Here he is AFHDS. Labs are reassuring; Hct is within \nis recent normal range.', 'medications': [{'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutr', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 182.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.45', 'valuenum': 5.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.21', 'valuenum': 5.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'exam on admission:\n\n- AAOx4, NAD, older male resting comfortably in bed in NAD; \nnoticeably hard of hearing\n- EOMI, face symmetric\n- skin WWP\n- breathing unlabored on RA\n- abd soft, NT; large reducible ventral hernia; no CVAT\n- normal circumcised phallus with orthotopic meatus, testes \ndescended bilaterally, AUS pump palpable in left hemiscrotum', 'diagnoses': [{'icd_code': '5609', 'desc': 'Unspecified intestinal obstruction'}, {'icd_code': '5920', 'desc': 'Calculus of kidney'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V1271', 'desc': 'Personal history of peptic ulcer disease'}], 'summary': '___ 08:47PM BLOOD WBC-4.4 RBC-4.08* Hgb-11.8* Hct-37.1* \nMCV-91 MCH-28.9 MCHC-31.8* RDW-14.8 RDWSD-49.2* Plt ___\n___ 08:47PM BLOOD Neuts-61.5 ___ Monos-9.6 Eos-2.8 \nBaso-0.7 Im ___ AbsNeut-2.68 AbsLymp-1.10* AbsMono-0.42 \nAbsEos-0.12 AbsBaso-0.03\n\n___ 08:47PM BLOOD Glucose-122* UreaN-24* Creat-0.8 Na-138 \nK-3.5 Cl-100 HCO3-26 AnGap-16\n\n___ 07:00PM URINE Color-Red Appear-Cloudy Sp ___\n___ 07:00PM URINE Blood-LG Nitrite-POS Protein->300 \nGlucose-NEG Ketone-TR Bilirub-MOD Urobiln-1 pH-6.0 Leuks-SM\n___ 07:00PM URINE RBC->182* WBC-35* Bacteri-FEW Yeast-NONE \nEpi-0\n\n___ 7:00 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH.\nMr. ___ was admitted to the urology service from the ED with \na complaint of gross hematuria and clot retention. In the ED, \nhis AUS was deactivated and his bladder hand-irrigated to pale \npink via a straight cath catheter; a ___ Fr Foley was then placed \nacross the AUS. He was started empirically on ceftriaxone due to \na positive UA.\n\nHe was monitored on the urology service with periodic catheter \nflushes. Over the course of the next two days his urine \ngradually cleared without further intervention. He was \ntransitioned from IV ceftriaxone to PO TMP/SMX on HD 3. Urine \ncultures were finalized with no growth; given his positive UA on \nadmission antibiotics were to be continued for a total of 7 \ndays.\n\nThe decision was made to discharge the patient with the Foley in \nplace for an additional ~1 week in order to allow time for the \nurethra to heal. Given his age, frailty, and difficulty with \nFoley catheter self-care, he requested discharge to rehab and \nwas discharged to rehab in good condition on HD 4. At the time \nof discharge his urine was clear amber with no evidence of clot \nor active bleeding. He was instructed to follow up with Dr. ___ \nin clinic in roughly one week for catheter removal.'}}
{'final_diagnoses': ['hematuria'], 'procedures': ['none'], 'visit_summary': 'Mr. ___ was admitted to the urology service from the ED with \na complaint of gross hematuria and clot retention. In the ED, \nhis AUS was deactivated and his bladder hand-irrigated to pale \npink via a straight cath catheter; a ___ Fr Foley was then placed \nacross the AUS. He was started empirically on ceftriaxone due to \na positive UA.\n\nHe was monitored on the urology service with periodic catheter \nflushes. Over the course of the next two days his urine \ngradually cleared without further intervention. He was \ntransitioned from IV ceftriaxone to PO TMP/SMX on HD 3. Urine \ncultures were finalized with no growth; given his positive UA on \nadmission antibiotics were to be continued for a total of 7 \ndays.\n\nThe decision was made to discharge the patient with the Foley in \nplace for an additional ~1 week in order to allow time for the \nurethra to heal. Given his age, frailty, and difficulty with \nFoley catheter self-care, he requested discharge to rehab and \nwas discharged to rehab in good condition on HD 4. At the time \nof discharge his urine was clear amber with no evidence of clot \nor active bleeding. He was instructed to follow up with Dr. ___ \nin clinic in roughly one week for catheter removal.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN Pain - Mild', 'Bacitracin Ointment 1 Appl TP TID', 'Ciprofloxacin HCl 500 mg PO ONCE Duration: 1 Dose \nTake before your appointment for catheter removal \nRX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth once Disp #*1 \nTablet Refills:*0', 'Sulfameth/Trimethoprim DS 1 TAB PO BID urinary tract \ninfection \nRX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by \nmouth twice a day Disp #*8 Tablet Refills:*0', 'amLODIPine 2.5 mg PO DAILY', 'Atorvastatin 5 mg PO QPM', 'Docusate Sodium 100 mg PO BID', 'enzalutamide 160 mg oral DAILY', 'Metoprolol Succinate XL 12.5 mg PO QHS', 'Omeprazole 20 mg PO BID:PRN reflux, dyspepsia', 'Polyethylene Glycol 17 g PO DAILY', 'Senna 17.2 mg PO BID', 'TraZODone 25 mg PO QHS:PRN insomnia']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 49, 'gender': 'M', 'symptoms': 'Left intertrochanteric fracture', 'medical_history': ['denies'], 'family_history': 'non-contributory', 'present_illness': '___ with positive ETOH, cocaine who sustained a left \nintertrochanteric femur fracture after a fall. She is admitted \nfor TFN nailing of her femur.', 'medications': [{'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bacitracin/Polymyxin B Sulfate Opht. Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'RIGHT EYE', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': '5X/DAY', 'doses_per_24_hrs': 5.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vigamox', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'OS', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vigamox', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'OS', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonidine Patch 0.2 mg/24 hr', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Bacitracin/Polymyxin B Sulfate Opht. Oint', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'LEFT EYE', 'frequency': 'Q1H', 'doses_per_24_hrs': 24.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin 0.3% Ophth Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'LEFT EYE', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Bacitracin Ophthalmic Oint', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'BOTH EYES', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Haemophilus B Conj. Vaccine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin 0.3% Ophth Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'LEFT EYE', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'LEFT EYE', 'frequency': 'Q1H', 'doses_per_24_hrs': 24.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'MENINGOcoccal Conj Vaccine (Menactra)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vigamox', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'OS', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'RIGHT EYE', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Clonidine Patch 0.2 mg/24 hr', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', 'frequency': 'QTHUR', 'doses_per_24_hrs': 0.0}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'LEFT EYE', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'BOTH EYES', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bacitracin/Polymyxin B Sulfate Opht. Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'LEFT EYE', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Methylnaltrexone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SUBCUT', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.46', 'valuenum': 2.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '432', 'valuenum': 432.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '207', 'valuenum': 207.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 626.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 236.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '___', 'valuenum': 0.31, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '535', 'valuenum': 535.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '-10', 'valuenum': -10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.93, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 5.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.17, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20/5.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 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'flag': None, 'priority': None, 'comments': '___'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '>50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.024', 'valuenum': 1.024, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'ABNORMAL COLOR, CAUTION WHEN INTERPRETING DIPSTICK RESULTS.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '278', 'valuenum': 278.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.64', 'valuenum': 2.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '269', 'valuenum': 269.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21-50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.032', 'valuenum': 1.032, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'ABN COLOR MAY AFFECT DIPSTICK.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 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'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '318', 'valuenum': 318.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 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{'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '384', 'valuenum': 384.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '431', 'valuenum': 431.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.89', 'valuenum': 2.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '393', 'valuenum': 393.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.74', 'valuenum': 2.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MANY', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Amber', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'ABNORMAL COLOR, INTERPRET DIPSTICK RESULTS WITH CAUTION.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '472', 'valuenum': 472.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.92', 'valuenum': 2.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 63.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 50.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '509', 'valuenum': 509.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.96', 'valuenum': 2.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 64.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '510', 'valuenum': 510.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 54.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '464', 'valuenum': 464.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '231', 'valuenum': 231.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '7.33', 'valuenum': 7.33, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 55.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'TR', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.013', 'valuenum': 1.013, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Straw', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '462', 'valuenum': 462.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '375', 'valuenum': 375.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '362', 'valuenum': 362.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '209', 'valuenum': 209.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '371', 'valuenum': 371.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES ALT.'}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 196.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST..'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.9,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 87.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES P..'}, {'value': '___', 'valuenum': 9.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '___', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES P..'}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Upon admission\n\nAlert and oriented\nCardiac: Regular rate rhythm\nChest: Lungs clear bilaterally\nAbdomen: Soft non-tender non-distended\nExtremities: LLE + sensation/movement, + pulses', 'diagnoses': [{'icd_code': '80315', 'desc': 'Other closed skull fracture with cerebral laceration and contusion, with prolonged [more than 24 hours] loss of consciousness, without return to pre-existing conscious level'}, {'icd_code': '9584', 'desc': 'Traumatic shock'}, {'icd_code': '8604', 'desc': 'Traumatic pneumohemothorax without mention of open wound into thorax'}, {'icd_code': '86503', 'desc': 'Injury to spleen without mention of open wound into cavity, laceration extending into parenchyma'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '5185', 'desc': 'Pulmonary insufficiency following trauma and surgery'}, {'icd_code': '48283', 'desc': 'Pneumonia due to other gram-negative bacteria'}, {'icd_code': 'E882'}, {'icd_code': '9212', 'desc': 'Contusion of orbital tissues'}, {'icd_code': '86803', 'desc': 'Injury to other intra-abdominal organs without mention of open wound into cavity, peritoneum'}, {'icd_code': '86405', 'desc': 'Injury to liver without mention of open wound into cavity laceration, unspecified'}, {'icd_code': '86600', 'desc': 'Injury to kidney without mention of open wound into cavity, unspecified injury'}, {'icd_code': '86121', 'desc': 'Contusion of lung without mention of open wound into thorax'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '37739', 'desc': 'Other optic neuritis'}, {'icd_code': '81341', 'desc': "Closed Colles' fracture"}, {'icd_code': '80708', 'desc': 'Closed fracture of eight or more ribs'}, {'icd_code': '8245', 'desc': 'Bimalleolar fracture, open'}, {'icd_code': '07070', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': '8024', 'desc': 'Closed fracture of malar and maxillary bones'}, {'icd_code': '8028', 'desc': 'Closed fracture of other facial bones'}, {'icd_code': '81000', 'desc': 'Closed fracture of clavicle, unspecified part'}, {'icd_code': '81500', 'desc': 'Closed fracture of metacarpal bone(s), site unspecified'}, {'icd_code': '81601', 'desc': 'Closed fracture of middle or proximal phalanx or phalanges of hand'}, {'icd_code': '80224', 'desc': 'Closed fracture of mandible, ramus, unspecified'}, {'icd_code': '80221', 'desc': 'Closed fracture of mandible, condylar process'}, {'icd_code': '83402', 'desc': 'Closed dislocation of interphalangeal (joint), hand'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}], 'summary': '___ 06:30AM BLOOD WBC-7.5 RBC-3.01* Hgb-10.2* Hct-27.6*\nMCV-92 MCH-34.0* MCHC-37.1* RDW-12.4 Plt ___\n___ 05:55AM BLOOD WBC-10.1 RBC-3.51* Hgb-11.4* Hct-32.3*\nMCV-92 MCH-32.5* MCHC-35.3* RDW-12.8 Plt ___\n___ 06:39AM BLOOD WBC-8.1 RBC-4.17* Hgb-13.3 Hct-38.2\nMCV-91 MCH-31.9 MCHC-34.8 RDW-13.0 Plt ___\n___ 06:39AM BLOOD ___ PTT-26.2 ___\n___ 05:55AM BLOOD Glucose-135* UreaN-6 Creat-0.6 Na-137\nK-4.2 Cl-104 HCO3-23 AnGap-14\n___ 05:55AM BLOOD Calcium-8.0* Phos-2.7 Mg-1.6\n___ 06:39AM BLOOD ASA-NEG Ethanol-17* Acetmnp-NEG\nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\nMs. ___ presented to the ___ on ___ after a fall. She\nwas evaluated and found to have a left hip fracture. She was\nadmitted, consented, and prepped for surgery. She was taken to\nthe operating room and underwent an ORIF of her Left hip. She\ntolerated the procedure well, was extubated, transferred to the\nrecovery room, and then to the floor. On the floor she was\nevaluated by the physical therapy to improve her strength and\nmobility. The rest of her hospital stay was uneventful with her\nlab data and vital signs within normal limits and her pain\ncontrolled. She is being discharged today in stable condition.'}}
{'final_diagnoses': ['Left Hip Fracture'], 'procedures': ['___: ORIF Left Hip'], 'visit_summary': 'Ms. ___ presented to the ___ on ___ after a fall. She\nwas evaluated and found to have a left hip fracture. She was\nadmitted, consented, and prepped for surgery. She was taken to\nthe operating room and underwent an ORIF of her Left hip. She\ntolerated the procedure well, was extubated, transferred to the\nrecovery room, and then to the floor. On the floor she was\nevaluated by the physical therapy to improve her strength and\nmobility. The rest of her hospital stay was uneventful with her\nlab data and vital signs within normal limits and her pain\ncontrolled. She is being discharged today in stable condition.', 'medications_prescribed': ['1. Oxycodone 5 mg Tablet Sig: ___ Tablets PO Every ___ Hours as \nneeded for pain: ___ cause drowsiness or dizziness. Do not \noperate any motor vehicle or machinary. Do not drink alcohol.\nDisp:*90 Tablet(s)* Refills:*0*', '2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '3. Enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) 40 Subcutaneous \nQ 24H (Every 24 Hours) for 3 weeks.\nDisp:*21 40* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 62, 'gender': 'M', 'symptoms': 'left lower quadrant pain and nausea', 'medical_history': ['PMH: "cardiogenic" syncope ___, pt describes having a + tilt\ntest; anxiety / PTSD', 'PSH: ___ inguinal hernia (childhood), tonsillectomy (childhood),\nopen gastric bypass ___ c/b GI bleed, ex-lap + LOA ___ for SBO,\nex-lap + LOA + SBR ___ for SBO'], 'family_history': 'FH: cancers (unspecified)', 'present_illness': "___ F s/p open gastric bypass ___ at ___, and h/o SBO x2\nrequiring operation, was in ___ until ~3wk ago when developed\nLLQ pains. Described as intermittent and crescendo, sharp,\ndoubles her over. Associated with nausea and emesis. Has\nexacerbated her pre-existing cardiogenic syncope causing \nmultiple\nepisodes of syncope. Symptoms have worsened over the past ~1wk. \n\nPreviously experienced diarrhea but now has not stooled over \npast\nseveral days. Visited ___ ED ~5d ago, dx'd with PID and\nrx'd zithromax, but cultures negative and when returned to ___ for continued abdominal pain the Abx were discontinued. Abd\nCT there ___ showed oral contrast within gastric remnant,\nsuspicious for gastrogastric fistula. Due to ongoing symptoms\nthat they couldn't explain, as well as suspected gastrogastric\nfistula, transferred to ___ ED for further evaluation. Denies\nfevers but multiple episodes of sweats and chills.", 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '3X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H', 'doses_per_24_hrs': 8.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 220.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 205.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '181', 'valuenum': 181.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.89', 'valuenum': 2.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 234.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '97.1 / 97.1 73 143/90 16 99% on RA\nA&Ox3, NAD but fatigued-appearing, obese\nCTAB\nRRR\nsoft, ND. tender focally in LLQ with mild tenderness \nepigastrium,\n+ local tap tenderness, no rebound, + voluntary guarding to LLQ.\nno masses nor hernias palpated, upper midline incision\nwell-healed.\nWWP sans C/C/E', 'diagnoses': [{'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '5854', 'desc': 'Chronic kidney disease, Stage IV (severe)'}, {'icd_code': '3481', 'desc': 'Anoxic brain damage'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '78902', 'desc': 'Abdominal pain, left upper quadrant'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': 'E8782', 'desc': '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'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '45981', 'desc': 'Venous (peripheral) insufficiency, unspecified'}, {'icd_code': '56409', 'desc': 'Other constipation'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '71690', 'desc': 'Arthropathy, unspecified, site unspecified'}], 'summary': '___ 08:05PM WBC-5.3 RBC-4.28 HGB-13.0# HCT-39.5# MCV-92# \nMCH-30.5# MCHC-33.1 RDW-12.7\n___ 08:05PM NEUTS-65.5 ___ MONOS-4.8 EOS-2.8 \nBASOS-1.2\n___ 08:05PM PLT COUNT-347\n___ 08:05PM ___ PTT-26.2 ___\n___ 08:05PM GLUCOSE-89 UREA N-7 CREAT-0.7 SODIUM-140 \nPOTASSIUM-3.7 CHLORIDE-107 TOTAL CO2-26 ANION GAP-11\n___ 08:05PM ALT(SGPT)-16 AST(SGOT)-18 ALK PHOS-87 TOT \nBILI-0.4\n\n___ EGD : \nPrevious gastric bypass surgery of the stomach\nSmall gastric pouch with wide open anastomosis. No evidence of \nfistula or ulceration in the pouch or the anastomosis.\nNormal anastomosis and jejunum.\nOtherwise normal EGD to jejunum\n\n ___ Cardiac echo : No structural cardiac cause of syncope \nidentified. Preserved global and regional biventricular systolic \nfunction. No significant valvular abnormality seen. No resting \nor inducible outflow tract obstruction\nMs. ___ was admitted to the hospital, made NPO and hydrated \nwith IV fluids. Her Abd CT at ___ revealed \npossible contrast in the gastric remnant consistant with a \npossible gastrogastric fistula. This prompted an endoscopy by \nthe GI service to rule out fistula, stenoses and ulcers. Her \nendoscopy was on ___ and showed no abnormalities. She was \nsubsequently placed on a stage 3 diet and tolerated it well.\nDue to the fact that she had a long history of syncope and more \nepisodes recently she was seen by the Cardiology service. They \nrecommended a cardiac echo to rule out any structural \nabnormalities and they also recommended stopping her beta \nblocker as her heart rate was in the 55-60 range. Her echo was \nnormal with an EF of 65%.\nShe was also evaluated by the Psychiatry service due to her \nincreased anxiety, h/o PTSD/ and narcotic abuse. They did not \nfind any acute issues and she preferred to follow up with her \nown therapist.\nHer diet was increased to stage 5 and she was able to eat \nwithout any nausea or vomiting. Her abdominal pain was much \nless and she had no episodes of syncope.\nShe was discharged to home and will follow up with her doctors \non ___.'}}
{'final_diagnoses': ['left lower quadrant pain'], 'procedures': ['Esophagogastroduodenoscopy'], 'visit_summary': 'Ms. ___ was admitted to the hospital, made NPO and hydrated \nwith IV fluids. Her Abd CT at ___ revealed \npossible contrast in the gastric remnant consistant with a \npossible gastrogastric fistula. This prompted an endoscopy by \nthe GI service to rule out fistula, stenoses and ulcers. Her \nendoscopy was on ___ and showed no abnormalities. She was \nsubsequently placed on a stage 3 diet and tolerated it well.\nDue to the fact that she had a long history of syncope and more \nepisodes recently she was seen by the Cardiology service. They \nrecommended a cardiac echo to rule out any structural \nabnormalities and they also recommended stopping her beta \nblocker as her heart rate was in the 55-60 range. Her echo was \nnormal with an EF of 65%.\nShe was also evaluated by the Psychiatry service due to her \nincreased anxiety, h/o PTSD/ and narcotic abuse. They did not \nfind any acute issues and she preferred to follow up with her \nown therapist.\nHer diet was increased to stage 5 and she was able to eat \nwithout any nausea or vomiting. Her abdominal pain was much \nless and she had no episodes of syncope.\nShe was discharged to home and will follow up with her doctors \non ___.', 'medications_prescribed': ['1. Citalopram 20 mg Tablet Sig: 1.5 Tablets PO DAILY (Daily). ', '2. Gabapentin 300 mg Capsule Sig: One (1) Capsule PO Q8H (every \n8 hours).\nDisp:*45 Capsule(s)* Refills:*2*', '3. Ambien CR 12.5 mg Tablet, Multiphasic Release Sig: One (1) \nTablet, Multiphasic Release PO QHS (once a day (at bedtime)). ', '4. Protonix 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO twice a day.\nDisp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', '5. Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*20 Tablet(s)* Refills:*0*', '6. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day. ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'Headache, neutropenia', 'medical_history': ['- Atrial fibrillation on warfarin; has pacemaker', '- LUE DVT on coumadin', '- CVA ___ with residual left sided weakness ', '- CKD, stage 3 ', '- DM, not on insulin, A1c 5.9 (___) ', '- Hyperlipidemia ', '- Hypertension ', '- Peripheral neuropathy: tingling sensation ', '- Gastroesophageal reflux disease ', '- Genign prostatic hypertrophy ', '- Glaucoma status post left eye surgery ', '- Multilevel degenerative change in the spine with foraminal \nnarrowing at L3-L4, L4-L5, and L5-S1 per CT ___'], 'family_history': 'N/C', 'present_illness': '___ year old male with history of CVA with residual left-sided \nweakness (___), atrial fibrillation on coumadin s/p pacemaker, \nCKD (baseline Cr~1.6-1.8), HTN, HLD, and glaucoma, presenting \nwith new onset left sided headache. Patient reports that two \ndays ago he started noticing sharp stabbing headaches in left \nfrontal and temporal area. Pain did not cross midline. Pain was \nintermittent happening very ___ minutes with shapr sensation \nthat lasted seconds and improved quickly. Pain was associated \nwith tenderness to palpation over left temporal area. He denies \nany fevers, night sweats, neck stiffness, photophobia, \nphonobhobia, jaw claduication, URI symptoms. He denies any new \nweaknes, numbness, tingling. \n.\nOf note, he was recently admitted to ___ from ___ to \n___ after presenting to the ED with left upper extremity \npain and swelling. He continues to take warfarin for his atrial \nfibrillation, but he had stopped this on his own several months \nprior. During that admission, a LUE DVT was discovered and he \nwas re-initiated on anticoagulation (enoxaparin + warfarin). \n.\nIn the ED, initial VS were: 97.8 60 142/78 18 96% on RA. For his \nheadache, he was given metoclopramide and ketorolac. CT head \nshowed no acute intracranial abnormality and small left mastoid \nosseous lesion. Given his history of glucoma and some worsening \nleft vision, Ophtho consult was called and obtained an \nintraocular pressure of 16 with no evidence of acute angle \nclosur glaucoma.\n. \nLabs were notable for persistent, relative neutropenia of \nunclear etiology (___ 828). The ED team spoke with HCA attending \nwho recommended either admission vs. close outpatient follow-up \nfor further work-up. Patient was admitted for neuropenia. \n\nCurrently patient reports that his headaches have improved \nsignificnatly. Does not have any new complaints.', 'medications': [{'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Carbidopa-Levodopa (25-100)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Carbidopa-Levodopa (25-100)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Guaifenesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.22', 'valuenum': 4.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.08', 'valuenum': 4.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Physical Exam:\nVS - 97.6 135/71 60 100%RA \nGENERAL - well-appearing man in NAD, comfortable, appropriate \nHEENT - EOMI, sclerae anicteric, MMM, OP clear without any \nexudates, no rahses on scalp, temporal arteries show normal \npulsation without significnat tenderness, some tenderness around \nV1 distribution.\nNECK - supple, no thyromegaly, no cervical or supraclaviular \nlymphadenopathy. \nLUNGS - Unlabored breathing, clear to ausculation bilaterally \nHEART - Irregularly irregular, no murmurs \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - no rashes or lesions \nNEURO - awake, A&Ox3, CNs II-XII intact except for visual loss \non right eye. Muscle strength ___ on right side and ___ on left \nside, sensation grossly intact to light touch throughout, gait \nsteady', 'diagnoses': [{'icd_code': '5523', 'desc': 'Diaphragmatic hernia with obstruction'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V1255', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'V151'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "Pertinent Labs:\n___ 12:20AM BLOOD WBC-3.6* RBC-6.18 Hgb-14.6 Hct-47.0 \nMCV-76* MCH-23.7* MCHC-31.1 RDW-15.9* Plt ___\n___ 12:20AM BLOOD Neuts-23* Bands-0 Lymphs-61* Monos-9 \nEos-3 Baso-0 Atyps-4* ___ Myelos-0\n___ 09:00AM BLOOD WBC-2.6* RBC-6.28* Hgb-14.9 Hct-49.0 \nMCV-78* MCH-23.7* MCHC-30.5* RDW-16.0* Plt ___\n___ 09:00AM BLOOD Neuts-70 Bands-0 ___ Monos-1* Eos-1 \nBaso-0 ___ Myelos-0\n___ 12:20AM BLOOD Hypochr-2+ Anisocy-NORMAL Poiklo-NORMAL \nMacrocy-NORMAL Microcy-2+ Polychr-NORMAL Target-2+\n___ 12:20AM BLOOD ___ PTT-46.7* ___\n___ 09:00AM BLOOD ___ PTT-50.8* ___\n___ 12:20AM BLOOD Glucose-99 UreaN-20 Creat-1.8* Na-139 \nK-5.4* Cl-104 HCO3-24 AnGap-16\n___ 09:00AM BLOOD Glucose-139* UreaN-18 Creat-1.6* Na-140 \nK-4.6 Cl-105 HCO3-28 AnGap-12\n___ 09:00AM BLOOD Calcium-8.7 Phos-2.7 Mg-2.0\n___ 12:20AM BLOOD CRP-0.7\n___ 12:20AM BLOOD ESR-1\n.\nCT head w/o Contrast: ___\nIMPRESSION: \n1. No evidence of an acute intracranial abnormality. \n2. Nonaggressive-appearing lesion in the posterior left \nmastoid, lucent with peripheral calcifications. Diagnostic \nconsiderations include fibroosseous and chondroid lesions. A \nmucocele could also be considered, but is less likely in the \nabsence of chronic inflammatory disease elsewhere within the \nleft mastoid. If there are no prior studies demonstrating long \nterm stability of this lesion, then MRI could be useful for \nfurther evaluation. \n3. A left posterior ethmoid air cell is completely opacified. \nPlease correlate whether this may be related to the patient's \nheadache.\n___ year old male with history of CVA with residual left-sided \nweakness (___), atrial fibrillation on coumadin s/p pacemaker, \nCKD (baseline Cr~1.6-1.8), HTN, HLD, and glaucoma, who presented \nwith new onset left sided headache and found to have worsening \npersistent neutropenia.\n.\n# Left Side Headache: Patient initially presented to ED with \nleft-sided intermittent sharp stabbing pain in his left side of \nscalp mostly in V1 distribution. Given headache and blurry \nvision and his history of glaucoma, he was evaluated by \nophthalmology who measured a normal intraoular pressure and \nruled out angle closure glaucoma. Additionally his ESR was \nnormal making temporal arteritis less likely cause for patient \nsymptoms. CT head showed did not show any acute intracranial \nprocess however it did show a left mastoid lesion which per \nradiology is chronic finding and not concerning for any \naggressive process however radiology recommended to document \nstability either by reviewing any available old head imaging or \nrepeating head imaging in the future. Given the V1 distribution \nand description of stabbing pain with tenderness to palpation on \nthe scalp raised suspicion for shingles. However at the time of \ndischarge patient did not have a characteristic shingles rash. \nHe was encouraged to seek urgent care if he develops any such \nrash. \n.\n# Neutropenia: Patient's WBC in the past has ranged in the \n3.4-4.7 region which is most likely normal for this patient \ngiven his ___ ethnicity. On this admission \npatient's WBC was 3.6 with ANC of ~800. He denied any recent \nfevers or infections. He did not appears sick or toxic on exam. \nHis repeat WBC was 2.6 with ANC increasing to ~1800. It is \npossible that patient may have had some viral infection leading \nto further decrease in WBC and ANC. He will follow up at ___ \nclinic for further monitoring of his WBC. \n.\n# Atrial fibrillation/LUE DVT: Rate well controlled on \nCarvedilol. Continue coumadin. His INR on discharge was 3.2. \nPer recommendation of ___ clinic he was sent with \ninstruction to decrease his next day dose of coumadin to 2mg and \nthen resume prior scheduled dosing. He will get his INR drawn \non ___ by ___. \n.\n# Chronic Kidney Disease: Cr was 1.6 baseline.\n\n# Hypertension: Continued Amlodipine and lisinopril\n. \n# Hyperlipidemia: Continued atorvastatin.\n \n# Diabetes mellitus: Controlled with diet. HbA1c of 5.9 in \n___ \n.\n# Glaucoma: No evidence of acute closure glaucoma per optho. \nContinued Timolol eye drops\n.\n# CODE: Full Code\n# CONTACT: daughter in ___ (___) ___ \n."}}
{'final_diagnoses': ['1. Neutropenia ___ secondary to viral infection', '2. Left sided headache'], 'procedures': ['None'], 'visit_summary': "___ year old male with history of CVA with residual left-sided \nweakness (___), atrial fibrillation on coumadin s/p pacemaker, \nCKD (baseline Cr~1.6-1.8), HTN, HLD, and glaucoma, who presented \nwith new onset left sided headache and found to have worsening \npersistent neutropenia.\n.\n# Left Side Headache: Patient initially presented to ED with \nleft-sided intermittent sharp stabbing pain in his left side of \nscalp mostly in V1 distribution. Given headache and blurry \nvision and his history of glaucoma, he was evaluated by \nophthalmology who measured a normal intraoular pressure and \nruled out angle closure glaucoma. Additionally his ESR was \nnormal making temporal arteritis less likely cause for patient \nsymptoms. CT head showed did not show any acute intracranial \nprocess however it did show a left mastoid lesion which per \nradiology is chronic finding and not concerning for any \naggressive process however radiology recommended to document \nstability either by reviewing any available old head imaging or \nrepeating head imaging in the future. Given the V1 distribution \nand description of stabbing pain with tenderness to palpation on \nthe scalp raised suspicion for shingles. However at the time of \ndischarge patient did not have a characteristic shingles rash. \nHe was encouraged to seek urgent care if he develops any such \nrash. \n.\n# Neutropenia: Patient's WBC in the past has ranged in the \n3.4-4.7 region which is most likely normal for this patient \ngiven his ___ ethnicity. On this admission \npatient's WBC was 3.6 with ANC of ~800. He denied any recent \nfevers or infections. He did not appears sick or toxic on exam. \nHis repeat WBC was 2.6 with ANC increasing to ~1800. It is \npossible that patient may have had some viral infection leading \nto further decrease in WBC and ANC. He will follow up at ___ \nclinic for further monitoring of his WBC. \n.\n# Atrial fibrillation/LUE DVT: Rate well controlled on \nCarvedilol. Continue coumadin. His INR on discharge was 3.2. \nPer recommendation of ___ clinic he was sent with \ninstruction to decrease his next day dose of coumadin to 2mg and \nthen resume prior scheduled dosing. He will get his INR drawn \non ___ by ___. \n.\n# Chronic Kidney Disease: Cr was 1.6 baseline.\n\n# Hypertension: Continued Amlodipine and lisinopril\n. \n# Hyperlipidemia: Continued atorvastatin.\n \n# Diabetes mellitus: Controlled with diet. HbA1c of 5.9 in \n___ \n.\n# Glaucoma: No evidence of acute closure glaucoma per optho. \nContinued Timolol eye drops\n.\n# CODE: Full Code\n# CONTACT: daughter in ___ (___) ___ \n.", 'medications_prescribed': ['1. Amlodipine 10 mg PO DAILY \nhold for SBP<100 and HR<60 \n2. Aspirin 81 mg PO DAILY \n3. Atorvastatin 10 mg PO DAILY \n4. Carvedilol 3.125 mg PO BID \n5. Lisinopril 10 mg PO DAILY \n6. Timolol Maleate 0.5% 1 DROP LEFT EYE BID \n7. Warfarin 2 mg PO DAILY16 \nRX *warfarin [Coumadin] 2 mg ___ tablet(s) by mouth Daily Disp \n#*30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 53, 'gender': 'F', 'symptoms': 'abdominal pain, nausea, vomiting', 'medical_history': ['- Systemic lupus erythematosus diagnosed ___ initially \npresenting with arthralgias, myalgias, positive ___ to 1:1280 \ntiter, positive double-stranded DNA, positive SSA and SSB \nantibodies, and positive ___ antibody', '- Diffuse proliferative lupus nephritis on CellCept and \nprednisone, ', '- Antiphospholipid antibody syndrome/positive lupus \nanticoagulant with ischemic right fifth toe diagnosed ___ on \ncoumadin', '- Hypertension', '- Dyslipidemia', '- Appendectomy in ___', '- G4,P3 (twin premature labor in ___, both died within hours of \ndelivery)', '- Asthma since childhood'], 'family_history': 'Older sister with lupus, died at age ___ from a complication of \nlupus (unclear what type). Father with liver cancer. Mother with \nDM, CAD, CHF. Brother with HTN. Older brother recently diagnosed \nwith prosate cancer (age ___. Younger sister with several \nmiscarriages and "difficulty having a baby."', 'present_illness': 'The patient is a ___ w/ SLE, APLS, lupus nephritis, HTN, \ndyslipidemia who presents with abdominal pain, nausea, vomiting, \nand diarrhea. She states this started at 9pm yesterday evening; \nthe last meal she had eaten before that was at 3pm and she has \nnot had anything outside her usual diet. No fevers or chills. \nShe first had a cramping epigastric pain with a "pulling" \nsensation that lasted about 45 minutes. At about 11:30pm she \nstarted vomiting green bilious material and also noticed a small \namount of blood with the first couple of episodes that has since \ndisappeared. Diarrhea started around midnight and she did not \nsee any blood in this. She had several (more than 10) episodes \nof vomiting and diarrhea throughout the night and then decided \nto come to the ED.\n\nIn the ED she received 1+ liters of IVF, morphine 4mg IV x 2, \nZofran 4mg IV x 2, and Decadron 10mg (given her chronic steroid \nuse). Lipase was found to be elevated at ___bdomen was \nsuggestive of early pancreatitis. She was admitted for further \ntreatment.\n\nROS:\n-Constitutional: [x]WNL []Weight loss []Fatigue/Malaise []Fever \n[]Chills/Rigors []Nightsweats []Anorexia\n-Eyes: [x]WNL []Blurry Vision []Diplopia []Loss of Vision \n[]Photophobia\n-ENT: []WNL [x]Dry Mouth []Oral ulcers []Bleeding gums/nose \n[]Tinnitus []Sinus pain []Sore throat\n-Cardiac: [x]WNL []Chest pain []Palpitations ___ edema \n[]Orthopnea/PND []DOE\n-Respiratory: [x]WNL []SOB []Pleuritic pain []Hemoptysis []Cough\n-Gastrointestinal: []WNL [x]Nausea [x]Vomiting [x]Abdominal pain \n[]Abdominal Swelling [x]Diarrhea []Constipation []Hematemesis \n[]Hematochezia []Melena\n-Heme/Lymph: [x]WNL []Bleeding []Bruising []Lymphadenopathy\n-GU: [x]WNL []Incontinence/Retention []Dysuria []Hematuria \n[]Discharge []Menorrhagia\n-Skin: []WNL [x]Rash []Pruritus\n-Endocrine: [x]WNL []Change in skin/hair []Loss of energy \n[]Heat/Cold intolerance\n-Musculoskeletal: [x]WNL []Myalgias []Arthralgias []Back pain\n-Neurological: []Numbness of extremities []Weakness of \nextremities []Parasthesias []Dizziness/Lightheaded []Vertigo \n[]Confusion []Headache\n-Psychiatric: [x]WNL []Depression []Suicidal Ideation', 'medications': [{'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methylnaltrexone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SUBCUT', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin Pump (Self Administering Medication)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.0', 'valuenum': 48.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical Exam:\nAppearance: NAD\nVitals: T: 100.1 BP: 132/82 HR: 92 RR: 18 O2: 100%\nEyes: EOMI, PERRL, conjunctiva clear, noninjected, anicteric, no \nexudate\nENT: dry\nNeck: No JVD, no LAD\nCardiovascular: RRR, nl S1/S2, no m/r/g\nRespiratory: CTA bilaterally, comfortable, no wheezing, no \nronchi, no rales\nGastrointestinal: soft, non-tender, non-distended, no \nhepatosplenomegaly, normal bowel sounds\nMusculoskeletal/Extremities: no clubbing, no cyanosis, \n+arthralgia, especially left knee, no edema in the bilateral \nextremities\nNeurological: Alert and oriented x3, fluent speech, non-focal\nIntegument: warm, hyperpigmented tender patches on arms and \nlegs, no ulcer\nPsychiatric: appropriate, pleasant', 'diagnoses': [{'icd_code': 'M4806', 'desc': 'Spinal stenosis, lumbar region'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'M960', 'desc': 'Pseudarthrosis after fusion or arthrodesis'}, {'icd_code': 'M4316', 'desc': 'Spondylolisthesis, lumbar region'}, {'icd_code': 'E890', 'desc': 'Postprocedural hypothyroidism'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'M353', 'desc': 'Polymyalgia rheumatica'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E109', 'desc': 'Type 1 diabetes mellitus without complications'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'Y831', 'desc': 'Surgical operation with implant of artificial internal device as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'Z85850', 'desc': 'Personal history of malignant neoplasm of thyroid'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}, {'icd_code': 'Z9221', 'desc': 'Personal history of antineoplastic chemotherapy'}, {'icd_code': 'Z8551', 'desc': 'Personal history of malignant neoplasm of bladder'}, {'icd_code': 'Z8542', 'desc': 'Personal history of malignant neoplasm of other parts of uterus'}], 'summary': '___ 10:50AM GLUCOSE-102 UREA N-17 CREAT-0.8 SODIUM-142 \nPOTASSIUM-4.0 CHLORIDE-106 TOTAL CO2-26 ANION GAP-14\n___ 10:50AM ALT(SGPT)-32 AST(SGOT)-25 ALK PHOS-73 TOT \nBILI-0.5\n___ 10:50AM LIPASE-214*\n___ 10:50AM WBC-14.8* RBC-3.99* HGB-10.9* HCT-32.6* \nMCV-82 MCH-27.2 MCHC-33.3 RDW-16.3*\n___ 10:50AM NEUTS-91.6* LYMPHS-5.5* MONOS-2.6 EOS-0.3 \nBASOS-0.1\n___ 10:50AM PLT COUNT-353\n___ 10:50AM ___ PTT-39.7* ___\nA/P: ___ w/ SLE, APLS, lupus nephritis, HTN, dyslipidemia who \npresents with abdominal pain, nausea, vomiting, and diarrhea.\n\n## abdominal pain/nausea/vomiting/diarrhea: This was initially \nthought to be pancreatitis given her elevated lipase and CT \nfindings suggestive of early pancreatitis. Given her history of \nautoimmune disease, autoimmune pancreatitis was considered. \nHowever, her lipase returned to normal within 24 hours and \nfurther review revealed that the appearance of her pancreas was \nactually unchanged when compared to ___. Triglycerides were \nnormal, and IgG 4 subclass (elevated in some cases of autoimmune \npancreatitis) was normal. Her stool then turned positive for C. \ndiff, so this was likely causing her symptoms, possibly because \nof recent amoxicillin use, she was started on Flagyl. She was \ninitially NPO and was given aggressive IVF, and as her symptoms \nimproved, her diet was advanced until she was tolerating regular \nfood. Cellcept was stopped as it may worsen diarrhea.\n\n## SLE: Has been recently seen by her rheumatologist in clinic \nwho decreased her predisone to 30mg qd from 40mg, started \nTemovate cream for skin lesions, maintained CellCept. Her \nworsening arthralgias were initially thought to possibly suggest \na lupus flare but her symptoms improved back to baseline with \ntreatment of her C. diff. Complement levels were normal. In \ndiscussion with her outpatient rheumatologist (Dr. ___, \nrecommended stopping CellCept for now but keeping prednisone at \nsame level. She will follow up with him for consideration of \nresuming Cellcept.\n \n## lupus nephritis: originally scheduled for a renal biopsy as \nan outpatient after her last discharge but she missed the \nappointment and renal re-considered, deciding to defer biopsy. \nHer creatinine remained at baseline.\n\n## Antiphospholipid antibody syndrome: has a history of clotting \nwith ischemic R toe. INR subtherapeutic on admission (1.6), \nunclear compliance with coumadin. She was taking lovenox ___ \nBID as outpatient while being bridged to coumadin. Goal INR \n2.5-3.5. Coumadin was continued at 7.5mg daily and she reached \nan INR of 2.5 while in-house so Lovenox was stopped. She was \nadvised to get her INR checked as usual within ___ days of \ndischarge and she stated she would be able to do this.\n \n## Ear infection: started on amoxicillin by her rheumatologist \nfor ear infection (presumably otitis media), pain and itching \nhas improved since then. Given her C. diff, her amoxicillin was \nstopped as she had completed a 7-day course and her symptoms had \nimproved.'}}
{'final_diagnoses': ['C. difficile infection', 'diarrhea', 'abdominal pain', 'nausea', 'vomiting', 'SLE', 'lupus nephritis', 'antiphospholipid syndrome', 'hypertension', 'dyslipidemia', 'asthma'], 'procedures': ['none'], 'visit_summary': 'A/P: ___ w/ SLE, APLS, lupus nephritis, HTN, dyslipidemia who \npresents with abdominal pain, nausea, vomiting, and diarrhea.\n\n## abdominal pain/nausea/vomiting/diarrhea: This was initially \nthought to be pancreatitis given her elevated lipase and CT \nfindings suggestive of early pancreatitis. Given her history of \nautoimmune disease, autoimmune pancreatitis was considered. \nHowever, her lipase returned to normal within 24 hours and \nfurther review revealed that the appearance of her pancreas was \nactually unchanged when compared to ___. Triglycerides were \nnormal, and IgG 4 subclass (elevated in some cases of autoimmune \npancreatitis) was normal. Her stool then turned positive for C. \ndiff, so this was likely causing her symptoms, possibly because \nof recent amoxicillin use, she was started on Flagyl. She was \ninitially NPO and was given aggressive IVF, and as her symptoms \nimproved, her diet was advanced until she was tolerating regular \nfood. Cellcept was stopped as it may worsen diarrhea.\n\n## SLE: Has been recently seen by her rheumatologist in clinic \nwho decreased her predisone to 30mg qd from 40mg, started \nTemovate cream for skin lesions, maintained CellCept. Her \nworsening arthralgias were initially thought to possibly suggest \na lupus flare but her symptoms improved back to baseline with \ntreatment of her C. diff. Complement levels were normal. In \ndiscussion with her outpatient rheumatologist (Dr. ___, \nrecommended stopping CellCept for now but keeping prednisone at \nsame level. She will follow up with him for consideration of \nresuming Cellcept.\n \n## lupus nephritis: originally scheduled for a renal biopsy as \nan outpatient after her last discharge but she missed the \nappointment and renal re-considered, deciding to defer biopsy. \nHer creatinine remained at baseline.\n\n## Antiphospholipid antibody syndrome: has a history of clotting \nwith ischemic R toe. INR subtherapeutic on admission (1.6), \nunclear compliance with coumadin. She was taking lovenox ___ \nBID as outpatient while being bridged to coumadin. Goal INR \n2.5-3.5. Coumadin was continued at 7.5mg daily and she reached \nan INR of 2.5 while in-house so Lovenox was stopped. She was \nadvised to get her INR checked as usual within ___ days of \ndischarge and she stated she would be able to do this.\n \n## Ear infection: started on amoxicillin by her rheumatologist \nfor ear infection (presumably otitis media), pain and itching \nhas improved since then. Given her C. diff, her amoxicillin was \nstopped as she had completed a 7-day course and her symptoms had \nimproved.', 'medications_prescribed': ['1. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily). ', '3. Hydroxychloroquine 200 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day). ', '4. Lasix 80 mg Tablet Sig: One (1) Tablet PO once a day. ', '5. Trimethoprim-Sulfamethoxazole 160-800 mg Tablet Sig: One (1) \nTablet PO 3X/WEEK (___). ', '6. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical QD (). ', '7. Warfarin 2.5 mg Tablet Sig: Three (3) Tablet PO Once Daily at \n4 ___. \nDisp:*90 Tablet(s)* Refills:*2*', '8. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '9. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', '10. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily). ', '11. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day). ', '12. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily) as needed. ', '13. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '14. Prochlorperazine Maleate 10 mg Tablet Sig: One (1) Tablet PO \nat bedtime. ', '15. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday). ', '16. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily). ', '17. Clobetasol 0.05 % Cream Sig: One (1) Appl Topical BID (2 \ntimes a day). ', '18. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H \n(every 8 hours) for 18 days. \nDisp:*54 Tablet(s)* Refills:*0*', '19. Pramoxine-Mineral Oil-Zinc ___ % Ointment Sig: One (1) \nAppl Rectal QD () as needed. \nDisp:*1 tube* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 60, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['___ on Humira', 'reflux with dysphagia', 'hiatal hernia', 'diverticulitis', 'bronchiectasis', 'positive hepatitis C antibody with a negative HCV RNA', 'history of a sleep disorder', 'pruritus', 'fibroid uterus', "Sjogren's syndrome (clinical; negative autoantibody testing)", 'interstitial cystitis', 'fibromyalgia and chronic ___'], 'family_history': 'Grandmother and several great aunts had ___ disease. Father \nwith type 2 diabetes. Brother passed away from AML in his ___.', 'present_illness': 'HISTORY OF PRESENT ILLNESS: ___ female patient with a\nhistory of ___ disease (restarted on Humira ___ for new\nflare) who came to the ED for abdominal pain since the morning \nof\n___ concerning for acute-on-chronic ___ flare, found to have\ncolitis on CT and leukocytosis to 27, and admitted for workup \nand\nIV antibiotics.\n\nPer her report, she was diagnosed with "hemorrhagic ___ in\nher ___ and nothing initially could control the bleeding; she\nrequired a partial resection. She eventually went into a\n___ admission, developing abdominal pain and cramping in\n___. She was initially diagnosed with diverticulitis but\non CT scan was found to have colitis. She had a 5 day admission\nto ___ at this time, for abdominal pain and symptomatic\nhypotension. At the end of ___ she underwent a colonoscopy which\nshowed chronic severely active colitis with ulceration, which \nwas\nnegative for CMV. She was started on Humira the beginning of\n___. \n\nThe morning of admission, she woke up feeling lightheaded and \nwas\ndizzy on standing and "knew that her blood pressure was low. \n"She also had cramping abdominal pain. Her last bowel movement\nwas 2 days prior to admission and was a formed stool. She has\nbeen unable to tolerate p.o. for the past several days. She has\nhad some nausea and reflux as well, these are more chronic\nsymptoms for. She feels fatigued and weak.\n\nIn the ED, initial VS were 96.0 110 51/37 1893% nasal cannula.\nShe triggered for hypotension and was given first 1L NS with\nimprovement to 112/70. \n\nShe received:\n-1 L normal saline at ___\n-1 g vancomycin at 1500\n-4.5g pip-tazo at 1500\n-1g APAP PO at 1640\n\nSubsequent pressures were ___ prompting the \nadditional NS mentioned above.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush PICC (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Penicillin G Potassium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 212.6, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 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'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '361', 'valuenum': 361.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam\n================\nVS: 97.8 | 153/72 | 97 | 20 | 91%Ra \nGENERAL: NAD, thin but not cachectic, appears elderly and mildly\ndiaphoretic but nontoxic.\nHEENT: PERRL, dry mucous membranes\nNECK: full rom, no LAD\nHART: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles \nABDOMEN: well-healed RLQ scar. Minimally distended. Tender to\npalpation throughout, worse in LLQ. No rebound/guarding.\nHyperactive bowel sounds. Typmpanic to percussion.\nEXTREMITIES: WWP, no cyanosis, clubbing, or edema\nPULSES: 2+ DP pulses bilaterally\nNEURO: A&Ox3, face grossly symmetric, no dysarthria. Moving all \n4\nextremities with purpose \nSKIN: no excoriations or lesions, no rashes \n\nDischarge Physical Exam\n================\nPHYSICAL EXAM:\nVS: 98.0 PO 137 / 81 nL Lying 76 RR 16 O292 Ra \nGENERAL: NAD, awake, alert \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, cracked lips, MMM\nHART: RRR, normal S1/S2, no murmurs, gallops, or rubs \nLUNGS: clear to auscultation, no increased work of breathing, no \ncrackles\nABDOMEN: soft, ND NT, no rebound/guarding, midline scar from \nremote surgery, normoactive/hypoactive bowel sounds, improved \nEXTREMITIES: no edema \nNEURO: A&Ox3, ambulating normal \nSKIN: warm and well perfused', 'diagnoses': [{'icd_code': '3241', 'desc': 'Intraspinal abscess'}, {'icd_code': '73028', 'desc': 'Unspecified osteomyelitis, other specified sites'}, {'icd_code': '72210', 'desc': 'Displacement of lumbar intervertebral disc without myelopathy'}, {'icd_code': '72293', 'desc': 'Other and unspecified disc disorder, lumbar region'}, {'icd_code': '04109', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus'}], 'summary': "Admission Labs\n===========\n___ 02:30PM BLOOD WBC-27.9*# RBC-4.12 Hgb-12.3 Hct-38.8 \nMCV-94 MCH-29.9 MCHC-31.7* RDW-13.4 RDWSD-46.4* Plt ___\n___ 02:30PM BLOOD Neuts-85.5* Lymphs-8.1* Monos-5.0 \nEos-0.3* Baso-0.5 Im ___ AbsNeut-23.82* AbsLymp-2.26 \nAbsMono-1.39* AbsEos-0.07 AbsBaso-0.14*\n___ 02:30PM BLOOD Plt ___\n___ 02:30PM BLOOD Glucose-163* UreaN-15 Creat-1.2* Na-139 \nK-3.7 Cl-103 HCO3-16* AnGap-24*\n___ 02:30PM BLOOD ALT-15 AST-23 AlkPhos-97 TotBili-0.5\n___ 02:30PM BLOOD Albumin-3.8\n___ 02:30PM BLOOD CRP-0.7\n___ 03:10PM BLOOD ___ pO2-27* pCO2-43 pH-7.26* \ncalTCO2-20* Base XS--8\n___ 03:10PM BLOOD Lactate-4.1*\n___ 06:45AM BLOOD CRP-46.1*\n___ 02:30PM BLOOD CRP-0.7\n\nDischarge Labs\n===========\n___ 07:40AM BLOOD WBC-22.7* RBC-4.05 Hgb-11.9 Hct-37.1 \nMCV-92 MCH-29.4 MCHC-32.1 RDW-14.4 RDWSD-48.2* Plt ___\n___ 07:40AM BLOOD Plt ___\n___ 07:40AM BLOOD Glucose-98 UreaN-17 Creat-0.5 Na-141 \nK-4.1 Cl-99 HCO3-28 AnGap-14\n___ 07:20AM BLOOD ALT-19 AST-14 AlkPhos-77 TotBili-0.3\n___ 07:40AM BLOOD Calcium-9.7 Phos-3.5 Mg-2.0\n___ 07:25AM BLOOD VitB12-224* Folate-6\n___ 07:25AM BLOOD CRP-3.3\nBrief Hospital Course:\n\n___ female patient with a history of ___ disease \n(restarted on ___ ___ for new flare) who came to the ED \nfor abdominal pain since the morning of ___ concerning for \nacute-on-chronic ___ flare, found to have colitis on CT and \nleukocytosis to 27, and admitted for workup and IV antibiotics. \nGI was consulted and followed the patient throughout the \nhospitalization. It was believed the abdominal pain came about \nsecondary to constipation and abdominal distention. The patient \nwas given an aggressive bowel regimen, which helped the symptoms \nwhich we believe were secondary to a previous botox injection \nfor pelvic floor disfunction. The patient also received her \nsecond loading dose of Humira while in the hospital and was \nstarted on a course of steroids (initially IV to PO prednisone). \nHer abdominal pain and distension continued to improve and was \nat baseline at discharge.\n\nThroughout the hospitalization, the patient also had continued \nhypoxia, which was something she had experienced at a recent \nhospitalization at ___, but without any clear reason. \nThe patient required ___ of oxygen for the first half of her \nstay to remain in the low ___ on her O2 stat and would desat \ninto the high ___ and low ___ during ambulation. Outside records \ncould not be gathered regarding any hypoxia. It was believe this \nwas caused by a raised right hemidiaphragm causing low lung \nvolumes, atlectosis from laying in bed, and blunting secondary \nto abdominal pain. The patient was also found to have a \npneumonia (CAP) which was treated for 5 days with levaquin. \nUltimately, once the patient began ambulating and her abdominal \npain improved she was able to come of all O2 without difficulty \nand did not require home oxygen.\n\nThe patient was also found to have leukocytosis on admission \nwhich reached a nadir of 10 during the middle of the \nhospitalization when the patient felt well, however began to \nrise without a clear cause. The WBC went up to 23.9 and \nstabilized around this value, and although the patient had been \nstarted on steroids, was a suspicious rise in the context of her \nclinical picture. A blood smear was obtained which showed \ninflammation, B12 deficiency, and some questionable MDS type \ncells. The patients B12 was found to be low at 224, but an MMA \nwas not obtained as it an outpatient lab. To evaluate for other \npotential causes of leukocytosis, a CT abdomin/pelvis was done \nto evaluate for potential abscess/occult infection, and revealed \na wedge-shaped infarct in a peripheral region of her liver. To \nfurther classify this and to look for any local process which \ncould have contributed, a MRI liver was done which did not \ndemonstrate the lesion and heme/onc did not recommend \nanticoagulation. The patient was discharged home in stable \ncondition.\n\n=======================\nTRANSITIONAL ISSUES:\n=======================\n[]Check CBC in 1 week to evaluate improving leukocytosis. If \ncontinues to be elevated, consider heme/onc referral for \npossible bone marrow biopsy for MDS ___\n[]Vitamin B12 was deficient. Will replete B12 and folate. \nConsider follow-up with methylmalonic acid and/or homocysteine \nlevels\n[]Patient had severe constipation and on numerous \nanticholinergeric medications. Can consider modifying her \nregimen.\n[]Cholestyramine was held due to constipation. Can consider \nrestarting if diarrhea reoccurs.\n[]Patient's blood pressure had dizziness when taking lisinopril. \nThis was held during hospitalization and not restarted on d/c. \nCan consider restarting as outpatient.\n\nMEDICATIONS:\n- New Meds: Prednisone 50mg daily, tapering 10mg weekly (on \n___ until 30mg daily\n- Stopped Meds: Sodium Chloride tablets, lisinopril\n- Changed Meds: None\n\nIncidental findings:\n#RENAL CYST: Large left upper pole renal cyst on CT ___, \nagain on CT abd/ pelvis with septations. Will need follow up in \n___ year with renal ultrasound\n#PULM NODULES: 5 mm left fissural nodule and 4 mm RML nodule on \nCT ___. For incidentally detected multiple solid pulmonary \nnodules <6mm, no CT follow-up is recommended in a low-risk \npatient. Optional CT follow-up in 12 months is recommended in a \nhigh-risk patient. Can consider f/u CT in 12 months\n\n# CONTACT: ___ ___\n# CODE: Full Code\n\nACTIVE:\n\n#COLITIS\n#CROHNS: Abdominal pain was consistent with acute-on-chronic \nCrohns flare. Ruled out infectious colitis w/ neg C.diff and \nstool cultures. KUB demonstrated dilated colon with potential \nileus. Was given a strong bowel regimen, started on steroids, \nand patient had Humira ___ loading dose on (___). A flex sig \n___ unremarkable to sigmoid, though unable to visualize much \ndue to poor prep. GI followed closely and recommended tapering \nsteroids weekly by 10mg starting on ___, eventually \ncontinuing at 30mg PO daily until follow-up with ___ \n___ in outpatient.\n\n#LEUKOCYTOSIS:\nWedge-shaped low attentuation found on CT A/P ___ which was \nsuspicious for a liver infarct. Was originally thought to be \ncause of leukocytosis, however was not redemonstrated on MRI. At \ndischarge, the ___ is 22.3. Will follow-up with PCP ___ 1 week \nand consider heme/onc referral for further evaluation, possible \nbone marrow biopsy, and consideration of MDS.\n\n#CONSTIPATION: Improving bowel function on bowel regimen (daily \nsuppositories, Colace, senna). Constipation ___ rectal sphincter \ndysfunction from hx of Botox injections for pelvic floor \ndysfunction. Also precipitated by inflammation from active \nCrohns flare. On numerous medications which can contribute, but \ndid not want to change regimen at this time. Her cholestyramine \nwas held during hospitalization.\n\n#HYPOXIA: Resolving, O2sat in low ___ on RA throughout \nhospitalization. Hypoxia likely secondary to splinting, \natelectasis, and poor lung expansion, precipitated by PNA and \ncompleted a 5-day levo. Unclear hx of preload failure but TTE \n___ without shunt or evidence of right heart strain. VBG \nappropriate on ___. CT negative for PE on admission. Pulm \nconsult ___ suggesting atelectasis as cause, appreciate recs. \nPatient was recommended to follow-up outpatient with \npulmonologist Dr. ___ at ___ and sleep doctor at ___.\n\n#B12 DEFICIENCY:\nB12 low at 224. No hyper segmentation seen on smear. Currently \nasymptomatic with no GI or neuro sxs. Heme/onc recommended to \nget an MMA and start B12 injections. These were not done in \nhouse as it is a send out lab.\n\nCHRONIC:\n#HYPERTENSION: \n- Home lisinopril was held.\n\n#POTS: Has episodes of dizziness a/w abdominal pain. \n- Holding home salt tablets, can continue outpatient\n\n#SJOGREN'S,\n#VAGINAL DRYNESS, \n#PELVIC FLOOR DYSFUNCTION,\n#MISC\n- Home eye drops \n- Home vaginal diazepam BID\n- Home doxepin HS\n- Hold home fluconazole unless having symptomatic yeast\ninfection\n- Home pregabalin TID\n- Home prevalite\n- Home carisoprodol"}}
{'final_diagnoses': ['___ Flare', 'Pneumonia', 'Vitamin B12 deficiency'], 'procedures': ['Flex sigmoidoscopy'], 'visit_summary': "Brief Hospital Course:\n\n___ female patient with a history of ___ disease \n(restarted on ___ ___ for new flare) who came to the ED \nfor abdominal pain since the morning of ___ concerning for \nacute-on-chronic ___ flare, found to have colitis on CT and \nleukocytosis to 27, and admitted for workup and IV antibiotics. \nGI was consulted and followed the patient throughout the \nhospitalization. It was believed the abdominal pain came about \nsecondary to constipation and abdominal distention. The patient \nwas given an aggressive bowel regimen, which helped the symptoms \nwhich we believe were secondary to a previous botox injection \nfor pelvic floor disfunction. The patient also received her \nsecond loading dose of Humira while in the hospital and was \nstarted on a course of steroids (initially IV to PO prednisone). \nHer abdominal pain and distension continued to improve and was \nat baseline at discharge.\n\nThroughout the hospitalization, the patient also had continued \nhypoxia, which was something she had experienced at a recent \nhospitalization at ___, but without any clear reason. \nThe patient required ___ of oxygen for the first half of her \nstay to remain in the low ___ on her O2 stat and would desat \ninto the high ___ and low ___ during ambulation. Outside records \ncould not be gathered regarding any hypoxia. It was believe this \nwas caused by a raised right hemidiaphragm causing low lung \nvolumes, atlectosis from laying in bed, and blunting secondary \nto abdominal pain. The patient was also found to have a \npneumonia (CAP) which was treated for 5 days with levaquin. \nUltimately, once the patient began ambulating and her abdominal \npain improved she was able to come of all O2 without difficulty \nand did not require home oxygen.\n\nThe patient was also found to have leukocytosis on admission \nwhich reached a nadir of 10 during the middle of the \nhospitalization when the patient felt well, however began to \nrise without a clear cause. The WBC went up to 23.9 and \nstabilized around this value, and although the patient had been \nstarted on steroids, was a suspicious rise in the context of her \nclinical picture. A blood smear was obtained which showed \ninflammation, B12 deficiency, and some questionable MDS type \ncells. The patients B12 was found to be low at 224, but an MMA \nwas not obtained as it an outpatient lab. To evaluate for other \npotential causes of leukocytosis, a CT abdomin/pelvis was done \nto evaluate for potential abscess/occult infection, and revealed \na wedge-shaped infarct in a peripheral region of her liver. To \nfurther classify this and to look for any local process which \ncould have contributed, a MRI liver was done which did not \ndemonstrate the lesion and heme/onc did not recommend \nanticoagulation. The patient was discharged home in stable \ncondition.\n\n=======================\nTRANSITIONAL ISSUES:\n=======================\n[]Check CBC in 1 week to evaluate improving leukocytosis. If \ncontinues to be elevated, consider heme/onc referral for \npossible bone marrow biopsy for MDS ___\n[]Vitamin B12 was deficient. Will replete B12 and folate. \nConsider follow-up with methylmalonic acid and/or homocysteine \nlevels\n[]Patient had severe constipation and on numerous \nanticholinergeric medications. Can consider modifying her \nregimen.\n[]Cholestyramine was held due to constipation. Can consider \nrestarting if diarrhea reoccurs.\n[]Patient's blood pressure had dizziness when taking lisinopril. \nThis was held during hospitalization and not restarted on d/c. \nCan consider restarting as outpatient.\n\nMEDICATIONS:\n- New Meds: Prednisone 50mg daily, tapering 10mg weekly (on \n___ until 30mg daily\n- Stopped Meds: Sodium Chloride tablets, lisinopril\n- Changed Meds: None\n\nIncidental findings:\n#RENAL CYST: Large left upper pole renal cyst on CT ___, \nagain on CT abd/ pelvis with septations. Will need follow up in \n___ year with renal ultrasound\n#PULM NODULES: 5 mm left fissural nodule and 4 mm RML nodule on \nCT ___. For incidentally detected multiple solid pulmonary \nnodules <6mm, no CT follow-up is recommended in a low-risk \npatient. Optional CT follow-up in 12 months is recommended in a \nhigh-risk patient. Can consider f/u CT in 12 months\n\n# CONTACT: ___ ___\n# CODE: Full Code\n\nACTIVE:\n\n#COLITIS\n#CROHNS: Abdominal pain was consistent with acute-on-chronic \nCrohns flare. Ruled out infectious colitis w/ neg C.diff and \nstool cultures. KUB demonstrated dilated colon with potential \nileus. Was given a strong bowel regimen, started on steroids, \nand patient had Humira ___ loading dose on (___). A flex sig \n___ unremarkable to sigmoid, though unable to visualize much \ndue to poor prep. GI followed closely and recommended tapering \nsteroids weekly by 10mg starting on ___, eventually \ncontinuing at 30mg PO daily until follow-up with ___ \n___ in outpatient.\n\n#LEUKOCYTOSIS:\nWedge-shaped low attentuation found on CT A/P ___ which was \nsuspicious for a liver infarct. Was originally thought to be \ncause of leukocytosis, however was not redemonstrated on MRI. At \ndischarge, the ___ is 22.3. Will follow-up with PCP ___ 1 week \nand consider heme/onc referral for further evaluation, possible \nbone marrow biopsy, and consideration of MDS.\n\n#CONSTIPATION: Improving bowel function on bowel regimen (daily \nsuppositories, Colace, senna). Constipation ___ rectal sphincter \ndysfunction from hx of Botox injections for pelvic floor \ndysfunction. Also precipitated by inflammation from active \nCrohns flare. On numerous medications which can contribute, but \ndid not want to change regimen at this time. Her cholestyramine \nwas held during hospitalization.\n\n#HYPOXIA: Resolving, O2sat in low ___ on RA throughout \nhospitalization. Hypoxia likely secondary to splinting, \natelectasis, and poor lung expansion, precipitated by PNA and \ncompleted a 5-day levo. Unclear hx of preload failure but TTE \n___ without shunt or evidence of right heart strain. VBG \nappropriate on ___. CT negative for PE on admission. Pulm \nconsult ___ suggesting atelectasis as cause, appreciate recs. \nPatient was recommended to follow-up outpatient with \npulmonologist Dr. ___ at ___ and sleep doctor at ___.\n\n#B12 DEFICIENCY:\nB12 low at 224. No hyper segmentation seen on smear. Currently \nasymptomatic with no GI or neuro sxs. Heme/onc recommended to \nget an MMA and start B12 injections. These were not done in \nhouse as it is a send out lab.\n\nCHRONIC:\n#HYPERTENSION: \n- Home lisinopril was held.\n\n#POTS: Has episodes of dizziness a/w abdominal pain. \n- Holding home salt tablets, can continue outpatient\n\n#SJOGREN'S,\n#VAGINAL DRYNESS, \n#PELVIC FLOOR DYSFUNCTION,\n#MISC\n- Home eye drops \n- Home vaginal diazepam BID\n- Home doxepin HS\n- Hold home fluconazole unless having symptomatic yeast\ninfection\n- Home pregabalin TID\n- Home prevalite\n- Home carisoprodol", 'medications_prescribed': ['Artificial Tears Preserv. Free ___ DROP BOTH EYES PRN dry \neyes', 'Bisacodyl ___AILY', 'Cyanocobalamin 100 mcg IM/SC DAILY Duration: 7 Days \nRX *cyanocobalamin (vitamin B-12) [Vitamin B-12] 1,000 mcg/mL \n1000 mcg IM weekly Disp #*3 Vial Refills:*0', 'Docusate Sodium 100 mg PO BID', 'FoLIC Acid 1 mg PO DAILY', 'PredniSONE 50 mg PO DAILY \nRX *prednisone 10 mg 5 tablet(s) by mouth daily Disp #*75 Tablet \nRefills:*0', 'Senna 8.6 mg PO BID:PRN constipation', 'Sucralfate 1 gm PO QID:PRN stomach pain', 'Humira (adalimumab) 40 mg subcutaneous 1X/WEEK (___)', 'carisoprodol 350 mg oral TID:PRN', 'Diazepam 20 mg PO Q12H pelvic floor dysfunction', 'Doxepin HCl 50 mg PO HS', 'Dronabinol 2.5 mg PO BID-TID:PRN nausea', 'Fluconazole 200 mg PO Q24H', 'Ondansetron ___ mg PO Q8H:PRN nausea', 'Pantoprazole 40 mg PO Q24H', 'Pregabalin 200 mg PO TID', 'HELD- Lisinopril 5 mg PO DAILY This medication was held. Do \nnot restart Lisinopril until you see your PCP.', 'HELD- Prevalite (cholestyramine-aspartame) 4 gram oral BID \nThis medication was held. Do not restart Prevalite until you \ntalk to your PCP or GI doctor because you were constipated in \nthe hospital.', 'HELD- Sodium Chloride Dose is Unknown PO TID This \nmedication was held. Do not restart Sodium Chloride until you \ntalk to your PCP .']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'fatigue, cough', 'medical_history': ['anemia', 'hypogammaglobulinemia', 'splenomegaly', 'atrial fibrillation on pradaxa', 'congestive heart failure', 'prostate cancer', 'peripheral neuropathy', "Crohn's disease", 'CKD', '___ esophagus, GERD', 'h/o hemorrhoidal bleed approximately ___ years ago, required \nblood transfusions', 'h/o B12 deficiency'], 'family_history': 'Has 3 sons: one diagnosed w/ GIST @ age ___. Father died from \ncolon CA at age ___ mother died of CHF @ age ___. ', 'present_illness': '___ h/o CHF, afib with low hct. Pt sent in by pcp for low hct. \nPt on pradaxa. He has been recently hospitalized for influenza, \nsubsequently developed PNA. Notes recently increasing dyspnea \nwith exertion. No chest pain. Denies ab pain, n/v. Denies change \nin the caliber of his stools. Chronically "black" appearing \nstool ___ iron supplements. No frank blood. \nIn the ED initial vitals were: 97.2 74 107/69 20 96% ra. \n- Labs were significant for HCT 30.4 (H/H 13.0/38.1 ___, \nBNP 2838, BUN/Cr ___, bicarb 20, trop 0.02. EKG with Afib, no \nischemia, unchanged from prior, CXR with pleural effusions. \nDiscussed with PCP ___ ___. Given patient\'s \nworsening dyspnea in the setting of anemia, will admit to \nmonitor hct\'s. \n\nOn the floor the patient reports his main complaint is an \nongoing cough.', 'medications': [{'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '303', 'valuenum': 303.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1710', 'valuenum': 1710.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1495', 'valuenum': 1495.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 7.54, 'valueuom': 'units', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': 'PLEURAL FLUID.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '301', 'valuenum': 301.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '283', 'valuenum': 283.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '316', 'valuenum': 316.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\nVitals - T 98.2 BP 138/72 HR 80 RR 20 O2 97%RA \nGENERAL: NAD \nHEENT: EOMI, conjunctiva without pallor \nCARDIAC: irreg irreg, no murmurs \nLUNG: Decreased lung sounds on left base with dullness to \npercussion, good air movement, no accessory muscle use \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: No edema/cyanosis, pulses intact DP bilaterally \n\nDISCHARGE PHYSICAL EXAM\nVitals - T 97.6 BP 123/84 HR 92 RR 24 O2 99%RA \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, dry MM, oropharynx clear, no \nconjunctival palor \nNeck: supple, JVP not elevated \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: irregular rhythm, normal rate, normal S1 + S2, no murmurs, \nrubs, gallops \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, difficult to assess for HSM \nas patient was coughing during exam and abdominal muscles were \ncontracted \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSkin: ecchymosis on upper extremities, chronic \nNeuro: CNII-XII grossly intact, impaired sensation in lower \nextremities', 'diagnoses': [{'icd_code': '5119', 'desc': 'Unspecified pleural effusion'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '7944', 'desc': 'Nonspecific abnormal results of function study of kidney'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '5693', 'desc': 'Hemorrhage of rectum and anus'}, {'icd_code': '4556', 'desc': 'Unspecified hemorrhoids without mention of complication'}, {'icd_code': '1749', 'desc': 'Malignant neoplasm of breast (female), unspecified'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': "==============\nADMISSION LABS\n==============\n___ 12:55PM BLOOD WBC-5.5 RBC-3.07* Hgb-10.2* Hct-30.4* \nMCV-99* MCH-33.2* MCHC-33.6 RDW-15.2 Plt ___\n___ 12:55PM BLOOD Neuts-85.0* Lymphs-8.8* Monos-4.7 Eos-0.9 \nBaso-0.6\n___ 12:55PM BLOOD ___ PTT-29.9 ___\n___ 12:55PM BLOOD Glucose-112* UreaN-25* Creat-1.5* Na-137 \nK-4.4 Cl-108 HCO3-20* AnGap-13\n___ 12:55PM BLOOD proBNP-2838*\n___ 12:55PM BLOOD cTropnT-0.02*\n___ 03:14PM BLOOD Lactate-1.6\n\n==============\nPERTINENT LABS\n==============\n___ 07:05AM BLOOD Ret Aut-4.0*\n___ 12:55PM BLOOD cTropnT-0.02*\n___ 07:05AM BLOOD CK-MB-4 cTropnT-0.03*\n___ 12:45PM BLOOD cTropnT-0.02*\n___ 07:05AM BLOOD Hapto-113\n\nB12 normal\nVitamin D normal\n\n==============\nMIRCO\n==============\n___ BCx x2 pending\n\n==============\nIMAGING\n==============\n___ CXR \nIMPRESSION: Small bilateral effusions, larger than remote prior \nstudy. \nOtherwise, no visualized acute cardiopulmonary process. \n\n==============\nDISCHARGE LABS\n==============\n\n___ 01:55PM BLOOD WBC-8.3# RBC-3.33* Hgb-10.7* Hct-33.6* \nMCV-101* MCH-32.0 MCHC-31.7 RDW-15.6* Plt ___\n___ y/o male with a past medical history of Afib on pradaxa, \ncrohn's disease, hypogammaglobulinemia, CHF, anemia, ___ \nesophagus and h/o prostate cancer who presents from SNF with \nanemia. Hospital course is outlined below by problem:\n\nACUTE ISSUES\n\n# Anemia, chronic blood loss: Patient was referred to the ED by \nhis primary care doctor due to his worsening anemia. On ___ \npatient's Hct was 25, down from his baseline of around 37-40. \n___ also reported worsening fatigue and dyspnea on exertion. \nDenied nausea, vomiting or hematochezia, however reported dark \nstools which was chronic given iron supplementation. In the ED, \nHct was 30 and patient was admitted for monitoring. His pradaxa \nand aspirin were held. Patient was hemodynamically stable and \nhis Hct was monitored and stable. Retic index was 2.0. \nHaptoglobin was normal. A B12 level was checked given \nmacrocytosis and was normal. GI was consulted due to the \nconcern for an UGIB v. LGIB. A colonoscopy was performed on ___ \nand showed diverticulosis but no active bleed. Outpatient EGD \nwas recommended\n\n# Potential GI bleed: Given the patient's anemia, history of \nCrohn's disease, ___ esophagus, and chronic \nanticoagulation for his atrial fibrillation, GI was consulted to \nevaluate for a GI bleed. Patient reported dark stools, which was \nchronic and unchanged. A colonoscopy was performed on ___ and \nshowed diverticulosis. No source of bleeding was identified. GI \nrecommended considering an EGD +/- capsule endoscopy as an \noutpatient. He has close f/u with his primary \ngastroenterologist.\n \n# Dyspnea: Patient complained of dyspnea which was primarily \nassociated with his cough. He was recently hospitalized for \ninfluenza which was followed by a pneumonia. He was treated with \nantibiotics and antitussive agents. A CXR was performed on \nadmission which showed small bilateral pleural effusions, \nhowever no focal consolidation. Dyspnea was most likely related \nto a post-viral reactive airway process combined with an anemia. \nHe received nebs as needed and scheduled antitussive \nmedications. His home Lasix was continued. \n\nCHRONIC ISSUES \n\n# Chronic diastolic CHF: Diastolic, EF 55% ___, on lasix. \nPleural effusions only slightly increased from ___, BNP below \nbaseline. He was continued on his lasix 40 mg daily. \n \n# Afib: CHADS 2 (age, CHF). Patient's pradaxa and aspirin were \nheld on admission due to concern for GIB. His pradaxa and \naspirin were held due to the concern for bleeding. His \nmedications were restarted after a negative colonoscopy. Would \nrecommend reconsidering the long term benefits v. risks of \nanticoagulation. \n\n# CKD II: Cr was 1.5 on admission and was stable. \n\n# Crohn's disease: Patient has been on mesalamine for years. No \nrecent flares. GI recommended that we consider changing \nmesalamine to pentasa given distribution of disease. We will \ndefer that decision to his outpatient gastroenterologist. \n \n# BPH: His tamsulosin and finasteride were continued. \n \nTRANSITIONAL ISSUES\n- consider outpatient EGD +/- capsule endoscopy \n- repeat CBC, CMP on ___\n- consider changing atenolol to metoprolol given renal function\n- restarted anticoagulation, consider the long-term benefits v. \nrisk of chronic anticoagulation in the setting of anemia\n- B12 and Vitamin D were pending at discharge"}}
{'final_diagnoses': ['anemia', 'cough', 'atrial fibrillation'], 'procedures': ['___ EGD/colonoscopy'], 'visit_summary': "___ y/o male with a past medical history of Afib on pradaxa, \ncrohn's disease, hypogammaglobulinemia, CHF, anemia, ___ \nesophagus and h/o prostate cancer who presents from SNF with \nanemia. Hospital course is outlined below by problem:\n\nACUTE ISSUES\n\n# Anemia, chronic blood loss: Patient was referred to the ED by \nhis primary care doctor due to his worsening anemia. On ___ \npatient's Hct was 25, down from his baseline of around 37-40. \n___ also reported worsening fatigue and dyspnea on exertion. \nDenied nausea, vomiting or hematochezia, however reported dark \nstools which was chronic given iron supplementation. In the ED, \nHct was 30 and patient was admitted for monitoring. His pradaxa \nand aspirin were held. Patient was hemodynamically stable and \nhis Hct was monitored and stable. Retic index was 2.0. \nHaptoglobin was normal. A B12 level was checked given \nmacrocytosis and was normal. GI was consulted due to the \nconcern for an UGIB v. LGIB. A colonoscopy was performed on ___ \nand showed diverticulosis but no active bleed. Outpatient EGD \nwas recommended\n\n# Potential GI bleed: Given the patient's anemia, history of \nCrohn's disease, ___ esophagus, and chronic \nanticoagulation for his atrial fibrillation, GI was consulted to \nevaluate for a GI bleed. Patient reported dark stools, which was \nchronic and unchanged. A colonoscopy was performed on ___ and \nshowed diverticulosis. No source of bleeding was identified. GI \nrecommended considering an EGD +/- capsule endoscopy as an \noutpatient. He has close f/u with his primary \ngastroenterologist.\n \n# Dyspnea: Patient complained of dyspnea which was primarily \nassociated with his cough. He was recently hospitalized for \ninfluenza which was followed by a pneumonia. He was treated with \nantibiotics and antitussive agents. A CXR was performed on \nadmission which showed small bilateral pleural effusions, \nhowever no focal consolidation. Dyspnea was most likely related \nto a post-viral reactive airway process combined with an anemia. \nHe received nebs as needed and scheduled antitussive \nmedications. His home Lasix was continued. \n\nCHRONIC ISSUES \n\n# Chronic diastolic CHF: Diastolic, EF 55% ___, on lasix. \nPleural effusions only slightly increased from ___, BNP below \nbaseline. He was continued on his lasix 40 mg daily. \n \n# Afib: CHADS 2 (age, CHF). Patient's pradaxa and aspirin were \nheld on admission due to concern for GIB. His pradaxa and \naspirin were held due to the concern for bleeding. His \nmedications were restarted after a negative colonoscopy. Would \nrecommend reconsidering the long term benefits v. risks of \nanticoagulation. \n\n# CKD II: Cr was 1.5 on admission and was stable. \n\n# Crohn's disease: Patient has been on mesalamine for years. No \nrecent flares. GI recommended that we consider changing \nmesalamine to pentasa given distribution of disease. We will \ndefer that decision to his outpatient gastroenterologist. \n \n# BPH: His tamsulosin and finasteride were continued. \n \nTRANSITIONAL ISSUES\n- consider outpatient EGD +/- capsule endoscopy \n- repeat CBC, CMP on ___\n- consider changing atenolol to metoprolol given renal function\n- restarted anticoagulation, consider the long-term benefits v. \nrisk of chronic anticoagulation in the setting of anemia\n- B12 and Vitamin D were pending at discharge", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath', 'Benzonatate 100 mg PO TID', 'Docusate Sodium 100 mg PO BID', 'Finasteride 5 mg PO DAILY', 'Furosemide 40 mg PO DAILY', 'Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY', 'Mesalamine 500 mg PO TID', 'Senna 8.6 mg PO HS', 'Tamsulosin 0.8 mg PO HS', 'Aspirin 40.5 mg PO DAILY', 'Atenolol 50 mg PO DAILY', 'Calcium Carbonate 1500 mg PO DAILY', 'Dabigatran Etexilate 150 mg PO BID', 'DuoNeb (ipratropium-albuterol) 0.5 mg-3 mg(2.5 mg base)/3 mL \ninhalation QID', 'Ferrous GLUCONATE 324 mg PO BID', 'Milk of Magnesia 30 mL PO Q6H:PRN constipation', 'Multivitamins 1 TAB PO DAILY', 'Potassium Chloride 20 mEq PO DAILY', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \ninhalation daily', 'Vitamin D 800 UNIT PO DAILY', 'Cheratussin AC (codeine-guaifenesin) ___ mg/5 mL oral QID \nprn cough']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'arrhythmia', 'medical_history': ['DM (Hg A1c 8.1, ___', 'Chronic renal insufficiency (3.0+)', 'Chronic lower back pain', 'L wrist tenosynovitis (started in ___), s/p carpel tunnel \nrelease ___', 'HTN', 'Hepatitis C (with high viral load)', 'GERD', 'MI (based on ECG)', 'Hyperuricemia', 'Obstructive sleep apnea'], 'family_history': 'Mother ___ y.o. and has diabetes; father died at ___, had an MI at \n___', 'present_illness': '___ yo recently discharged from cellulitis (diabetic ulcers). \nSwitched from bactrim to doxycycline yesterday. Took a dose \ntoday and an hour or two afterwards noticed the acute onset of \npalpitations, LH, weakness, tingling of bil hands, and slight \nSOB. He took his BP which showed systolic 127 but HR in the \n120s. He also noticed substernal/epigastric CP, which he \nassociated with his chronic GERD symptoms. The CP did not \nradiate, he had mild nausea, and the CP went away in the ED. The \npalpitations continued intermittently in the ED. In the ED, EKG: \njunctional rhythm at 127, then sinus with fluid. Then back in \njunctional rhythm. He was given IV metoprolol 5mg which improved \nhis rate to the ___. Seen by cards fellow. Denies new focal \nsources of infection. Reports constipation.', 'medications': [{'medication': 'Methocarbamol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'ranolazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '41.9', 'valuenum': 41.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '302', 'valuenum': 302.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.78', 'valuenum': 4.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.2,. Estimated GFR = 57 if non African-American (mL/min/1.73 m2). Estimated GFR = 69 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: 98.3 181/82 62 20 100%RA \nGEN: Well-appearing, NAD \nHEENT: Sclera anicteric, EOMI, MMD \nNECK: Supple, no LAD, no elevated JVD \nCV: RRR, ___ SEM > at LUSB, radiates to left carotid \nPULM: CTAB, no W/R/R \nABD: Soft, NT, ND, +BS \nEXT: legs wrapped bilaterally - c/d/i. ___ ___ edema. right hand \nswelling. \nNEURO: AAOx3, CN II-XII grossly intact, moving all extremities \nwell', 'diagnoses': [{'icd_code': '72210', 'desc': 'Displacement of lumbar intervertebral disc without myelopathy'}, {'icd_code': '73679', 'desc': 'Other acquired deformities of ankle and foot'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}], 'summary': "___ 01:20PM CK(CPK)-74\n___ 01:20PM CK-MB-NotDone cTropnT-0.26*\n___ 07:35AM GLUCOSE-55* UREA N-51* CREAT-3.4* SODIUM-143 \nPOTASSIUM-4.0 CHLORIDE-106 TOTAL CO2-29 ANION GAP-12\n___ 07:35AM CK(CPK)-72\n___ 07:35AM CK-MB-NotDone cTropnT-0.29*\n___ 07:35AM CALCIUM-8.1* PHOSPHATE-3.5 MAGNESIUM-1.8\n___ 07:35AM TSH-0.66\n___ 07:35AM WBC-7.7 RBC-3.56* HGB-10.3* HCT-31.8* MCV-89 \nMCH-28.8 MCHC-32.3 RDW-15.2\n___ 07:35AM PLT COUNT-202\n___ 07:59PM LACTATE-1.5 K+-4.6\n___ 07:50PM GLUCOSE-89 UREA N-49* CREAT-3.5* SODIUM-141 \nPOTASSIUM-4.1 CHLORIDE-102 TOTAL CO2-26 ANION GAP-17\n___ 07:50PM CK(CPK)-75\n___ 07:50PM cTropnT-0.09*\n___ 07:50PM CK-MB-3\n___ 07:50PM NEUTS-84.1* LYMPHS-10.4* MONOS-5.0 EOS-0.2 \nBASOS-0.2\n___ 07:50PM PLT COUNT-209\n \nCXR ___ dictation: \nno acute cardiopulm process, stable cardiomegaly \n. \nEKG in ED: dissociation between p waves and QRS complexes c/w \ncomplete heart block. T-wave inversion in III. \n. \nEKG on floor: NSR rate 64bpm. nl axis. slight depression in III \nwith T-wave back upright (consistent with ___ EKG), J-point in \nV2-3 (seen previously).\nRhythm: Pt's symptoms of palipitations, light-headedness, SOB \nand HR 120s was attributed to Atrial Tachycardia. Pt's AT was \nfound to be responsive to vagal maneuvers and pt was taught \nvalsavla to return him to normal rhythm. Pt's atenolol was \ninitially increased from 100 to 150mg, however pt intermittently \nwas continuing to become tachycardic. His atenolol was then \nincreased to 200mg QD. On day of dishcarge was no longer \ntachycardic. Pt was also reassured that doxcycycline was not \ncause of atrial tachycardia, and that he should continue taking \nit for his cellulitis.\n\nHTN: Pt's BP was increased during admission 170-190s systolic, \nand increased losartan from 100mg to 125mg QD\n\nPump: Hyperdynamic LV with EF 75% by last ECHO. Not fluid \noverloaded by exam. Pt was continued on ___, diuretics \n \nCAD: Has Q waves on EKG to suggest previous MI. Elevated trop \nlikely from renal failure, normal MB. Incr CE due to mismatch of \nsupply and demand from tachycardia, and does not represent ACS. \nPt ___. No chest pain currently. \n \nCRI: Pt's baseline is > 3.0. Currently 3.5. \n \nDM: Stable on ISS \n \nCellulitis: Pt was recently discharged on Bactrim. Did not \ntolerate so placed on doxycycline. Vascular surgery saw pt and \nrecommended only to follow up with ___ clinic as prevously \nscheduled since dressing changes were weely. \n \nGout: Pt had right hand discomfort which was consistent with his \nprevious gout attacks, likely explaination for the edema of his \nright hand. Was not receiving colchicine during recent admission \nper patient report. Could also be exacerbated by changes in \ndiuretics. Pain was stable on discharge.\n\nSleep apnea: Pt was stable on CPAP"}}
{'final_diagnoses': ['Atrial tachycardia', 'hypertensive urgency', 'bilataral cellulitis', 'diabetes', 'chronic renal insufficiency', 'chronic lower back pain', 'hypertension', 'hepatitis C', 'GERD', 'old myocardial infarction based on EKG', 'obstructive sleep apnea', 'hyperuricemia'], 'procedures': ['None'], 'visit_summary': "Rhythm: Pt's symptoms of palipitations, light-headedness, SOB \nand HR 120s was attributed to Atrial Tachycardia. Pt's AT was \nfound to be responsive to vagal maneuvers and pt was taught \nvalsavla to return him to normal rhythm. Pt's atenolol was \ninitially increased from 100 to 150mg, however pt intermittently \nwas continuing to become tachycardic. His atenolol was then \nincreased to 200mg QD. On day of dishcarge was no longer \ntachycardic. Pt was also reassured that doxcycycline was not \ncause of atrial tachycardia, and that he should continue taking \nit for his cellulitis.\n\nHTN: Pt's BP was increased during admission 170-190s systolic, \nand increased losartan from 100mg to 125mg QD\n\nPump: Hyperdynamic LV with EF 75% by last ECHO. Not fluid \noverloaded by exam. Pt was continued on ___, diuretics \n \nCAD: Has Q waves on EKG to suggest previous MI. Elevated trop \nlikely from renal failure, normal MB. Incr CE due to mismatch of \nsupply and demand from tachycardia, and does not represent ACS. \nPt ___. No chest pain currently. \n \nCRI: Pt's baseline is > 3.0. Currently 3.5. \n \nDM: Stable on ISS \n \nCellulitis: Pt was recently discharged on Bactrim. Did not \ntolerate so placed on doxycycline. Vascular surgery saw pt and \nrecommended only to follow up with ___ clinic as prevously \nscheduled since dressing changes were weely. \n \nGout: Pt had right hand discomfort which was consistent with his \nprevious gout attacks, likely explaination for the edema of his \nright hand. Was not receiving colchicine during recent admission \nper patient report. Could also be exacerbated by changes in \ndiuretics. Pain was stable on discharge.\n\nSleep apnea: Pt was stable on CPAP", 'medications_prescribed': ['Chlorthalidone 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) \nSpray Nasal BID (2 times a day).', 'Atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Colchicine 0.6 mg Tablet Sig: One (1) Tablet PO EVERY OTHER \nDAY (Every Other Day).', 'Methylprednisolone 8 mg Tablet Sig: 1.5 Tablets PO QAM (once \na day (in the morning)).', 'Latanoprost 0.005 % Drops Sig: One (1) Drop Ophthalmic HS (at \nbedtime).', 'Ipratropium Bromide 17 mcg/Actuation Aerosol Sig: Two (2) \nPuff Inhalation Q4H (every 4 hours) as needed for SOB.', 'Timolol Maleate 0.5 % Drops Sig: One (1) Drop Ophthalmic \nDAILY (Daily).', 'Torsemide 20 mg Tablet Sig: Two (2) Tablet PO BID (2 times a \nday).', 'Prazosin 5 mg Capsule Sig: One (1) Capsule PO BID (2 times a \nday).', 'Morphine 15 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO Q8H (every 8 hours).', 'Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed.', 'Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO \nQ12H (every 12 hours).', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).', 'Clonidine 0.3 mg/24 hr Patch Weekly Sig: One (1) Patch \nWeekly Transdermal QTHUR (every ___.', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID \n(2 times a day).', 'Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).', 'Losartan 50 mg Tablet Sig: 2.5 Tablets PO DAILY (Daily).\nDisp:*75 Tablet(s)* Refills:*2*', 'Atenolol 100 mg Tablet Sig: Two (2) Tablet PO once a day.\nDisp:*60 Tablet(s)* Refills:*2*', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 47, 'gender': 'F', 'symptoms': 'Choledocholithiasis', 'medical_history': ['Gallstones', 'Seasonal allergies', 'Diabetes type ___', 'Fibroids'], 'family_history': 'No family members with diabetes or gallstones.', 'present_illness': "Ms. ___ is a ___ w/ delayed development and DMII who was \nhospitalized at ___ in ___ with epigastric \npain, nausea/vomiting, and inability to tolerate PO, found to \nhave cholelithiasis and choledocholithiasis with biliary ductal \ndilation. She underwent an ERCP, sphincterotomy and stone \nextraction and then returned to the hospital a few days later \nwith the same symptoms as well as subjective fevers and was \nfound to have elevated LFTs. She was transferred to ___ where \nrepeat ERCP showed multiple stones and sludge with pus built up \nin the common bile duct. Balloon sweeps were performed and a \nplastic stent was placed. The patient was discharged home on \n___ on cipro and pantoprazole and was scheduled to follow up \nwith Dr. ___ cholecystectomy and Dr. ___ stent \nremoval after cholecystectomy.\n\nAt her most recent clinic visit with Dr. ___ in ___, Ms. \n___ had no ___ complaints or \nfevers/chills/jaundice, and her abdomen was soft, nontender, \nnondistended. The decision was made for a laparoscopic \ncholecystectomy to prevent recurrence. There was some concern \nfor Mirizzi Syndrome, which if present would require a biliary \nbypass in addition to cholecystectomy, but the radiology re-read \nof the ___ did not indicate that that would be necessary. The \npatient's mother (HCP) was consented for laparoscopic \ncholecystectomy and expressed understanding and agreement with \nthe plan to proceed.", 'medications': [{'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+.'}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '<1', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Hazy', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '<1', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90.1', 'valuenum': 90.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.60', 'valuenum': 3.6, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '223', 'valuenum': 223.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: 98.6 / HR 106 / BP 112/64 / RR 18 / 99%RA\nGeneral: comfortable, no acute distress, developmental delay\nHEENT: normocephalic/atraumatic, moist mucous membranes\nNeck: supple, no thyromegaly\nCardiovascular: regular rate/rhythm, no murmurs/rubs/gallops\nPulmonary: clear to auscultation bilaterally\nAbdomen: incision C/D/I, drain removed, drain site intact, soft, \nappropriately tender, nondistended\nGU: no CVAT\nExtremities: warm and well-perfused\nNeuro: A&OX3', 'diagnoses': [{'icd_code': '7907', 'desc': 'Bacteremia'}, {'icd_code': '481', 'desc': 'Pneumococcal pneumonia [Streptococcus pneumoniae pneumonia]'}, {'icd_code': '5119', 'desc': 'Unspecified pleural effusion'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '04109', 'desc': 'Streptococcus infection in conditions classified elsewhere and of unspecified site, other streptococcus'}, {'icd_code': '04189', 'desc': 'Other specified bacterial infections in conditions classified elsewhere and of unspecified site, other specified bacteria'}, {'icd_code': '78609', 'desc': 'Other respiratory abnormalities'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '7098', 'desc': 'Other specified disorders of skin'}], 'summary': "Lab work:\n___\nRadiology ___:\n\nTECHNIQUE: Portable abdominal radiograph.\n \nCOMPARISON: Abdominal radiograph from ___.\n\nIMPRESSION: \n \nMildly prominent loops of bowel in the left upper quadrant but \nno definite\nevidence of obstruction. No radiopaque common bile duct stent \nidentified.\n \nSmall calcifications project over the right eleventh rib. Given \nthe history of a partial cholecystectomy, these may reflect \nresidual calculi.\nMs. ___ was admitted to the ___ Service on ___ \nafter laparoscopic converted to open subtotal cholecystectomy. \nThe procedure was converted to open due to prior inflammation \ncomplicating the dissection. For full details of the procedure, \nplease see the operative report. Intra-operatively, the patient \nhad a drain placed in the gallbladder fossa. Ms. ___ tolerated \nthe procedure well, remained hemodynamically stable in the PACU, \nwas started on IV toradol for pain control, and was transferred \nto the floor in stable condition. Due to the patient's history \nof developmental delay, pain control was discussed with her \nmother and it was decided that an epidural and/or dilaudid PCA \nwould not be appropriate for the patient, and that PO pain \nmedications prn would be the best method.\n\nAt post-op check on HD 0, Ms. ___ appeared comfortable, the \nabdominal incision was clean/dry/intact, and the drain output \nwas serosanguinous, and her diet was advanced as tolerated to \nregular. Her Foley had been removed and she voided successfully, \nalthough incontinent. On HD 1, the patient's mother reported \nthat she was in some mild discomfort due to abdominal incisional \npain, and the patient's PO oxycodone prn regimen was increased \nin frequency, as well as breakthrough medication. The patient \nreported improved comfort afterwards and the drain was \nserosanguinous. The patient tolerated a regular diet with one \nepisode of emesis, the patient and her mother were encouraged to \nslow down her PO intake and request anti-emetic medication as \nneeded, and the patient was HLIV. The patient ambulated \nindependently. On HD 2, the patient's dressings were removed, \nthe incision was C/D/I, and the drain continued to be \nserosanguinous and minimal. The patient reported passing flatus, \nand was started on a bowel regimen. A KUB was obtained, which \ndemonstrated that no stent was present in the CBD or elsewhere \nin the bowel. The patient did have another bout of emesis, and \nwas backed down to clears. On HD 3, the patient reported having \nno nausea/vomiting, and reportedly passed flatus and having BM, \nand so the diet was advanced to regular, which the patient \ntolerated. The patient continued to ambulate independently and \nher pain was controlled. She remained hemodynamically stable \nthroughout the hospital course. The KUB results were explained \nto the mother and she expressed understanding that a repeat ERCP \nwas no longer necessary to remove the stent. The drain output \nwas minimal and it was removed prior to discharge, and a dry \ndressing was placed, the incision was C/D/I. The patient's pain \nwas well-controlled with PO oxycodone, and she was discharged \nwith a prescription for that as well as a bowel regimen. \n\nDuring this hospitalization, the patient ambulated early and \nfrequently, was adherent with respiratory toilet and incentive \nspirometry, and actively participated in the plan of care. The \npatient received subq heparin and venodyne boots were used \nduring this stay. The patient's blood sugar was monitored \nregularly throughout the stay. Lab work was routinely followed; \nelectrolytes were repleted when indicated.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient and her mother received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan. The patient \nwill follow-up with Dr. ___ in clinic in 2 weeks, and does not \nrequire any further follow-up with Dr. ___ as the CBD stent \nis no longer present. The patient and her mother (HCP) expressed \nunderstanding and agreed to proceed with the plan."}}
{'final_diagnoses': ['Choledocholithiasis', 'Cholelithiasis', 'Diabetes Type II', 'Developmental Delay'], 'procedures': ['Laparoscopic converted to open subtotal cholecystectomy'], 'visit_summary': "Ms. ___ was admitted to the ___ Service on ___ \nafter laparoscopic converted to open subtotal cholecystectomy. \nThe procedure was converted to open due to prior inflammation \ncomplicating the dissection. For full details of the procedure, \nplease see the operative report. Intra-operatively, the patient \nhad a drain placed in the gallbladder fossa. Ms. ___ tolerated \nthe procedure well, remained hemodynamically stable in the PACU, \nwas started on IV toradol for pain control, and was transferred \nto the floor in stable condition. Due to the patient's history \nof developmental delay, pain control was discussed with her \nmother and it was decided that an epidural and/or dilaudid PCA \nwould not be appropriate for the patient, and that PO pain \nmedications prn would be the best method.\n\nAt post-op check on HD 0, Ms. ___ appeared comfortable, the \nabdominal incision was clean/dry/intact, and the drain output \nwas serosanguinous, and her diet was advanced as tolerated to \nregular. Her Foley had been removed and she voided successfully, \nalthough incontinent. On HD 1, the patient's mother reported \nthat she was in some mild discomfort due to abdominal incisional \npain, and the patient's PO oxycodone prn regimen was increased \nin frequency, as well as breakthrough medication. The patient \nreported improved comfort afterwards and the drain was \nserosanguinous. The patient tolerated a regular diet with one \nepisode of emesis, the patient and her mother were encouraged to \nslow down her PO intake and request anti-emetic medication as \nneeded, and the patient was HLIV. The patient ambulated \nindependently. On HD 2, the patient's dressings were removed, \nthe incision was C/D/I, and the drain continued to be \nserosanguinous and minimal. The patient reported passing flatus, \nand was started on a bowel regimen. A KUB was obtained, which \ndemonstrated that no stent was present in the CBD or elsewhere \nin the bowel. The patient did have another bout of emesis, and \nwas backed down to clears. On HD 3, the patient reported having \nno nausea/vomiting, and reportedly passed flatus and having BM, \nand so the diet was advanced to regular, which the patient \ntolerated. The patient continued to ambulate independently and \nher pain was controlled. She remained hemodynamically stable \nthroughout the hospital course. The KUB results were explained \nto the mother and she expressed understanding that a repeat ERCP \nwas no longer necessary to remove the stent. The drain output \nwas minimal and it was removed prior to discharge, and a dry \ndressing was placed, the incision was C/D/I. The patient's pain \nwas well-controlled with PO oxycodone, and she was discharged \nwith a prescription for that as well as a bowel regimen. \n\nDuring this hospitalization, the patient ambulated early and \nfrequently, was adherent with respiratory toilet and incentive \nspirometry, and actively participated in the plan of care. The \npatient received subq heparin and venodyne boots were used \nduring this stay. The patient's blood sugar was monitored \nregularly throughout the stay. Lab work was routinely followed; \nelectrolytes were repleted when indicated.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and pain was well \ncontrolled. The patient and her mother received discharge \nteaching and follow-up instructions with understanding \nverbalized and agreement with the discharge plan. The patient \nwill follow-up with Dr. ___ in clinic in 2 weeks, and does not \nrequire any further follow-up with Dr. ___ as the CBD stent \nis no longer present. The patient and her mother (HCP) expressed \nunderstanding and agreed to proceed with the plan.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H', 'Docusate Sodium 100 mg PO BID', 'OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN Pain - \nModerate \nRX *oxycodone 5 mg 1 tablet(s) by mouth Q4H:PRN Disp #*20 Tablet \nRefills:*0', 'Senna 8.6 mg PO DAILY', 'Loratadine 10 mg PO DAILY', 'Lovastatin 40 mg oral DAILY', 'NovoLOG Mix 70-30 (insulin asp prt-insulin aspart) ___ \nunits subcutaneous QAM/QDinner', 'Pantoprazole 40 mg PO Q12H']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 30, 'gender': 'F', 'symptoms': 'syncope', 'medical_history': ['ANOREXIA NERVOSA', 'GASTROPARESIS - gastric study ___, previous dependence on GJ \ntube', 'HX OF ___ TEAR & PNEUMONMEDIASTINUM', 'ANEMIA', 'ORTHOSTASIS', 'AUTONOMIC NEUROPATHY', 'BRADYCARDIA / CARDIAC ARRHYTHMIA'], 'family_history': '- Father with eating disorder\n- Mother with alcoholism, ___ years sober, used heroin + other \nsubstances', 'present_illness': 'Ms. ___ is a ___ yo female here with weakness and syncope in \nthe setting of eating disorder relapse.\n\nPt reports that she had a relapse of her eating disorder several \nweeks ago. She flew up from ___ to get treatment and was \nhospitalized in ___ for starvation ketoacidosis and \nelectrolyte abnormalities. She was then admitted to ___ and \nhad a feeding tube placed 2 weeks ago. However, for the past \nweek, pt has been shutting off her feeds, and finally yesterday \ngot tired of treatment and left AMA. While at ___, she \nreports she had frequent falls, but did not think they were \nconcerning. This morning, she had a syncopal episode this \nmornign when getting out of bed. She presented to the ED to get \nhydrated, and is surprised that she was admitted. \n\nIn the ED, initial vitals: 99.2 110 112/48 18 100%. Labs were \nnotable for a stable anemia with hct 30, cr 0.6, normal LFT and \nlipase, UA pending. She had a CXR, which was unrevealing. Her \nEKG showed TWI in V1-V3, unchanged from prior. Vitals prior to \ntransfer: 98.1 76 107/59 17 99% RA.\n\nOn arrival to the floor, pt was evaluted by nutrition and agreed \nto the eating disorder protocol.\n\nCurrently, pt states she will refuse to eat dinner. States she \nwill tolerate a feeding tube. Does not want her rights taken \naway from her.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': 'NEG', 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.027', 'valuenum': 1.027, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81.1', 'valuenum': 81.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '239', 'valuenum': 239.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals- 98.1 110/57 -> 78/44 on standing 99-> 102 16 99% RA\nGeneral- Alert, oriented, no acute distress \nHEENT- Sclera anicteric, dry mucous membranes, oropharynx clear \n\nNeck- supple, JVP not elevated, no LAD \nLungs- CTAB no wheezes, rales, rhonchi \nCV- RRR, Nl S1, S2, No MRG \nAbdomen- soft, NT/ND bowel sounds present, no rebound tenderness \nor guarding, no organomegaly \nGU- no foley \nExt- warm, well perfused, 2+ pulses, non pitting edema\nNeuro- CNs2-12 intact, motor function grossly normal \n\nDISCHARGE PHYSICAL EXAM\nPHYSICAL EXAM:\nVS: 98.0 - 91/51 - ___ - ___ - 99RA\northostatics: none yet this morning\nweight 74.6<-- 73.4 <- 74 <-- 73.8 kg <-- weight 74.3 <-- \n74.8kg\nGeneral- awake, alert, NAD\nHEENT- Sclera anicteric, MMM, NG tube in place w dressing intact\nNeck- supple, JVP not elevated, no LAD \nLungs- CTAB no wheezes, rales, rhonchi \nCV- RRR, Nl S1, S2, No MRG \nAbdomen- soft, NT/ND bowel sounds present, no rebound or \nguarding \nExt- warm, well perfused, 2+ pulses, no edema\nNeuro- face symmetric, speech fluent, moves all extremities', 'diagnoses': [{'icd_code': '5409', 'desc': 'Acute appendicitis without mention of peritonitis'}], 'summary': '___ 12:20PM BLOOD WBC-8.3 RBC-3.29* Hgb-10.2* Hct-30.7* \nMCV-93 MCH-31.1 MCHC-33.3 RDW-13.6 Plt ___\n___ 12:20PM BLOOD Neuts-75.9* Lymphs-17.0* Monos-4.8 \nEos-2.0 Baso-0.4\n___ 12:20PM BLOOD Neuts-75.9* Lymphs-17.0* Monos-4.8 \nEos-2.0 Baso-0.4\n___ 12:20PM BLOOD Glucose-89 UreaN-13 Creat-0.6 Na-139 \nK-3.8 Cl-108 HCO3-19* AnGap-16\n___ 12:20PM BLOOD Glucose-89 UreaN-13 Creat-0.6 Na-139 \nK-3.8 Cl-108 HCO3-19* AnGap-16\n___ 12:20PM BLOOD Lipase-46\n___ 12:20PM BLOOD Albumin-3.5 Calcium-7.8* Phos-3.9 Mg-1.7\n___ 12:20PM BLOOD TSH-1.6\n___ 12:20PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-POS\n\nOTHER LABS\n===========\n___ 07:45AM BLOOD ___\n___ 07:45AM BLOOD VitB12-620\n___ 07:45AM BLOOD VitB12-620\n\nMICROBIOLOGY - ALL W/ MIXED BACTERIAL FLORA\n=============\n___ CULTURE-FINALINPATIENT\n___ CULTURE-FINALINPATIENT\n___\nBRIEF HOSPITAL COURSE\n=======================\n___ year old young lady with history of anorexia nervosa, \ngastroparesis presenting from home after leaving from ___ \n___ AMA with presyncope, now with legal appointed guardian, \ns/p dobhoff placement and initiation of tube feeds, with ongoing \northostatic hypotension. Her thorazine was stopped given concern \nabout orthostatic hypotension as a cause and she was \ntransitioned to ziprasidone. She was initially started on salt \ntabs but this was not found to be helpful. She was then started \non low dose midodrine. She continued to be orthostatic by the \ntime of discharge, but was dramatically improved compared to \nadmission, and was tolerating ambulation by the time of \ndischarge.'}}
{'final_diagnoses': ['Anorexia nervosa', 'Orthostatic hypotension', 'Urinary tract infection', 'Chronic urinary retention'], 'procedures': ['Placement of NG tube.'], 'visit_summary': 'BRIEF HOSPITAL COURSE\n=======================\n___ year old young lady with history of anorexia nervosa, \ngastroparesis presenting from home after leaving from ___ \n___ AMA with presyncope, now with legal appointed guardian, \ns/p dobhoff placement and initiation of tube feeds, with ongoing \northostatic hypotension. Her thorazine was stopped given concern \nabout orthostatic hypotension as a cause and she was \ntransitioned to ziprasidone. She was initially started on salt \ntabs but this was not found to be helpful. She was then started \non low dose midodrine. She continued to be orthostatic by the \ntime of discharge, but was dramatically improved compared to \nadmission, and was tolerating ambulation by the time of \ndischarge.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H:PRN pain', 'ClonazePAM 1 mg PO TID:PRN anxiety', 'ClonazePAM 1 mg PO BID', 'Docusate Sodium 100 mg PO HS', 'Fluvoxamine Maleate 150 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Sucralfate 1 gm PO QID', 'Zolpidem Tartrate 10 mg PO HS', 'Calcium Carbonate 500 mg PO TID', 'Magnesium Oxide 400 mg PO DAILY', 'Midodrine 2.5 mg PO TID', 'Multivitamins 1 TAB PO DAILY', 'Vitamin D 1000 UNIT PO DAILY', 'Promethazine 25 mg PO Q8H:PRN nausea', 'ChlorproMAZINE 25 mg PO TID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 60, 'gender': 'F', 'symptoms': 'Leg swelling', 'medical_history': ['Ulcerative colitis s/p colectomy ___', '___ - ___ liver biopsy which showed stage ___ fibrosis; \nsubsequently had another liver biopsy ___', 'Chylous Ascites', 'AIH on liver biopsy ___', 'Hypothyroidism', 'Rash - In ___ he developed bilateral knee pain and swelling \nas well as raised erythematous lesions on his legs. PCP made \ndiagnosis of likely HSP.', 'Celiac disease', 'Parastomal hernia'], 'family_history': 'Mother ___ BREAST CANCER \nFather ___ ___ MULTIPLE SCLEROSIS \nDaughter Living ___ \nSon Living ___ \nSister Living ___ ASTHMA \n HYPOTHYROIDISM \nBrother Living ___ ', 'present_illness': 'Mr. ___ is a ___ year old man with a past medical history of\nulcerative colitis s/p total colectomy with ileostomy for\nhigh-grade dysplasia, primary sclerosing cholangitis/autoimmune\nhepatitis overlap syndrome with cirrhosis (Child C, MELD-Na 21 \non\nadmission) decompensated by ascites (with SBP history) and\nvarices s/p TIPS (___) which was complicated by occlusion\ns/p revision (___), celiac disease, ampullary adenoma who\npresents with increasing abdominal distension, lower extremity\nedema, and lower extremity rash. \n\nThe patient was seen in liver clinic on ___. At this visit,\ndoppler ultrasound showed patent TIPS. He was started on\nbudesonide for treatment of celiac disease and prednisone was\ndiscontinued. About 10 days later, he began to note a rash on \nthe\ninner right thigh that progressed into both legs. The rash was\nred and was companied by significant lower extremity swelling. \n\nHe has noted three to four days of increased abdominal \ndistention\nand lower extremity edema despite increasing doses of amiloride.\nHe has no fevers, chills, nausea, vomiting, decreased appetite,\nor pain. \n\nIn the ED:\nInitial vitals: \nT 98.5 HR 82 BP 109/76 RR 20 SaO2 95% RA\n \nExam notable for:\n2+ edema through thighs, +ascites\nrash anterior shins b/l R>L\n\nLabs notable for:\nNa 133 K 3.7 Cl 94 BUN 25 Cr 1 Glc 102\nCa 8.3 Mg 1.8 Phos 3.4 \nALT 50 AST 85 AP 142 Bili 3.3 Alb 2.5\nCBC: 13.9>13.2/38.7<117\n___ 18.3 PTT 29.6 INR 1.7\n\nDiagnositic paracentesis was performed showing:\nTNC 1569, 38% poly = 596 poly, 12,226 RBC. \n\nImaging:\nBILATERAL LOWER EXTREMTIY DOPPLER ULTRASOUND\nBilateral deep venous thrombosis: In the right popliteal vein \nand\nin the proximal portion of 1 of the left posterior tibial veins. \n\n\nRUQ ULTRASOUND WITH DOPPLER\n1. Patent TIPS, with fluctuating TIPS velocities throughout the\nstudy. \n2. Cirrhotic liver without concerning lesions. \n3. Moderate ascites. \n\nCXR\nSmall to moderate left pleural effusion with overlying\natelectasis, underlying consolidation not excluded. \n\nPatient was given: No medications.\n\nOf note, Mr. ___ was recently admitted from ___\nfollowing TIPS for refractory ascites and esophageal varices.\nDuring this hospitalization, he was found to have chylous \nascites\nwith elevated triglycerides in the peritoneal fluid. Cytology \nwas\nnegative for malignancy. On ___ he was found to have a\nthrombosed TIPS and underwent TIPS revision on ___. \n\nOn interview, the patient confirms the above. He is feeling well\nwith the exception of leg swelling and rash. His breathing is\ncomfortable. He has no chest pain. Abdomen is moderately\ndistended but not painful. He has no nausea, vomiting, or\ndiarrhea. He is using the tube feeds at home - but does not use\nthem at night because he cannot sleep with them in. He has\nchanged the prednisone to budesonide as above but then decreased\nthe budesonide from 9mg daily to 6mg daily in discussion with \nDr.\n___. He has increased the diuretics because his abdomen felt\nmore distended as well in discussion with Dr. ___. \n\nA ten point review of systems was performed and negative except\nas noted above.', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAMINATION:\nVS: T 97.7 BP 118/78 HR 77 RR 18 SaO2 97% ra \nGENERAL: in no acute distress, alert and oriented \nHEENT: AT/NC, EOMI, PERRL, nonicteric sclerae \nNECK: supple, clean gauze over access site \nHEART: RRR, S1/S2, no murmurs, gallops, or rubs\nLUNGS: Diminished sounds at left lung base, otherwise clear to\nauscultation, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles\nABDOMEN: moderately distended, nontender in all quadrants, no\nrebound/guarding, band-aid over paracentesis site \nEXTREMITIES: 2+ lower extremity edema up to upper thighs, warm \nPULSES: 2+ DP pulses bilaterally\nNEURO: A&Ox3, moving all 4 extremities with purpose\nSKIN: warm and well perfused, erythematous diffuse rash over the\nlegs bilaterally\n\nDISCHARGE:\nvs: 99.3 PO 117 / 64 100 18 96 Ra \nGENERAL: resting comfortably in bed, in no acute distress,\nalert and oriented, pleasant and cooperative with exam\nHEENT: mild scleral icterus\nHEART: RRR, S1/S2, no murmurs, gallops, or rubs\nLUNGS: Breathing comfortably on room air. CTAB. No wheezes,\nrhonchi, crackles. \nABDOMEN: mild distension, typmanitic, soft to palpation, \nnontender in all\nquadrants, reducible periumbilical hernia\nEXTREMITIES: 2+ lower extremity edema up to knees, no pain to \npalpation, symmetric \nNEURO: A&Ox3, no asterixis\nSKIN: warm and well perfused, petechiae diffusely over bilateral\nlower extremities. ', 'diagnoses': [{'icd_code': '29623', 'desc': 'Major depressive affective disorder, single episode, severe, without mention of psychotic behavior'}, {'icd_code': '4373', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': '28800', 'desc': 'Neutropenia, unspecified'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '30590', 'desc': 'Other, mixed, or unspecified drug abuse, unspecified'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': '71696', 'desc': 'Arthropathy, unspecified, lower leg'}, {'icd_code': '7852', 'desc': 'Undiagnosed cardiac murmurs'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}], 'summary': "LABS\n====\n___ 03:57PM BLOOD WBC-13.9* RBC-3.98* Hgb-13.2* Hct-38.7* \nMCV-97 MCH-33.2* MCHC-34.1 RDW-17.0* RDWSD-60.4* Plt ___\n___ 06:28AM BLOOD WBC-10.4* RBC-3.10* Hgb-10.3* Hct-30.1* \nMCV-97 MCH-33.2* MCHC-34.2 RDW-17.2* RDWSD-60.4* Plt ___\n___ 04:21PM BLOOD ___ PTT-29.6 ___\n___ 06:28AM BLOOD ___ PTT-35.0 ___\n___ 05:43AM BLOOD Ret Aut-3.6* Abs Ret-0.11*\n___ 03:57PM BLOOD Glucose-102* UreaN-25* Creat-1.0 Na-133* \nK-3.7 Cl-94* HCO3-26 AnGap-13\n___ 06:28AM BLOOD Glucose-83 UreaN-15 Creat-0.6 Na-131* \nK-3.7 Cl-96 HCO3-26 AnGap-9*\n___ 03:57PM BLOOD ALT-50* AST-85* LD(LDH)-264* AlkPhos-142* \nTotBili-3.3* DirBili-2.1* IndBili-1.2\n___ 05:47AM BLOOD ALT-30 AST-58* AlkPhos-81 TotBili-2.2*\n___ 06:28AM BLOOD ALT-39 AST-84* TotBili-2.8*\n___ 03:57PM BLOOD Albumin-2.5* Calcium-8.3* Phos-3.4 Mg-1.8\n___ 06:28AM BLOOD Albumin-2.7* Calcium-7.9* Phos-2.4* \nMg-1.6\n___ 05:47AM BLOOD calTIBC-116* Ferritn-420* TRF-89*\n___ 03:57PM BLOOD Triglyc-54\n___ 03:57PM BLOOD IgA-301\n___ 03:57PM BLOOD tTG-IgA-59*\n\nASCITES \nASCITES ANALYSIS TNC RBC Polys Lymphs Monos \n___ 19:00 1569* ___ 38* 29* 33* \nPERITONEAL FLUID \n\nASCITES CHEMISTRY TotPro Glucose LD(LDH) Amylase TotBili Albumin \n Triglyc \n___ 19:00 2.2 117 100 37 1.2 <1 \n 1351 \n\nMICRO\n=====\n___ 7:00 pm PERITONEAL FLUID PERITONEAL FLUID. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n FLUID CULTURE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH. \n\nIMAGING\n=========\nB/l ___ ___\nIMPRESSION: \nBilateral deep venous thrombosis: In the right popliteal vein \nand in the \nproximal portion of 1 of the left posterior tibial veins. \n\nAbd US ___\nIMPRESSION: \n1. Patent TIPS, with velocities as above. \n2. Cirrhotic liver without concerning lesions. \n3. Moderate ascites. \n \nLymphangiogram ___\nFINDINGS: \n \n1. Brisk flow of lympahtics from the groin nodes to the level of \nthe cisterna \nchyli. \n2. Cisterna chyli lymphangioram via direct access confirming \nocclusion of the \nproximal thoracic duct. \n3. Left neck thoracic duct retrograde access confirming cranial \nend of \nthoracic duct occlusion. \n4. Successful recanalization of thoracic duct occlusion. \n5. Lymphangiography demonstrating occlusion of the thoracic duct \njunction with \nthe subclavian vein. \n6. Left brachial venography showing multiple collaterals. \n7. Successful stenting of the thoracic duct occlusion and \ncommunication \nbetween thoracic duct and subclavian vein. \n8. Successful angioplasty of the left brachiocephalic vein \nocclusion. \nIMPRESSION: \n \nSuccessful left neck and thoracic duct lymphangiography with \nstenting of two \nsites of thoracic duct occlusion. \nSuccessful angioplasty of left brachiocephalic vein. \n___ year old man with a past medical history of ulcerative \ncolitis\ns/p total colectomy with ileostomy for high-grade dysplasia,\nprimary sclerosing cholangitis/autoimmune hepatitis overlap\nsyndrome with cirrhosis (Child C, MELD-Na 21 on admission)\ndecompensated by ascites (with SBP history), and varices s/p TIPS\n(___) complicated by occlusion s/p revision (___), and\nchylous ascites (negative workup for malignancy, TB; currently \non\ndietary modifications) admitted with bilateral ___ DVT and\nrecurrent chylous ascites.\n\nACUTE ISSUES:\n================\n# Bilateral lower extremity DVT\nRisk factors include autoimmune disease, cirrhosis. Was \ninitially treated with heparin gtt. Hemoglobin initially \ndowntrended on AC then stabilized, with no clinical signs of \nbleeding. Given difficulty with monitoring warfarin in setting \nof elevated INR from liver disease, on ___ was started on \nLovenox 1 mg/kg (100 mg) BID. there was also some concern for \nRUE DVT, but imaging was deferred as he would be on systemic \nanticoagulation regardless. He had no clinical evidence of PE.\n\n# Chylous Ascites\n# History of Refractory ascites\nHad paracentesis on ___ consistent with chylous ascites. \nUnderwent ___ lymphogram ___ with thoracic duct stenting and L \nbrachiocephalic vein angioplasty. Although >250 PMNs, likely \nfalse positive and was not treated for SBP. After holding \ndiuretics in setting of surgery, he was restarted on home \namiloride 15 daily and furosemide 80 daily\n\n# Cirrhosis ___ AIH-PSC overlap syndrome\nAdmission MELD 21, Childs ___ C. Previously decompensated by\nportal HTN, refractory ascites, variceal bleed (esophageal and\nstomal). Last EGD ___ with small grade I varices. s/p\nTIPS, revised ___. This admission RUQUS with variable\nvelocities through TIPS. Cont'd Lactulose TID, Rifaximin BID, \ndiuretics as above. he is not on a beta blocker.\n\n#MALNUTRITION: NJ dobhoff in place for optimization prior to \npotential surgery for pancreatic lesion. Nutrition consulted, \ncont'd tube feeding regimen in house.\n\nCHRONIC/STABLE ISSUES\n======================\n# Ulcerative colitis: \n# Autoimmune hepatitis: \n# Primary Sclerosing Cholangitis\nRecently with flare requiring higher dose prednisone ___, \nhas\nbeen slowly tapered and recently switched to budesonide on ___. \nContinued budesonide at 6mg daily, Mycophenolate Mofetil 1000 mg \nPO BID, ursodiol.\n\n# Hyponatremia: remained stable in low to mid ___. \n\n# Celiac disease: \nTTG had been downtrending as outpatient, however still elevated. \nrepeat value lower this admission. Cont'd Gluten-free diet and \nBudesonide 6mg daily.\n\n# Hypothyroidism: home levothyroxine \n# Allergies: home cetirizine \n# Hx cholangitis: has been on doxycycline for ppx\n\nTRANSITIONAL ISSUES\n===================\n[] Discharged on Lovenox 1 mg/kg BID for acute DVT treatment. \nplan course of at least 3 months. consider longer treatment \ngiven involvement of multiple extremities\n[] Discharge Hgb 10.3. Please check CBC on ___. Fax results to \n___ Attn: Dr. ___. \n[] re-evaluate aspirin treatment for Budd-Chiari syndrome in the \nsetting of systemic anticoagulation\n[] consider repeat diagnostic paracentesis at next follow up to \nevaluate for resolution of chylous ascites s/p thoracic duct \nstenting on ___\n[] decreased amiloride dose to 15 mg daily (cont'd Lasix 80 \ndaily). patient euvolemic at time of discharge. discharge weight \n100.7 kg \n[] increased lactulose from BID to TID. no encephalopathy at \ntime of discharge\n[] consider beta blocker for variceal bleeding ppx\n[] outpatient consideration of surgery for pancreatic lesion\n[] continued on tube feeds\n[] some question of budesonide related rash based on temporal \ncorrelation. Inpatient team felt this was unlikely. continue to \nevaluate \n# CODE: FULL\n# CONTACT:\nName of health care proxy: ___ \nRelationship: Wife \nPhone number: ___ \n \n___ on Admission:\nThe Preadmission Medication list is accurate and complete.\n1. aMILoride 20 mg PO DAILY \n2. Cetirizine 10 mg PO DAILY \n3. Doxycycline Hyclate 100 mg PO Q12H \n4. Furosemide 80 mg PO DAILY \n5. Levothyroxine Sodium 175 mcg PO DAILY \n6. Mycophenolate Mofetil 1000 mg PO BID \n7. Omeprazole 20 mg PO DAILY \n8. Rifaximin 550 mg PO BID \n9. Ursodiol 500 mg PO QAM \n10. Ursodiol 750 mg PO QPM \n11. Lactulose 30 mL PO BID \n12. Multivitamins W/minerals 1 TAB PO DAILY \n13. Budesonide 6 mg PO DAILY "}}
{'final_diagnoses': ['Bilateral deep vein thrombosis in lower extremities', 'Chylous ascites', 'Cirrhosis', 'Ulcerative colitis', 'Primary sclerosing cholangitis'], 'procedures': ['lymphogram ___ with thoracic duct stenting and L \nbrachiocephalic vein angioplasty'], 'visit_summary': "___ year old man with a past medical history of ulcerative \ncolitis\ns/p total colectomy with ileostomy for high-grade dysplasia,\nprimary sclerosing cholangitis/autoimmune hepatitis overlap\nsyndrome with cirrhosis (Child C, MELD-Na 21 on admission)\ndecompensated by ascites (with SBP history), and varices s/p TIPS\n(___) complicated by occlusion s/p revision (___), and\nchylous ascites (negative workup for malignancy, TB; currently \non\ndietary modifications) admitted with bilateral ___ DVT and\nrecurrent chylous ascites.\n\nACUTE ISSUES:\n================\n# Bilateral lower extremity DVT\nRisk factors include autoimmune disease, cirrhosis. Was \ninitially treated with heparin gtt. Hemoglobin initially \ndowntrended on AC then stabilized, with no clinical signs of \nbleeding. Given difficulty with monitoring warfarin in setting \nof elevated INR from liver disease, on ___ was started on \nLovenox 1 mg/kg (100 mg) BID. there was also some concern for \nRUE DVT, but imaging was deferred as he would be on systemic \nanticoagulation regardless. He had no clinical evidence of PE.\n\n# Chylous Ascites\n# History of Refractory ascites\nHad paracentesis on ___ consistent with chylous ascites. \nUnderwent ___ lymphogram ___ with thoracic duct stenting and L \nbrachiocephalic vein angioplasty. Although >250 PMNs, likely \nfalse positive and was not treated for SBP. After holding \ndiuretics in setting of surgery, he was restarted on home \namiloride 15 daily and furosemide 80 daily\n\n# Cirrhosis ___ AIH-PSC overlap syndrome\nAdmission MELD 21, Childs ___ C. Previously decompensated by\nportal HTN, refractory ascites, variceal bleed (esophageal and\nstomal). Last EGD ___ with small grade I varices. s/p\nTIPS, revised ___. This admission RUQUS with variable\nvelocities through TIPS. Cont'd Lactulose TID, Rifaximin BID, \ndiuretics as above. he is not on a beta blocker.\n\n#MALNUTRITION: NJ dobhoff in place for optimization prior to \npotential surgery for pancreatic lesion. Nutrition consulted, \ncont'd tube feeding regimen in house.\n\nCHRONIC/STABLE ISSUES\n======================\n# Ulcerative colitis: \n# Autoimmune hepatitis: \n# Primary Sclerosing Cholangitis\nRecently with flare requiring higher dose prednisone ___, \nhas\nbeen slowly tapered and recently switched to budesonide on ___. \nContinued budesonide at 6mg daily, Mycophenolate Mofetil 1000 mg \nPO BID, ursodiol.\n\n# Hyponatremia: remained stable in low to mid ___. \n\n# Celiac disease: \nTTG had been downtrending as outpatient, however still elevated. \nrepeat value lower this admission. Cont'd Gluten-free diet and \nBudesonide 6mg daily.\n\n# Hypothyroidism: home levothyroxine \n# Allergies: home cetirizine \n# Hx cholangitis: has been on doxycycline for ppx\n\nTRANSITIONAL ISSUES\n===================\n[] Discharged on Lovenox 1 mg/kg BID for acute DVT treatment. \nplan course of at least 3 months. consider longer treatment \ngiven involvement of multiple extremities\n[] Discharge Hgb 10.3. Please check CBC on ___. Fax results to \n___ Attn: Dr. ___. \n[] re-evaluate aspirin treatment for Budd-Chiari syndrome in the \nsetting of systemic anticoagulation\n[] consider repeat diagnostic paracentesis at next follow up to \nevaluate for resolution of chylous ascites s/p thoracic duct \nstenting on ___\n[] decreased amiloride dose to 15 mg daily (cont'd Lasix 80 \ndaily). patient euvolemic at time of discharge. discharge weight \n100.7 kg \n[] increased lactulose from BID to TID. no encephalopathy at \ntime of discharge\n[] consider beta blocker for variceal bleeding ppx\n[] outpatient consideration of surgery for pancreatic lesion\n[] continued on tube feeds\n[] some question of budesonide related rash based on temporal \ncorrelation. Inpatient team felt this was unlikely. continue to \nevaluate \n# CODE: FULL\n# CONTACT:\nName of health care proxy: ___ \nRelationship: Wife \nPhone number: ___ \n \n___ on Admission:\nThe Preadmission Medication list is accurate and complete.\n1. aMILoride 20 mg PO DAILY \n2. Cetirizine 10 mg PO DAILY \n3. Doxycycline Hyclate 100 mg PO Q12H \n4. Furosemide 80 mg PO DAILY \n5. Levothyroxine Sodium 175 mcg PO DAILY \n6. Mycophenolate Mofetil 1000 mg PO BID \n7. Omeprazole 20 mg PO DAILY \n8. Rifaximin 550 mg PO BID \n9. Ursodiol 500 mg PO QAM \n10. Ursodiol 750 mg PO QPM \n11. Lactulose 30 mL PO BID \n12. Multivitamins W/minerals 1 TAB PO DAILY \n13. Budesonide 6 mg PO DAILY ", 'medications_prescribed': ['Enoxaparin Sodium 100 mg SC Q12H \nRX *enoxaparin 100 mg/mL 100 mg SC every twelve (12) hours Disp #*60 Syringe Refills:*2', 'aMILoride 15 mg PO DAILY \nRX *amiloride 5 mg 3 tablet(s) by mouth daily Disp #*90 Tablet Refills:*1', 'Lactulose 30 mL PO TID \nRX *lactulose 20 gram/30 mL 30 mL by mouth three times a day Disp #*2 Bottle Refills:*5', 'Budesonide 6 mg PO DAILY', 'Cetirizine 10 mg PO DAILY', 'Doxycycline Hyclate 100 mg PO Q12H', 'Furosemide 80 mg PO DAILY', 'Levothyroxine Sodium 175 mcg PO DAILY', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Mycophenolate Mofetil 1000 mg PO BID', 'Omeprazole 20 mg PO DAILY', 'Rifaximin 550 mg PO BID', 'Ursodiol 500 mg PO QAM', 'Ursodiol 750 mg PO QPM', 'Outpatient Lab Work\nD64.9 Anemia\nPlease check CBC on ___\nFax results to ___ Attn: Dr. ___']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 60, 'gender': 'F', 'symptoms': 'fever', 'medical_history': ['remote history of ovarian cancer status post hysterectomy\nand chemotherapy in ___, who was admitted to the hospital on\n___ for chest pain that radiated down her left arm. Ruled in \nfor NSTEMI. A cardiac catheterization performed on ___ \nrevealed three-vessel coronary artery disease. As part of her \nworkup for CABG surgery, she underwent a chest CT on ___, \nwhich showed a pathologic lymphadenopathy within the \nmediastinum, right hilum, and right axilla. Followup CT torso \non ___ revealed right axillary\nlymph node measuring approximately 3 x 2.6 cm with subcarinal\nadenopathy and abnormal soft tissue within the right hilum.\nProminent precarinal nodes are also identified. There was\nabnormal soft tissue density surrounding the right kidney\ncollecting system and proximal ureter with a perinephric soft\ntissue nodule with retrocrural lymph nodes and abnormal soft\ntissue within the porta hepatitis that encases the common bile\nduct and infiltrates along the central intrahepatic ducts. \nThere\nis also bulky appearance of the pancreatic head.', 'She had a right axillary lymph node on ___.', 'This revealed diffuse large B-cell lymphoma, immunoblastic\nvariant. Areas of extensive geographic and tumor cell necrosis\nare noted with a diffuse proliferation of medium-to-large cells.', "Immunohistochemistry revealed pan B-cell marker CD20, which also\ncoexpress CD10. BCL2 was negative, CD3 was positive in \nscattered\nT cells. MIB-1 immunostaining showed proliferation fraction at\n50% to 60% with focal areas up to 70%. Bilateral bone marrow\naspirates and biopsies on ___ is not finalized in the\ncomputer, but by report shows minimal involvement. Cytogenetics\nfrom the right side showed 4 of 20 cells analyzed with multiple\nnumerical and structural chromosome aberrations, some of these\nare typically found in non-Hodgkin's lymphoma. The cytogenetics\nfrom the left side did not show any similar abnormalities.", 'Echocardiogram from ___ showed an ejection fraction of 60%. \nHowever, the apical half of the anterior septum and the apex\nitself are hypokinetic. Because of the aggressive nature of \nMrs.\n___ lymphoma, but also in light of her recent MI and\nthree-vessel disease, she was given chemotherapy with CVP on\n___. She was discharged on ___. She was to receive a dose \nof\nRituxan on ___ in order to desensitize her, given her\nhigh-grade lymphoma. The Rituxan and indium where then planned \nfor\n___ and Rituxan with Zevalin on ___.', '-NSTEMI ___', '- CAD with severe 3 vessel disease', '-stroke', '-ovarian cancer s/p TAH/BSO in ___ treated with chemotherapy \nand\nhysterectomy ', '-c/b ventral hernia (repaired in ___', '-hypertension', '-glaucoma'], 'family_history': 'patient is single/widowed\nMother: died with ___ years, regarding note from ovarian cancer.\nFather: died when patient was ___ years old in an accident.\n3 Siblings: one sister died if ovarian cancer with 39, another\nwith 82 on ?bone cancer, and the third of unknown cause.', 'present_illness': 'HPI: ___ y/o with h/o ovarian cancer, recent NSTEMI, and DLBCL \ndiagnosed ___ and cycle 1 CVP on ___. He was doing well at \nhome until this am when she developed Tm of 101. She complains \nof fatiuge but otherwise ROS is negative. No Chill, sweats, sore \nthroat, nasal congestion, cough, sob, chest pain, palpatations, \nStiff neck, HA, change in vision, abd pain, diarrhea, edema, \ndysuria, hematuria, bloody stool, focal weakness, or dysarthria. \nShe is constipated with last normal BM 2 days ago.\n.\nIn the ED VS T 98.2, rose to 100.7, HR 88, BP 120/85, then \ndroped to SBP 90 but improving after IVF., RR 16, 96 RAShe \nreceived Cefepime 2gm IV and 1 gm tylenol', 'medications': [{'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ursodiol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'rifAXIMin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.1', 'valuenum': 21.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.14', 'valuenum': 2.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83.1', 'valuenum': 83.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '267', 'valuenum': 267.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.27', 'valuenum': 2.27, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79.7', 'valuenum': 79.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 207.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PE: \nVS: T 98.7, BP 102/50, P 85, R 20, 95% RA\nGEN: Elderly caucassion woman in NAD\nHEENT: non icteric, PERRL, EOMI, OP dentures in place, no OP \nlesions\nNeck: no JVD\nCV: RRR, no m/r/g\nlungs: Clear to auscultation ___\nabd: NT/ND, +BS, no HSM\nExt: no edema, 2+ DP\neuro: A+Ox3, cn intact, ___ strength', 'diagnoses': [{'icd_code': 'K7290', 'desc': 'Hepatic failure, unspecified without coma'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'R188', 'desc': 'Other ascites'}, {'icd_code': 'E441', 'desc': 'Mild protein-calorie malnutrition'}, {'icd_code': 'K743', 'desc': 'Primary biliary cirrhosis'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'Z6822', 'desc': 'Body mass index [BMI] 22.0-22.9, adult'}], 'summary': '___ 12:50PM URINE RBC-0 ___ BACTERIA-MANY YEAST-NONE \n___ 12:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-TR\n___ 12:50PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 12:50PM PLT SMR-LOW PLT COUNT-126*\n___ 12:50PM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-OCCASIONAL MACROCYT-NORMAL MICROCYT-NORMAL \nPOLYCHROM-NORMAL OVALOCYT-OCCASIONAL STIPPLED-OCCASIONAL\n___ 12:50PM NEUTS-14* BANDS-8* ___ MONOS-35* EOS-2 \nBASOS-0 ATYPS-3* METAS-1* MYELOS-1* PROMYELO-2*\n___ 12:50PM WBC-2.6*# RBC-3.39* HGB-10.5* HCT-30.9* \nMCV-91 MCH-31.0 MCHC-34.0 RDW-13.4\n___ 12:50PM GLUCOSE-108* UREA N-16 CREAT-1.0 SODIUM-135 \nPOTASSIUM-4.3 CHLORIDE-102 TOTAL CO2-25 ANION GAP-12\n___ 12:58PM LACTATE-1.9\n___ 03:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n___ 03:50PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 06:15AM BLOOD WBC-3.3* RBC-3.02* Hgb-9.3* Hct-27.9* \nMCV-93 MCH-30.9 MCHC-33.3 RDW-13.3 Plt ___\n___ 06:15AM BLOOD Neuts-46* Bands-18* Lymphs-10* Monos-19* \nEos-1 Baso-0 ___ Metas-3* Myelos-3*\n___ 06:15AM BLOOD Plt Smr-LOW Plt ___\n___ 06:15AM BLOOD ___ PTT-36.5* ___\n___ 06:15AM BLOOD ___\n___ 06:15AM BLOOD Glucose-93 UreaN-17 Creat-0.9 Na-137 \nK-3.8 Cl-110* HCO3-23 AnGap-8\n___ 06:15AM BLOOD ALT-10 AST-12 LD(LDH)-148 AlkPhos-89 \nTotBili-0.4\n.\n___ CXR: No acute cardiopulmonary abnormality. Left lower lobe \nAVM and\nright middle lobe nodular opacity are unchanged from recent \nchest CT.\n.\n___ 12:50 pm BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n.\n___ 12:50 pm URINE Site: CLEAN CATCH\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: <10,000 organisms/ml. \n.\n___ 3:50 pm URINE Site: CLEAN CATCH\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n.\n___ 9:43 am Rapid Respiratory Viral Screen & Culture\n Source: Nasopharyngeal aspirate. \n\n **FINAL REPORT ___\n\n Respiratory Viral Culture (Final ___: \n No respiratory viruses isolated. \n Culture screened for Adenovirus, Influenza A & B, \nParainfluenza type\n 1,2 & 3, and Respiratory Syncytial Virus..\n Detection of viruses other than those listed above will \nonly be\n performed on specific request. Please call Virology at \n___\n within 1 week if additional testing is needed. \n\n Rapid Respiratory Viral Antigen Test (Final ___: \n Respiratory viral antigens not detected. \n SPECIMEN SCREENED FOR: ADENO,PARAINFLUENZA 1,2,3 INFLUENZA \nA,B AND\n RSV. \n This kit is not FDA approved for the direct detection of \nrespiratory\n viruses in specimens; interpret negative result with \ncaution..\n Refer to respiratory viral culture for further \ninformation.\nA+P: ___ y/o with DLBCL and severe CAD s/p NSTEMI, s/p Cycle 1 of \nCVP on ___ presents with fever x 1 day and neutropenia\n.\n# Febrile neutropenia: No clear source identified. Blood and \nurine culture, and rapid respiratory viral screen were negative. \nMrs ___ was started on Cefepime in ED and was continued on \nit overnight. In the Emergency department Mrs ___ had \ntransient hypotension with SBP in the ___. Sepsis was considered \nbut the rest of the VS remained stable and the patient was \nwithout symptoms. She was given IVF. Ultimately the asymptomatic \nhypotension was felt to be secondary to excessive beta blockade. \nHer Metoprolol was decreased from 25 to 12.5 mg BID with \nimprovement in her blood pressure. By hospital day two the \nfever had subsided, BP was stable, and the ___ had improved to \n2240 meaning she was no longer neutropenic. She appeared well \nand was transitioned to PO levofloxacin prior to discharge. She \nwith follow up closely with her primary oncologist.\n.\n# Hypotension: as explained above Mrs ___ was asymptomatic. \nIt was felt to be ___ to excessive beta blockade and her \npressures improved with decreasing the metoprolol dose.\n.\n# CAD: 3 vessel tight dz being medically managed. Continued \nImdur, metoprolol (at a decreased dose) atorvastatin and ASA.\n.\n# glaucoma: Continued home drops\n.\n# Constipation: Continued on senna, colace, dulcolax'}}
{'final_diagnoses': ['Febrile neutropenia', 'Coronary Artery Disease', 'Hypotension secondary to excessive beta blockade', "Non Hodgkin's lymphoma"], 'procedures': ['none'], 'visit_summary': 'A+P: ___ y/o with DLBCL and severe CAD s/p NSTEMI, s/p Cycle 1 of \nCVP on ___ presents with fever x 1 day and neutropenia\n.\n# Febrile neutropenia: No clear source identified. Blood and \nurine culture, and rapid respiratory viral screen were negative. \nMrs ___ was started on Cefepime in ED and was continued on \nit overnight. In the Emergency department Mrs ___ had \ntransient hypotension with SBP in the ___. Sepsis was considered \nbut the rest of the VS remained stable and the patient was \nwithout symptoms. She was given IVF. Ultimately the asymptomatic \nhypotension was felt to be secondary to excessive beta blockade. \nHer Metoprolol was decreased from 25 to 12.5 mg BID with \nimprovement in her blood pressure. By hospital day two the \nfever had subsided, BP was stable, and the ___ had improved to \n2240 meaning she was no longer neutropenic. She appeared well \nand was transitioned to PO levofloxacin prior to discharge. She \nwith follow up closely with her primary oncologist.\n.\n# Hypotension: as explained above Mrs ___ was asymptomatic. \nIt was felt to be ___ to excessive beta blockade and her \npressures improved with decreasing the metoprolol dose.\n.\n# CAD: 3 vessel tight dz being medically managed. Continued \nImdur, metoprolol (at a decreased dose) atorvastatin and ASA.\n.\n# glaucoma: Continued home drops\n.\n# Constipation: Continued on senna, colace, dulcolax', 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', 'Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', 'Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', 'Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) \nTablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for \nconstipation.', 'Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) Tablet, \nSublingual Sublingual PRN (as needed): for chest pain, please \ntake one tab q5 min as needed, if does not resolve after 3 tabs, \ngo to the hospital.', 'Ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, \nRapid Dissolve PO Q8H (every 8 hours) as needed for nausea.', 'Fluconazole 100 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours).', 'Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic Q8H \n(every 8 hours).', 'Dorzolamide-Timolol ___ % Drops Sig: One (1) Drop \nOphthalmic BID (2 times a day).', 'Isosorbide Mononitrate 30 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).', 'Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 \ntimes a day).\nDisp:*30 Tablet(s)* Refills:*2*', 'Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day \nfor 5 days.\nDisp:*5 Tablet(s)* Refills:*0*', 'Miralax 17 gram (100 %) Powder in Packet Sig: One (1) packet \nPO once a day as needed for constipation.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 32, 'gender': 'M', 'symptoms': 'fever, malaise', 'medical_history': ['PAST ONCOLOGIC HISTORY: (summarized from OMR)\n- ___: developed nausea, vomiting, fatigue, choluria, and\npruritus. Was seen by PCP and found to have elevated LFTs. CT\nscan with diffuse enlargement of the pancreatic head with soft\ntissue extending along the proximal SMA and SMV concerning for\nprimary neoplasm.', '- ___: Referred to Dr. ___ at ___ and underwent\nERCP/EUS that showed dilated CBD with hypoechoic mucosal\nabnormality around the distal CBD, but no discrete mass was \nseen.\nFNA non-diagnostic and\nampullary biopsies showed only duodenitis. The pancreatic duct\nand parenchyma appeared normal. A dilated CBD was noted on\ncholangiogram and she had 2 plastic stents placed. CA ___ and\nIgG4 both mildly elevated to 126 and 96, respectively', '- ___: repeat CT continued to be suspicious for malignancy.', '- ___: ERCP/EUS with 2.1 x 2.2 cm mass in HOP with poorly\ndefined borders and the remainder of the pancreas was\nunremarkable. FNA was again negative. ERCP with Spy showed some\nedematous changes in the intra and extrahepatic biliary system,\nbut Spybite biopsies again non-diagnostic.', '- Patient continued to be symptomatic, lost ~ 50 lbs', '- ___: Triple phase CT with similar findings and more\nsuspicious for AIP.', '- ___: started empirically on prednisone 40', '- ___: underwent MRCP given high concern for malignancy and\nto assess for treatment response since steroid initiation. MRCP\nconfirmed\na 1.9cm mass in the uncinate with diffuse and infiltrating soft\ntissue encasing the SMA and SMV as well as focal segmental\nnarrowing of the SMV without thrombosis.', '- ___ EUS confirmed an approx. 2cm pancreatic head/uncinate\nmass with two1.5cm LNs in the porta hepatis and peripancreatic\nregion. FNB of\nmass was consisted for ductal adenocarcinoma and LN FNBs\nnegative.', '- ___: referred to pancreatic center, felt to have locally\nadvanced disease, likely unresectable', '- ___ Duodenal stent placed for duodenal obstruction\nsecondary to compression from pancreatic lesion.', '- ___: C1D1 FOLFIRNOX', 'PAST MEDICAL HISTORY: \nHypertension'], 'family_history': 'Mother with ovarian CA (diagnosed ___). \nFather with bladder CA. \nPGF with pancreatic CA (diagnosed in his ___. \nPGM with colon CA (diagnosed in ___.', 'present_illness': "Ms. ___ is a ___ year old female with pancreatic cancer on\nFOLFIRI who presents from ___ with hyperbilirubinemia and\nfevers.\n\nThe patient noted progressive weakness and fatigue over the last\n___ days and then, 1 day ago, noted a measured fever to ___. \nShe\ncalled triage at ___ and was instructed to go to the nearest\nemergency room given her recent chemo. The patient presented to\n___ where she was found to be febrile to 100 and tachycardic \nto\n120. Her BP and SpO2 were stable. Chest XR and UA were negative.\nLactate wnl. Labs notable for WBC 12.9 Hgb 10.8 plt 109. DBil \n2.0\nAST/ALT 88/102.\n\nThe inpatient heme/onc fellow was consulted who recommended \nbroad\nspectrum antibiotics and she was started on vanc/zosyn and\nsubsequently admitted to the medical service.\n\nOvernight, the patient did well and remained hemodynamically\nstable and afebrile. This morning, the patient's labs showed\nresolution of her leukocytosis. TBil 3.5, AP 311 AST/ALt 50/75.\n\nHer flu PCR was negative but viral screen was positive for\nrhinovirus.\n\nThe patient's vancomycin was discontinued but her zosyn was\ncontinued. Given her history of biliary stricture/stenting and\nelevated rising hyperbilirubinemia, the patient was transferred\nto ___ for ERCP.\n\nOf note, the patient's apixaban which she takes for her LLE DVT\nwas held in anticipation of her ERCP. Last dose was at 1030 on\n___. \n\nRegarding the patient's history of biliary stricture, she\nunderwent ERCP at ___ on ___ where a metal stent was\nplaced. \n\nUpon arrival to 11R, the patient endorses the above history. She\nis comfortable without complaints.\n\nShe is without headache or vision changes. She notes no prior\nsore throat or rhinorrhea but did not myalgia. No chest pain,\ndyspnea or palpitations. Occasional nausea but no vomiting. No\nabdominal pain. No diarrhea or constipation. Notes concentrated\nurine but no dysuria.", 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%/Epinephrine 1:100000', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Linezolid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Silver Nitrate Applicator', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clotrimazole Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 0.5%/Epinephrine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Silver Sulfadiazine 1% Cream', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Silver Nitrate Applicator', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hyoscyamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Immune Globulin Intravenous (Human)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Alteplase 1mg/2mL ( Clearance ie. PICC, tunneled access line )', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alteplase 1mg/2mL ( Clearance ie. PICC, tunneled access line )', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '66.0', 'valuenum': 66.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85.7', 'valuenum': 85.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '364', 'valuenum': 364.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '319', 'valuenum': 319.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO SPECIFIC ABNORMALITIES SEEN; INTERPRETED BY ___.'}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1446', 'valuenum': 1446.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.022', 'valuenum': 1.022, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '75.8', 'valuenum': 75.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO MONOCLONAL IMMUNOGLOBULIN SEEN. NEGATIVE FOR BENCE-JONES PROTEIN. INTERPRETED BY ___.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MULTIPLE PROTEIN BANDS SEEN, WITH ALBUMIN PREDOMINATING. BASED ON IFE (SEE SEPARATE REPORT),. NO MONOCLONAL IMMUNOGLOBULIN SEEN. NEGATIVE FOR BENCE-JONES PROTEIN. 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{'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '470', 'valuenum': 470.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.2', 'valuenum': 79.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '684', 'valuenum': 684.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53.7', 'valuenum': 53.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '586', 'valuenum': 586.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.7', 'valuenum': 87.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SM .'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.014', 'valuenum': 1.014, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '441', 'valuenum': 441.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '80', 'valuenum': 80.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '470', 'valuenum': 470.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '61.1', 'valuenum': 61.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65.1', 'valuenum': 65.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '414', 'valuenum': 414.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '68.7', 'valuenum': 68.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '432', 'valuenum': 432.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 30-39 is 107 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86.6', 'valuenum': 86.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '513', 'valuenum': 513.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 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'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '2+. MANUAL.'}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.0', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '511', 'valuenum': 511.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.87', 'valuenum': 2.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.97', 'valuenum': 2.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission physical Exam:\n========================\nGENERAL: NAD\nHEENT: Clear OP, no oral lesions. Membranes moist\nEYES: Anicteric, PERRL\nNECK: supple\nRESP: CTAB, no wheezing, rhonchi or craklces\n___: RRR no MRG\nGI: Soft, NTND. No RUQ Pain on palpation. \nEXT: warm, no edema\nSKIN: dry\nNEURO: CN II-XII intact\nACCESS: PIV, R POC not accessed \n\nDischarge Physical Exam:\n========================\nPhysical Examination:\nVS: ___ 0748 Temp: 98.6 PO BP: 130/92 R Sitting HR: 94 RR:\n18 O2 sat: 96% O2 delivery: Ra \nGENERAL: NAD, A&Ox3, lying in bed comfortably \nEYES: Sclera clear, anicteric, PERRL\nHENT: MMM, NCAT \nNeck: no JVD\nCV: RRR, normal s1/s2, no MRG \nRESP: CTAB, no wheezes/crackles/rhonci. No accessory muscle \nusage\nABD: Bowel sounds normoactive, soft and NTND, no HSM. No\nguarding/rebound tenderness. \nSKIN: No rashes/lesions. No jaundice. Warm. No evidence of skin\nbreakdown. \nNEURO: CN2-12, no gross deficits \nPSYCH: Mood/affect appropriate.', 'diagnoses': [{'icd_code': '41513', 'desc': 'Saddle embolus of pulmonary artery'}, {'icd_code': '32361', 'desc': 'Infectious acute disseminated encephalomyelitis (ADEM)'}, {'icd_code': '34830', 'desc': 'Encephalopathy, unspecified'}, {'icd_code': '34400', 'desc': 'Quadriplegia, unspecified'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '2763', 'desc': 'Alkalosis'}, {'icd_code': '99731', 'desc': 'Ventilator associated pneumonia'}, {'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '51909', 'desc': 'Other tracheostomy complications'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '1369', 'desc': 'Unspecified infectious and parasitic diseases'}, {'icd_code': '7948', 'desc': 'Nonspecific abnormal results of function study of liver'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': 'E8798', 'desc': 'Other specified procedures as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}, {'icd_code': 'E8783', 'desc': 'Surgical operation with formation of external stoma causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}], 'summary': 'Admission Labs:\n===============\n___ 05:39AM BLOOD WBC-5.7 RBC-2.93* Hgb-8.7* Hct-28.1* \nMCV-96 MCH-29.7 MCHC-31.0* RDW-15.1 RDWSD-53.0* Plt Ct-78*\n___ 05:39AM BLOOD ALT-60* AST-28 AlkPhos-276* TotBili-2.4* \nDirBili-2.0* IndBili-0.4\n___ 05:39AM BLOOD Glucose-100 UreaN-5* Creat-0.6 Na-142 \nK-3.4* Cl-109* HCO3-22 AnGap-11\n\nPertinent Studies:\n==================\nFinal Report \nEXAMINATION: BILAT LOWER EXT VEINS \n \nINDICATION: ___ year old woman with pancreatic cancer and new \nleft lower \nextremity edema// new left lower extremity edema- concerns for \nDVT \n \nTECHNIQUE: Grey scale, color, and spectral Doppler evaluation \nwas performed \non the bilateral lower extremity veins. \n \nCOMPARISON: No relevant comparison identified. \n \nFINDINGS: \n \nThere is normal compressibility, flow, and augmentation of the \nbilateral \ncommon femoral, femoral, and popliteal veins. In the left \nposterior tibial \nveins, color flow and compressibility can only be documented in \none of the two \nveins. There is suggestion echogenicity within the other \nposterior tibial \nvein, lack of compressibility, and minimal color flow concerning \nfor \nnonocclusive thrombosis. There is nonvisualization of the left \nperoneal \nveins. Normal color flow demonstrated in the right posterior \ntibial and \nperoneal veins. \n \nThere is normal respiratory variation in the common femoral \nveins bilaterally. \n \nNo evidence of medial popliteal fossa (___) cyst. \n \nIMPRESSION: \n \nNonocclusive thrombosis in one of the two posterior tibial \nveins. \nNonvisualization of the left peroneal veins. \n\nDischarge Labs:\n==============\n___ 06:00AM BLOOD WBC-4.5 RBC-2.97* Hgb-8.9* Hct-28.1* \nMCV-95 MCH-30.0 MCHC-31.7* RDW-14.8 RDWSD-51.7* Plt Ct-88*\n___ 06:00AM BLOOD Plt Ct-88*\n___ 06:00AM BLOOD Glucose-78 UreaN-5* Creat-0.6 Na-141 \nK-3.2* Cl-106 HCO3-22 AnGap-13\n___ 06:00AM BLOOD ALT-45* AST-21 LD(LDH)-150 AlkPhos-270* \nTotBili-1.7*\n___ 06:00AM BLOOD Albumin-3.3* Calcium-8.7 Phos-4.0 Mg-1.___ yo F PMHx pancreatic cancer course c/b biliary obstruction on\n___ transfered from ___ c/f cholangitis.\n#Common Bile Duct Stent Occlusion\nPatient called triage at ___ with symptoms of fever and \nmalaise and was advised to go to the nearest ER which was ___. \nAt ___, bilirubin was reported to be 3.5 and she was \ntransferred to ___. Here, here bilirubin was 2.4. On ___, \nshe underwent ERCP with stent exchange which was successful. She \ntolerated a regular diet after the procedure. She had no \nabdominal pain/nausea/vomiting. She was able to be discharged on \na 5 day course of ciprofloxacin (completing ___. Her \ndischarge bilirubin was ***\n\n#Rhinovirus\nPatient had been having cold symptoms (sore throat, cough, runny \nnose) prior to presentation. She had a viral panel at ___ \nwhich was positive for rhinovirus. She did no require \nprecautions while in house because her symptoms had an onset of \n>4 days prior to admission. \n\n#Pancreatic Cancer\nPreviously treated with FOLFIRINOX, but developed peripheral\nneuropathy, subsequently transitioned to FOLFIRI. Plan for\nrestaging scans and then consideration of radiation. We \ncontinued her creon with meals. \n\n#History of DVT\nPatient on abixaban which was held on admission due to impending \nERCP procedure. It was able to be restarted before discharge. \n\nChronic Issues:\n===============\n#Depression\nWe continued her home Mirtazapine\n\n#GERD \nContinue ompeprazole \n\n#Thrombocytopenia \n#Normocytic anemia \nAppears near baseline. No signs of active bleeding. Likely from\nchornic disease and chemotherapy. Given overall stability, no\nconcern for consumptive process.'}}
{'final_diagnoses': ['Common Bile Duct Stent Obstruction', 'Pancreatic Cancer', 'Rhinovirus', 'Chemotherapy-Induced Neuropathy', 'History of DVT', 'Thrombocytopenia', 'Depression'], 'procedures': ['___ with stent exchange'], 'visit_summary': '#Common Bile Duct Stent Occlusion\nPatient called triage at ___ with symptoms of fever and \nmalaise and was advised to go to the nearest ER which was ___. \nAt ___, bilirubin was reported to be 3.5 and she was \ntransferred to ___. Here, here bilirubin was 2.4. On ___, \nshe underwent ERCP with stent exchange which was successful. She \ntolerated a regular diet after the procedure. She had no \nabdominal pain/nausea/vomiting. She was able to be discharged on \na 5 day course of ciprofloxacin (completing ___. Her \ndischarge bilirubin was ***\n\n#Rhinovirus\nPatient had been having cold symptoms (sore throat, cough, runny \nnose) prior to presentation. She had a viral panel at ___ \nwhich was positive for rhinovirus. She did no require \nprecautions while in house because her symptoms had an onset of \n>4 days prior to admission. \n\n#Pancreatic Cancer\nPreviously treated with FOLFIRINOX, but developed peripheral\nneuropathy, subsequently transitioned to FOLFIRI. Plan for\nrestaging scans and then consideration of radiation. We \ncontinued her creon with meals. \n\n#History of DVT\nPatient on abixaban which was held on admission due to impending \nERCP procedure. It was able to be restarted before discharge. \n\nChronic Issues:\n===============\n#Depression\nWe continued her home Mirtazapine\n\n#GERD \nContinue ompeprazole \n\n#Thrombocytopenia \n#Normocytic anemia \nAppears near baseline. No signs of active bleeding. Likely from\nchornic disease and chemotherapy. Given overall stability, no\nconcern for consumptive process.', 'medications_prescribed': ['Ciprofloxacin HCl 500 mg PO Q12H Duration: 5 Days \nRX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth twice a day \nDisp #*10 Tablet Refills:*0', 'Apixaban 5 mg PO BID', 'Creon 12 2 CAP PO TID W/MEALS', 'Mirtazapine 15 mg PO QHS', 'Omeprazole 40 mg PO DAILY', 'Outpatient Physical Therapy\nBalance Training \nICD 10 Code: ___.89 (other abnormalities of gait/mobility)\nICD 10 Code: ___.3 (malignant neoplasm of pancreatic duct)']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 31, 'gender': 'F', 'symptoms': 'R thalamic IPH with IVE', 'medical_history': ['Right proximal humerus fracture', 'HTN', 'Afib (previously on Apixaban and ASA)', 'HLD', 'breast cancer ___ - ___ with lumpectomy and XRT', 'osteopenia', 'h/o frequent falls at home'], 'family_history': 'mother with HTN', 'present_illness': '___ is an ___ right handed woman with a history of \nHTN and afib (on apixaban and ASA) who presents with a right \nthalamic intraparenchymal hemorrhage with intraventricular \nextension. \n\nToday she was in her usual state of health. She took a nap but \nwhen she awoke around 2:30 she was unable to get out of bed. Her \nfriend called ___ and noted left sided weakness. She presented \nto ___ where BP was initially in the 140s systolic. ___ \nrevealed a right thalamic IPH with IVE. Her BP increased to the \n160s and she was treated with labetalol. She was transferred to \n___ for further care. Here, she was seen by neurosurgery who \nrecommended Keppra, KCentra (given the apixaban), CTA, and \nSBP<140. She was placed on a nicardipine gtt for BP in the 160s \nsystolic. She reports having a headache. She has frequent falls \nbut has had none recently.', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dermoplast Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Carboprost Tromethamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Misoprostol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diphenoxylate-Atropine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '297', 'valuenum': 297.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.44', 'valuenum': 3.44, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '431', 'valuenum': 431.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '296', 'valuenum': 296.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.12', 'valuenum': 3.12, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.5', 'valuenum': 44.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '==============================\nADMISSION PHYSICAL EXAM\n==============================\nVitals: 100 80 149/79 18 94% RA \nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT\nPulmonary: clear to auscultation bilaterally\nCardiac: RRR, no murmurs\nAbdomen: soft, nondistended\nExtremities: no edema, warm\nSkin: no rashes or lesions noted.\n\nNEUROLOGIC EXAMINATION\n-Mental Status: Alert, conversant. Not oriented to situation and\ndoes not realize her left side is weak. Language is fluent with\nintact repetition and normal prosody. There were no paraphasic\nerrors. Pt. was able to name both high and low frequency \nobjects\non the stroke card (self corrects hammock from "canopy").\nDescribed both sides of the cookie jar picture. Speech sounds\nmildly dysarthric though per family is at baseline. Able to\nfollow both midline and appendicular commands. Able to name ___\nbackward to ___ with ease and requires prompting to complete \nit\nbackwards to ___. Able to register 3 objects and recall ___\nat 5 minutes - chooses ___ correctly with multiple choice\noptions. Bisects lines to the right of midline. She has a dense\nleft sided neglect. There was no evidence of right neglect.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm bilaterally. VFF to confrontation with \nfinger\nwiggling, intermittently extinguishes to DSS on the left. \nIII, IV, VI: EOMI without nystagmus. \nV: Endorses intact facial sensation to light touch bilaterally \nVII: Left NLFF with almost complete activation. \nVIII: Hearing intact to voice.\nIX, X: Palate elevates symmetrically.\nXI: full strength in trapezii bilaterally (though required extra\ncueing to lift the left shoulder).\nXII: Tongue protrudes in midline with full ROM right and left \n\n-Motor: \n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL ___ ___ 3 0 0 0 0 0 0 0\nR ___ ___ ___ 5 5 5 5 5\n- no volitional movement in left leg, though did have some mild\nw/d to Babinski testing \n\n-DTRs:\n ___ Tri ___ Pat Ach\nL 2+ 2+ 2+ 2+ 0\nR 2+ 2+ 2+ 3 2\n- Toes were upgoing bilaterally.\n- crossed adductor present on the right\n\n-Sensory: Sensation is absent to light touch and pinprick in the\nleft arm and leg. \n\n-Coordination: No dysmetria on FNF on the right; unable on left. \n\n\n-Gait: unable \n\n=============================\nDISCHARGE PHYSICAL EXAM\n==============================\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT\nPulmonary: clear to auscultation bilaterally\nCardiac: RRR, no murmurs\nAbdomen: soft, nondistended\nExtremities: no edema, warm\nSkin: no rashes or lesions noted.\n\nNEUROLOGIC EXAMINATION\n-Mental Status: Alert, conversant. Language is fluent with \nintact repetition and normal prosody. Able to follow both \nmidline and appendicular commands. Able to name ___ backward. \nDense left sided neglect. There was no evidence of right \nneglect.\n\n-Cranial Nerves:\nII: PERRL 3 to 2mm bilaterally\nIII, IV, VI: EOMI without nystagmus. \nV: Endorses intact facial sensation to light touch bilaterally \nVII: Left NLFF with almost complete activation. \nVIII: Hearing intact to voice.\nIX, X: Palate elevates symmetrically.\nXI: Full strength in trapezii bilaterally\nXII: Tongue protrudes in midline\n\n-Motor: Moving Lt index finger spontaneously and had some \nflexion and extension movements of left fingers and also some \ndorsiflexion of left wrist;\n- no volitional movement in left leg, though did have some mild\nw/d to Babinski testing \n\n-DTRs:\n ___ Tri ___ Pat Ach\nL 2+ 2+ 2+ 2+ 0\nR 2+ 2+ 2+ 3 2\n- Toes were upgoing bilaterally.\n- crossed adductor present on the right\n\n-Sensory: Sensation is absent to light touch and pinprick in the\nleft arm and leg. \n\n-Coordination: No dysmetria on FNF on the right; unable on left. \n\n\n-Gait: unable ', 'diagnoses': [{'icd_code': 'O403XX0', 'desc': 'Polyhydramnios, third trimester, not applicable or unspecified'}, {'icd_code': 'O721', 'desc': 'Other immediate postpartum hemorrhage'}, {'icd_code': 'O480', 'desc': 'Post-term pregnancy'}, {'icd_code': 'O660', 'desc': 'Obstructed labor due to shoulder dystocia'}, {'icd_code': 'Z370', 'desc': 'Single live birth'}, {'icd_code': 'O6981X0', 'desc': 'Labor and delivery complicated by cord around neck, without compression, not applicable or unspecified'}, {'icd_code': 'Z3A49', 'desc': 'Greater than 42 weeks gestation of pregnancy'}, {'icd_code': 'O99214', 'desc': 'Obesity complicating childbirth'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6838', 'desc': 'Body mass index [BMI] 38.0-38.9, adult'}, {'icd_code': 'O9902', 'desc': 'Anemia complicating childbirth'}, {'icd_code': 'Z3A40', 'desc': '40 weeks gestation of pregnancy'}], 'summary': '==========================================\nADMISSION LABS\n==========================================\n___ 07:20PM BLOOD WBC-6.3 RBC-4.30 Hgb-12.8 Hct-38.9 MCV-91 \nMCH-29.8 MCHC-32.9 RDW-14.9 RDWSD-48.7* Plt ___\n___ 07:20PM BLOOD ___ PTT-32.9 ___\n___ 07:20PM BLOOD Glucose-118* UreaN-10 Creat-0.7 Na-137 \nK-4.1 Cl-100 HCO3-24 AnGap-17\n___ 07:20PM BLOOD ALT-19 AST-29 AlkPhos-55 TotBili-0.2\n___ 01:34AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-8* \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 07:20PM BLOOD estGFR >75\n\n==========================================\nDISCHARGE LABS\n==========================================\n___ 07:50AM BLOOD WBC-11.4* RBC-4.12 Hgb-12.4 Hct-37.3 \nMCV-91 MCH-30.1 MCHC-33.2 RDW-14.4 RDWSD-47.3* Plt ___\n___ 07:50AM BLOOD Plt ___\n___ 07:50AM BLOOD Glucose-110* UreaN-14 Creat-0.6 Na-137 \nK-4.3 Cl-97 HCO3-26 AnGap-18\n___ 07:50AM BLOOD Calcium-10.3 Phos-3.9 Mg-1.8\n==========================================\nMICROBIOLOGY\n==========================================\nURINE CULTURE (Final ___: \n ESCHERICHIA COLI. >100,000 ORGANISMS/ML..\n PRESUMPTIVE IDENTIFICATION. \n Cefazolin interpretative criteria are based on a dosage \nregimen of\n 2g every 8h. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n ESCHERICHIA COLI\n | \nAMPICILLIN------------ 4 S\nAMPICILLIN/SULBACTAM-- 4 S\nCEFAZOLIN------------- <=4 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n.\n.\n==========================================\nIMAGING\n==========================================\nCTA Head and Neck ___:\nIMPRESSION:\n1. Stable appearance of the a 2 cm right thalamic \nintraparenchymal hematoma with intraventricular extension. \n2. 3 mm triangular outpouching at the expected location of the \nright posterior communicating artery origin, likely representing \nan infundibulum rather than an aneurysm. \n3. Narrowing at the origin of the left anterior cerebral artery \nand distal \nleft M1 MCA, likely secondary to atherosclerosis. \n4. Beading of the right internal carotid artery, suggestive of \nfibromuscular dysplasia. \n5. Patchy right upper lobe airspace disease, which may represent \ninfectious or inflammatory etiologies. \n6. Enlarged multi nodular thyroid gland for which a dedicated \nthyroid \nultrasound is recommended per the ___ College of Radiology \nguidelines. \n7. A 1.6 cm pseudoaneurysm of the aortic arch. \n.\nCT Head w/o Contrast ___:\nIMPRESSION: \n1. Parenchymal hemorrhage in the posterior right basal ganglia, \nwhich is \nrelatively unchanged. \n2. Intraventricular extension with increased layering blood \nwithin the left occipital horn lateral ventricle. Unchanged \nblood within the right lateral, third, and fourth ventricles. \n3. Prominence of ventricles which is unchanged comparison to \nprior study but increased in comparison to ___, which may \nrepresent central volume loss versus mild hydrocephalus.\n.\nCXR ___:\nIMPRESSION: \nNo comparison. The lung volumes are normal. Moderate \ncardiomegaly. No\npleural effusions. No pulmonary edema. No pneumonia. No \nradiographic\nevidence of aspiration.\n.\nVideo Swallow ___:\nFINDINGS: \nBarium passes freely through the oropharynx and esophagus \nwithout evidence of\nobstruction. There was trace penetration with thin liquids. \nThere was\notherwise no gross aspiration or penetration.\n.\nCT Head w/o Contrast ___:\nIMPRESSION:\nContinued evolution of the right thalamic intraparenchymal \nhemorrhage and\ndecrease in intraventricular hemorrhage. No new site of \nhemorrhage is\nidentified. Ventricular size is similar in appearance to prior \nexamination.\n.\nCXR ___:\nIMPRESSION: \nIn comparison with the study of ___, there is little overall \nchange. \nCardiac silhouette remains mildly enlarged with no vascular \ncongestion,\npleural effusion, or acute focal pneumonia.\nOf incidental note is again an old healed fracture of the \nproximal right\nhumerus.\n.\nCT Head w/o Contrast ___:\nIMPRESSION: \nUnchanged right thalamic intraparenchymal hemorrhage with \nslightly decreased\nsurrounding vasogenic edema. No new hemorrhage.\n.\nAbd XR ___:\nIMPRESSION:\nNonobstructive bowel gas pattern.\n___ is an ___ yo woman with a history of HTN and afib \non apixaban/ASA who presented with left sided weakness and was \nfound to have a right thalamic hemorrhage with significant \nextension into the ventricular system. On exam she has \nsignificant left sided weakness, sensory loss, and resolving \nneglect. She is alert and has no s/sx of hydrocephalus and no \nevidence of this on imaging either. Etiology of her bleed is \nlikely related to her HTN and/or anticoagulation. \n\n# Neuro: right thalamic IPH with IVE. CTA notable for 3mm Pcomm \naneurysm and stable thalamic bleed. NCHCT ___ after a fall from \nchair height demonstrated no new bleeding and stable old bleed. \nNCHCT ___ after altered mental status on AM exam again \ndemonstrated stable old bleed and mental status changes \nultimately attributed to urinary retention after CT and \ninfectious workup.\n- NSAIDs, anticoagulants and anti-platelet agents held \ninitially, ASA restarted ___. \n- continue home ASA 81mg daily\n- BP control with goal SBP < 160 as in CV\n- Speech/Swallow Evaluation: ground solids with thin liquids\n\n# CV: History of afib and htn. Was monitored on telemetry \nthroughout stay.\n- Early ICU course c/b afib with RVR requiring IV metoprolol, IV \ndiltiazem and transient diltizem drip. Subsequently stable on \nhome diltiazem 180mg PO QDay and metoprolol 25mg BID.\n- Initially on nicardipine gtt for bp control, transitioned to \nPO on HD2\n- Titrated lisinopril and hctz to achieve goal SBP < 160: \nlisinopril 40mg day, HCTZ 25mg day\n- Stop apixaban\n- continue home ASA ___\n- continue home simvastatin 10mg Qday\n\n# Renal: On ___ she was a bit more confused and with borderline \nfever. Infectious work-up revealed UTI, please see ID for \ndetails. Additionally, on ___ she was again altered, lethargic \nand confused. Exam demonstrated severe urinary retention, foley \nplaced for >1.5L.\n- Foley is to remain in place at discharge, voiding trial can be \nattempted ___. \n\n# ENDO: FSBG monitoring with insulin sliding scale for goal of \neuglycemia\n\n# TOX/METAB:\n- LFTs wnl\n- urine and serum screens wnl\n\n# ID: ___ she was a bit more confused and with borderline \nfever. Infectious work-up revealed UTI. She was started on CTX, \nwith a planned ___. Cultures ultimately grew \npan-sensitive e. coli. She subsequently remained afebrile and \nhemodynamically stable.\n- continue on CefTRIAXone 1 gm IV Q24H Duration: 10 Doses \n___'}}
{'final_diagnoses': ['Acute hemorrhagic stroke', 'Urinary tract infection', 'Acute urinary retention', 'Atrial fibrillation with RVR', 'Hypertension'], 'procedures': ['None'], 'visit_summary': '___ is an ___ yo woman with a history of HTN and afib \non apixaban/ASA who presented with left sided weakness and was \nfound to have a right thalamic hemorrhage with significant \nextension into the ventricular system. On exam she has \nsignificant left sided weakness, sensory loss, and resolving \nneglect. She is alert and has no s/sx of hydrocephalus and no \nevidence of this on imaging either. Etiology of her bleed is \nlikely related to her HTN and/or anticoagulation. \n\n# Neuro: right thalamic IPH with IVE. CTA notable for 3mm Pcomm \naneurysm and stable thalamic bleed. NCHCT ___ after a fall from \nchair height demonstrated no new bleeding and stable old bleed. \nNCHCT ___ after altered mental status on AM exam again \ndemonstrated stable old bleed and mental status changes \nultimately attributed to urinary retention after CT and \ninfectious workup.\n- NSAIDs, anticoagulants and anti-platelet agents held \ninitially, ASA restarted ___. \n- continue home ASA 81mg daily\n- BP control with goal SBP < 160 as in CV\n- Speech/Swallow Evaluation: ground solids with thin liquids\n\n# CV: History of afib and htn. Was monitored on telemetry \nthroughout stay.\n- Early ICU course c/b afib with RVR requiring IV metoprolol, IV \ndiltiazem and transient diltizem drip. Subsequently stable on \nhome diltiazem 180mg PO QDay and metoprolol 25mg BID.\n- Initially on nicardipine gtt for bp control, transitioned to \nPO on HD2\n- Titrated lisinopril and hctz to achieve goal SBP < 160: \nlisinopril 40mg day, HCTZ 25mg day\n- Stop apixaban\n- continue home ASA ___\n- continue home simvastatin 10mg Qday\n\n# Renal: On ___ she was a bit more confused and with borderline \nfever. Infectious work-up revealed UTI, please see ID for \ndetails. Additionally, on ___ she was again altered, lethargic \nand confused. Exam demonstrated severe urinary retention, foley \nplaced for >1.5L.\n- Foley is to remain in place at discharge, voiding trial can be \nattempted ___. \n\n# ENDO: FSBG monitoring with insulin sliding scale for goal of \neuglycemia\n\n# TOX/METAB:\n- LFTs wnl\n- urine and serum screens wnl\n\n# ID: ___ she was a bit more confused and with borderline \nfever. Infectious work-up revealed UTI. She was started on CTX, \nwith a planned ___. Cultures ultimately grew \npan-sensitive e. coli. She subsequently remained afebrile and \nhemodynamically stable.\n- continue on CefTRIAXone 1 gm IV Q24H Duration: 10 Doses \n___', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Acetaminophen 650 mg PO Q6H:PRN pain', 'CefTRIAXone 1 gm IV Q24H Duration: 10 Doses \nStarted ___, last dose to be ___ (10 day course)', 'Heparin 5000 UNIT SC BID', 'Senna 8.6 mg PO BID:PRN constipation', 'Hydrochlorothiazide 25 mg PO DAILY', 'Simvastatin 10 mg PO QPM', 'Docusate Sodium 100 mg PO BID \nPlease hold for loose stools', 'Diltiazem Extended-Release 180 mg PO DAILY \nPlease hold for SBP < 90', 'Metoprolol Tartrate 25 mg PO BID', 'Lisinopril 40 mg PO DAILY', 'FLUoxetine 20 mg PO DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 71, 'gender': 'M', 'symptoms': 'Seizure, meningioma', 'medical_history': ['- Testicle cancer (left): ___ years ago, s/p XRT and orchiectomy\nwith subsequent left leg edema. ', '- DVT post orchiectomy, ___ filter placed and not\nretrieved', '- Left > right leg edema', '- Left knee and hip replacements', '- Osteoarthritis', '- HTN: well-controlled', '- Depression'], 'family_history': 'Negative for malignancy or seizure. Sister is well, brother with\nheart disease and possible secondary respiratory problems.', 'present_illness': 'Mr. ___ is a ___ RHM h/o testicular cancer s/p resection, XRT\n___ years ago now p/w seizure and new diagnosis intracranial \nmass.\n\nMr. ___ has recently been in his usual state of health. He \nhas\nnot been ill, has not been complaining of headache, vision\nchanges, nausea, focal numbness, or weakness. He has never had\nany seizures. He has not had any sleep deprivation and smokes 2\ncigarettes per day; he does not use drugs. \n\nHis wife woke to the sound of coughing and gagging this morning\nand found her husband sitting at the computer at about 7am. His\nright face drooped at the time and he was not quite his normal\nself - he was not as sharp and he denied that he had any \nproblems\nat all. \n\nHis wife and daughter brought him to ___\nwhere ___ showed an approximately 6x4cm left frontal\nintracranial lesion with stippled calcification, a dural base,\nand local hyperostosis. After ___ was done, he had a seizure \nof\nunclear duration involving a short prodrome of feeling like\nsomething was wrong followed closely by right eye version, right\nhead turn, and right arm extension with fine shaking. As the\nfamily was asked to leave the room at this point, further \ndetails\nare unclear. He got 2mg IV LZP and 1gm IV Keppra with 10mg\ndexamethasone and was subsequently transferred here. \n\nHe dropped his BP on propofol and was started on neosynephrine.\nThe nadir of his BP is unknown, but first recorded vitals (on\npressor) were 36.4 59 130/75 18.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '40.9', 'valuenum': 40.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.31', 'valuenum': 4.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.7', 'valuenum': 45.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.87', 'valuenum': 4.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.0', 'valuenum': 43.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '48.3', 'valuenum': 48.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '=================\nDISCHARGE EXAM:\n=================\nAwake, alert, speech limited to "yes/no" answers, following \ncommands intermittently. global aphasia, BUE full, BLE \nantigravity appear full but exam limited due to aphasia, right \nnasal labial fold flattening \nincision is clean and dry- well approximated- staples removed \nthe day of discharge\n\n=================\nADMISSION EXAM:\n=================\n36.4 59 130/75 18 100% vent \nGEN: Intubated, non-diaphoretic\nHEENT: NC/AT. Bridle and ETT tube. \nNECK: Able to move without resistance (when sedated)\nCARD: RRR no m/r/g\nPULM: CTAB no r/r/w\nABD: Soft NT ND obese NABS\nEXTREM: Edema in both legs L > R\nNEUROLOGIC (15 minutes off propofol; still on fentanyl at 50)\n - MS: Eyes closed initially, brief eye opening to name called\nmoderately loudly and shoulder shake. More sustained eye opening\nwith sternal rub. Follows simple commands only (wiggle toes) but\nnot more complex ones (show 2 fingers). With more time off\npropofol, pursues purposeful movements (going for ETT) with both\narms. \n - CN: OD 2->1.5, OS 1.75->1.5, difficult to ascertain BTT. Eyes\nconjugate and midline. When awake, difficult to assess EOMs but\nlooks to right more than left without any nystagmus or forced \neye\nversion. Blinks to stimulation of eye lashes bilaterally. Face\nsymmetric (lower face in bit). Weak cough to deep suction.\n - MOTOR: Tone is equal throughout and normal. No ___ or\nBabinski. Left alone, moves the left arm more than the right.\nLocalizes briskly to midline stimulus. Withdraws both legs\nbriskly.\n - SENSORY: Sensible to minimally noxious stimuli in all\nextremities. \n - REFLEXES: Difficult to obtain, question trace biceps b/l. \n - CEREBELLAR: No obvious tremor when localizing to ETT with\neither arm.\n - GAIT: Deferred', 'diagnoses': [{'icd_code': '41402', 'desc': 'Coronary atherosclerosis of autologous vein bypass graft'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4139', 'desc': 'Other and unspecified angina pectoris'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V173'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}], 'summary': '=================\nADMISSION LABS:\n=================\n___ 11:40AM BLOOD WBC-15.4* RBC-5.22 Hgb-14.4 Hct-45.2 \nMCV-87 MCH-27.6 MCHC-31.9 RDW-13.0 Plt ___\n___ 11:40AM BLOOD Plt ___\n___ 11:40AM BLOOD ___ PTT-27.7 ___\n___ 11:40AM BLOOD ___\n___ 11:40AM BLOOD Glucose-140* UreaN-16 Creat-0.9 Na-139 \nK-4.7 Cl-106 HCO3-23 AnGap-15\n___ 11:40AM BLOOD ALT-15 AST-20 AlkPhos-57 TotBili-0.3\n___ 11:40AM BLOOD Lipase-81*\n___ 11:40AM BLOOD Albumin-4.2\n___ 12:12PM BLOOD Type-ART Tidal V-450 PEEP-5 FiO2-100 \npO2-101 pCO2-58* pH-7.27* calTCO2-28 Base XS--1 AADO2-550 REQ \nO2-92 -ASSIST/CON Intubat-INTUBATED\n___ 11:47AM BLOOD Glucose-135* Lactate-2.9* Na-141 K-4.6 \nCl-104 calHCO3-23\n___ 11:40AM URINE Color-Yellow Appear-Hazy Sp ___\n___ 11:40AM URINE Blood-NEG Nitrite-NEG Protein-600 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ 11:40AM URINE RBC-2 WBC-12* Bacteri-NONE Yeast-NONE \nEpi-<1\n___ 11:40AM URINE CastGr-19* CastHy-92* CastWBC-11* \nCastCel-6*\n.\n=================\nIMAGES\n=================\n\n___ ___ ___ ___\n \nCardiovascular Report ECG Study Date of ___ 11:52:50 AM \n \n \nAtrial fibrillation with average ventricular rate of 66 beats \nper minute. \nOtherwise, normal ECG. No previous tracing available for \ncomparison. \nTRACING #1 \n \n\nRead by: ___. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n66 0 92 ___\n \nCardiovascular Report ECG Study Date of ___ 5:52:34 ___\n \n \nAtrial fibrillation with average ventricular rate of 78 beats \nper minute. \nOtherwise, normal ECG. No significant change from the previous \ntracing. \nTRACING #2 \n \n\nRead by: ___. \n \n ___ Axes \nRate PR QRS QT/QTc P QRS T \n78 0 88 400/431 0 25 17 \n \nRadiology Report MRA BRAIN W/O CONTRAST Study Date of ___\n8:44 ___\n\nIMPRESSION: \n1. Large 6.2 cm left frontotemporal extra-axial mass, with \nimaging features diagnostic for meningioma with internal \ncalcification. \n2. Mass effect upon the subjacent brain with 6 mm rightward \nshift of the \nnormally-midline structures, but no evidence of contralateral \nlateral \nventricular "trapping" or more central herniation. \n3. No finding to suggest arteriovenous malformation. \n4. Fluid-opacification of the right mastoid air cells, \ndiffusely; correlate clinically. \n5. Cranial MRA notable for expected deviation of MCA branches \naround the \nlarge extra-axial mass, as well as prominent left middle \nmeningeal vessel, \nlikely the principal vascular supply to the tumor. \n6. Incidentally noted absence of the right distal vertebral \narterial \nflow-void and flow-related enhancement, which may simply \nrepresent \n___ of a hypoplastic vessel; however, high-grade \nstenosis or \nocclusion of this vessel, more proximally, is not excluded. \n \nRadiology Report MR HEAD W & W/O CONTRAST Study Date of \n___ 8:44 ___\n\n IMPRESSION: \n1. Large 6.2 cm left frontotemporal extra-axial mass, with \nimaging features diagnostic for meningioma with internal \ncalcification. \n2. Mass effect upon the subjacent brain with 6 mm rightward \nshift of the \nnormally-midline structures, but no evidence of contralateral \nlateral \nventricular "trapping" or more central herniation. \n3. No finding to suggest arteriovenous malformation. \n4. Fluid-opacification of the right mastoid air cells, \ndiffusely; correlate clinically. \n5. Cranial MRA notable for expected deviation of MCA branches \naround the \nlarge extra-axial mass, as well as prominent left middle \nmeningeal vessel, \nlikely the principal vascular supply to the tumor. \n6. Incidentally noted absence of the right distal vertebral \narterial \nflow-void and flow-related enhancement, which may simply \nrepresent \n___ of a hypoplastic vessel; however, high-grade \nstenosis or \nocclusion of this vessel, more proximally, is not excluded. \n \nRadiology Report CHEST (PRE-OP PA & LAT) Study Date of \n___ 9:06 AM FINDINGS: No acute cardiopulmonary process \n\n\n___ ECG\nAtrial fibrillation with a slow ventricular response rate of 52 \nbeats per \nminute. Non-specific ST segment changes. Compared to the \nprevious tracing of ___ the ventricular response rate is \nslower. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n52 0 ___ 0 36 5 \n \n___ MR head with and without contrast\nLarge left frontotemporal extra-axial mass, compatible with \nmeningioma, \nunchanged over the short interval. \n\n___ MRI head\n1. Large acute infarct within the left middle cerebral artery \nterritory. \n2. Postoperative multi compartmental hemorrhage, pneumocephalus \nand dural \nenhancement. A small nodular region of enhancement at the \nlateral inferior \naspect of the resection cavity may be postoperative or may be \nrepresent \nresidual tumor. \n\nRadiology Report CHEST (PORTABLE AP) Study Date of ___\n4:23 AM \n \n \nIMPRESSION: \n \nIn comparison with the study ___, the tip of the \nnasogastric tube is difficult to demonstrate but would appears \nto extend into the stomach. The side-port cannot be definitely \nseen. \nFor better definition of the precise position of the tip of the \ntube, a study of the upper abdomen using abdominal technique \nmight prove rewarding. Otherwise, little change in the \nappearance of the heart and lungs \n\nRadiology Report CHEST (PORTABLE AP) Study Date of ___\n6:35 ___\n \n \nIMPRESSION: \n \nNGT not well visualized past distal to the mid esophagus. No \nother interval change from prior study. \n\n___ ECHOCARDIOGRAPHY REPORT\n\n___ ___ MRN: ___ Portable TTE \n(Complete) Done ___ at 10:19:58 AM FINAL \n\nThe left atrium is normal in size. Left ventricular wall \nthickness, cavity size, and global systolic function are normal \n(LVEF = 65%). Due to suboptimal technical quality, a focal wall \nmotion abnormality cannot be fully excluded. Right ventricular \nchamber size and free wall motion are normal. The ascending \naorta is mildly dilated. The aortic valve leaflets (3) are \nmildly thickened but aortic stenosis is not present. No aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. Trivial mitral regurgitation is seen. There is no \npericardial effusion. \n\nRadiology Report BILAT LOWER EXT VEINS Study Date of ___\n11:22 AM \nIMPRESSION: \n \n1. Nonocclusive thrombus in the left mid to distal superficial \nfemoral vein and popliteal vein. \n2. No evidence of DVT in the right lower extremity\n___: Transferred from ___ to ED. Had a focal \nseizure (right eye version, R head turn, R arm extension) at OSH \nand intubated after 2mg LZP, 1gm Keppra. Plan to extubate today, \nMRI to confirm meningioma. The patient was extubated. The \npatient\'s diet was advanced.\n \nOn ___, The patient\'s family and patient decided that they \nwould like to go ahead with surgery. The patient foley catheter \nwas discontinued. The patient was transferred to the floor. \nThe patient was hypotensive to a systolic blood pressure of 82 \nafter atenolol. The patient was asymptomatic and spontaneously \nand quickly the systolic blood pressure was corrected to a \nsystolic blood pressure in teh ___. The atenolol dose was \nhalfed. \n \nOn ___, The patient underwent a pre operative work up which \nincluded a negative urine analysis, chest xray and a EKG which \nrevealed atrial fibrillation with a slow ventricular response \n(52). The patient was typed and crossed for two units of PRBC. \nThe patient was consented for surgery. Atenolol was held. \n\nOn ___, Mr. ___ was taken to the Operating Suite for \nresection of his left frontotemporal extra-axial mass. The \npatient tolerated the procedure well. Please see the operative \nreport for further details. Post-operatively, Mr. ___ was \ntransferred to the ICU for further management and observation \novernight. He remained on IV fluids. He underwent a post \noperative CT that showed a small hypodense area and trace \namounts of subarachnoid blood in the resection cavity. Keppra \nwas initiated for seizure prophylaxis.\n\nOn ___, patient was transferred from the pacu to the ICU for \nclose monitoring. He remained on a drip for blood pressure \ncontrol. On exam, he was found to have expressive aphasia. \n\nOn ___, patient\'s exam was stable. ___ was consulted. SBP was \nliberalized. Patient was weaned off drips. \n\nOn ___ Patient was weaned off drips and blood pressure remained \nless than SBP 160. Orders were written for the floor. \n\nOn ___, the patient\'s exam was stable. He continued ___. \n\nOn ___, The patient passed his swallow study and his diet was \nadvanced to regular with thin liquids. The tube feedings were \ndiscontinued. The patient tolerated his diet well and the \ndobhoff tube was discontinued. Lower extremity ultrasound was \nperformed for RIGHT calf pain noted on the morning exam and was \nconsistent with LEFT sided superficial femoral vein and \npopliteal non-occlusive DVT. The decadron was discontinued. The \nserum magnesium was low and was repleated. Cardiology was \nconsulted and made the following recomendations: aspirin 325mg \npo qd. metoprolol XL 100 mg qd, discontinue the home dosing of \natenolol, discontinue the short acting lopressor. A follow up \nappointment was made with cardiology to discuss atrial \nfibrillation and the possibility of starting anticoagulation in \nthe future. The BUN was slightly elevated and the patient was \ngiven a 250cc NS bolus. \n\nOn ___, the patient\'s exam was stable. He continued ___. His \nscalp staples were removed and the incision was c/d/i and left \nopen to air. Vascular surgery was consulted regarding the \npatient\'s DVT history, ___ filter that has been in place \nfor ___ years, and his current LLE non-occlusive DVT; their \nrecommendations were to elevate the LLE, use an ace wrap \ncompression bandage, and to start anticoagulation when OK to do \nso from a neurosurgical standpoint. The ___ filter will \nstay in place and he does not need to follow up with vascular \nsurgery after discharge.'}}
{'final_diagnoses': ['Left frontal mass'], 'procedures': ['___ Left craniotomy and extra-axial mass resection'], 'visit_summary': "___: Transferred from ___ to ED. Had a focal \nseizure (right eye version, R head turn, R arm extension) at OSH \nand intubated after 2mg LZP, 1gm Keppra. Plan to extubate today, \nMRI to confirm meningioma. The patient was extubated. The \npatient's diet was advanced.\n \nOn ___, The patient's family and patient decided that they \nwould like to go ahead with surgery. The patient foley catheter \nwas discontinued. The patient was transferred to the floor. \nThe patient was hypotensive to a systolic blood pressure of 82 \nafter atenolol. The patient was asymptomatic and spontaneously \nand quickly the systolic blood pressure was corrected to a \nsystolic blood pressure in teh ___. The atenolol dose was \nhalfed. \n \nOn ___, The patient underwent a pre operative work up which \nincluded a negative urine analysis, chest xray and a EKG which \nrevealed atrial fibrillation with a slow ventricular response \n(52). The patient was typed and crossed for two units of PRBC. \nThe patient was consented for surgery. Atenolol was held. \n\nOn ___, Mr. ___ was taken to the Operating Suite for \nresection of his left frontotemporal extra-axial mass. The \npatient tolerated the procedure well. Please see the operative \nreport for further details. Post-operatively, Mr. ___ was \ntransferred to the ICU for further management and observation \novernight. He remained on IV fluids. He underwent a post \noperative CT that showed a small hypodense area and trace \namounts of subarachnoid blood in the resection cavity. Keppra \nwas initiated for seizure prophylaxis.\n\nOn ___, patient was transferred from the pacu to the ICU for \nclose monitoring. He remained on a drip for blood pressure \ncontrol. On exam, he was found to have expressive aphasia. \n\nOn ___, patient's exam was stable. ___ was consulted. SBP was \nliberalized. Patient was weaned off drips. \n\nOn ___ Patient was weaned off drips and blood pressure remained \nless than SBP 160. Orders were written for the floor. \n\nOn ___, the patient's exam was stable. He continued ___. \n\nOn ___, The patient passed his swallow study and his diet was \nadvanced to regular with thin liquids. The tube feedings were \ndiscontinued. The patient tolerated his diet well and the \ndobhoff tube was discontinued. Lower extremity ultrasound was \nperformed for RIGHT calf pain noted on the morning exam and was \nconsistent with LEFT sided superficial femoral vein and \npopliteal non-occlusive DVT. The decadron was discontinued. The \nserum magnesium was low and was repleated. Cardiology was \nconsulted and made the following recomendations: aspirin 325mg \npo qd. metoprolol XL 100 mg qd, discontinue the home dosing of \natenolol, discontinue the short acting lopressor. A follow up \nappointment was made with cardiology to discuss atrial \nfibrillation and the possibility of starting anticoagulation in \nthe future. The BUN was slightly elevated and the patient was \ngiven a 250cc NS bolus. \n\nOn ___, the patient's exam was stable. He continued ___. His \nscalp staples were removed and the incision was c/d/i and left \nopen to air. Vascular surgery was consulted regarding the \npatient's DVT history, ___ filter that has been in place \nfor ___ years, and his current LLE non-occlusive DVT; their \nrecommendations were to elevate the LLE, use an ace wrap \ncompression bandage, and to start anticoagulation when OK to do \nso from a neurosurgical standpoint. The ___ filter will \nstay in place and he does not need to follow up with vascular \nsurgery after discharge.", 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN headache/pain ', '2. Aspirin 325 mg PO DAILY ', '3. Bisacodyl 10 mg PO/PR DAILY ', '4. Docusate Sodium 100 mg PO BID ', '5. Heparin 5000 UNIT SC TID ', '6. HydrALAzine 10 mg PO Q6H:PRN for SBP > 160 ', '7. LeVETiracetam 1000 mg PO BID ', '8. Lisinopril 5 mg PO DAILY ', '9. Metoprolol Succinate XL 100 mg PO DAILY ', '10. Ondansetron 4 mg IV Q8H:PRN nasuea ', '11. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN post \noperative headache ', '12. Paroxetine 30 mg PO DAILY ', '13. Polyethylene Glycol 17 g PO DAILY ', '14. Senna 8.6 mg PO BID Constipation ', '15. Sodium Chloride 0.9% Flush 3 mL IV Q8H and PRN, line flush ', '16. Haloperidol 0.5 mg IV BID:PRN delirium ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 25, 'gender': 'F', 'symptoms': 'progressive RLE weakness/numbness, 2 days of urinary and fecal\nincontinence', 'medical_history': ['Anterior/posterior lumbar fusion L3-5 on ___ and ___', 's/p cervical spine laminectomy/fusion', 'retroperitoneal seroma s/p ___ drainage (___)', 'Essential tremor', 'DMI', 'Papillary Thyroid Cancer s/p ___ resection c/b left brachial\nplexus injury', 'Hypertension', 'Hyperlipidemia'], 'family_history': 'Mother and grandmother with stroke, and grandmother who passed \naway with Alzheimers. No history of diabetes.', 'present_illness': 'Mr. ___ underwent a previous anterior and posterior L3-5\ndecompression and fusion. He now presents with leg weakness and\ncauda equina symptoms. His MRI demonstrates adjacent segment\ndegeneration at L2-3. 1 week of progressive RLE \nweakness/numbness, 5 days of\nprogressive RLE weakness/numbness, 2 days of urinary and fecal\nincontinence.', 'medications': [{'medication': 'Dibucaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate (L&D)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Codeine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'NIFEdipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'NIFEdipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '344', 'valuenum': 344.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2253.0, 'valueuom': 'mg/24hr', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'REFERENCE RANGE -- ROUGHLY 1000 MG/DAY [MEN 20 MG/KG, WOMEN 15 MG/KG].'}, {'value': '636', 'valuenum': 636.0, 'valueuom': 'mg/24hr', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'Ratio', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2650', 'valuenum': 2650.0, 'valueuom': 'mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '363', 'valuenum': 363.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '356', 'valuenum': 356.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On examination the patient is well developed, well nourished, \nA&O x3 in NAD. AVSS.\n\nRange of motion of the lumbar spine is somewhat limited on \nflexion, extension and lateral bending due to pain.\n\nAmbulating well with the assistance of a walker and ___, with \nlumbar corset brace for support.\n\nGross motor examination reveals good strength throughout the \nbilateral lower extremities.\n\nThere is no clonus present. \n\nSensation is intact throughout all affected dermatomes.\n\nThe posterior/lateral lumbar incisions are clean, dry and intact \nwithout erythema, edema or drainage.\n\nThe patient is voiding well without a foley catheter.', 'diagnoses': [{'icd_code': '64271', 'desc': 'Pre-eclampsia or eclampsia superimposed on pre-existing hypertension, delivered, with or without mention of antepartum condition'}, {'icd_code': '9971', 'desc': 'Cardiac complications, not elsewhere classified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '64911', 'desc': 'Obesity complicating pregnancy, childbirth, or the puerperium, delivered, with or without mention of antepartum condition'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '67482', 'desc': 'Other complications of puerperium, delivered, with mention of postpartum complication'}, {'icd_code': 'V270'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '64202', 'desc': 'Benign essential hypertension, complicating pregnancy, childbirth, and the puerperium, delivered, with mention of postpartum complication'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}], 'summary': '___ 09:25AM BLOOD WBC-8.9 RBC-3.73* Hgb-10.6* Hct-31.0*\nMCV-83 MCH-28.5 MCHC-34.3 RDW-14.7 Plt ___\nBriefly, the patient was admitted to the ___ Spine Surgery \nService and taken to the Operating Room on ___ for \nXLIF/posterior fusion. Refer to the dictated operative note for \nfurther details. The surgery was performed without \ncomplication, the patient tolerated the procedure well, and was \ntransferred to the ICU in a stable condition. He was transferred \nto inpatient floor two days later. TEDs/pneumoboots and heparin \nSC were used for postoperative DVT prophylaxis. Intravenous \nantibiotics were continued for 24hrs postop per standard \nprotocol. Initially, postop pain was controlled with a PCA. Diet \nwas advanced as tolerated. The patient was transitioned to oral \npain medication when tolerating PO diet. Foley was removed on \nPOD#2 and the patient was voiding well. Post-operative labs were \ngrossly stable. A hemovac drain that was placed at the time of \nsurgery was also removed on POD#2. Physical therapy was \nconsulted for mobilization OOB to ambulate. A lumbar corset \nbrace was fitted for the patient. Hospital course was otherwise \nunremarkable. On the day of discharge the patient was afebrile \nwith stable vital signs, comfortable on oral pain control and \ntolerating a regular diet.'}}
{'final_diagnoses': ['Spinal stenosis and paraparesis'], 'procedures': ['posterior revision fusion L2-L4', 'XLIF L2-L3'], 'visit_summary': 'Briefly, the patient was admitted to the ___ Spine Surgery \nService and taken to the Operating Room on ___ for \nXLIF/posterior fusion. Refer to the dictated operative note for \nfurther details. The surgery was performed without \ncomplication, the patient tolerated the procedure well, and was \ntransferred to the ICU in a stable condition. He was transferred \nto inpatient floor two days later. TEDs/pneumoboots and heparin \nSC were used for postoperative DVT prophylaxis. Intravenous \nantibiotics were continued for 24hrs postop per standard \nprotocol. Initially, postop pain was controlled with a PCA. Diet \nwas advanced as tolerated. The patient was transitioned to oral \npain medication when tolerating PO diet. Foley was removed on \nPOD#2 and the patient was voiding well. Post-operative labs were \ngrossly stable. A hemovac drain that was placed at the time of \nsurgery was also removed on POD#2. Physical therapy was \nconsulted for mobilization OOB to ambulate. A lumbar corset \nbrace was fitted for the patient. Hospital course was otherwise \nunremarkable. On the day of discharge the patient was afebrile \nwith stable vital signs, comfortable on oral pain control and \ntolerating a regular diet.', 'medications_prescribed': ['Glargine 30 Units Breakfast\nGlargine 30 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Levothyroxine Sodium 100 mcg PO DAILY', 'Lisinopril 20 mg PO DAILY', 'Acetaminophen 1000 mg PO Q6H pain', 'Diazepam 5 mg PO Q6H:PRN muscle spasm', 'Docusate Sodium 100 mg PO BID', 'Gabapentin 200 mg PO Q8H', 'Heparin 5000 UNIT SC BID', 'HYDROmorphone (Dilaudid) ___ mg PO Q3H:PRN pain', 'Senna 8.6 mg PO BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 27, 'gender': 'F', 'symptoms': 'mechanical fall, EtOH abuse', 'medical_history': ['Alcohol abuse', 'Grand mal seizure (presumed d/t EtOH)', '?Anemia of chronic disease (normal B12, folate, iron studies)', 'Mild proteinuria', 'Mild aortic stenosis', 'Peripheral vascular disease', 'Spinal stenosis c/b neurogenic claudication, s/p L2-5 \nLaminectomy with L3-5 fusion; C5-6 and C6-7 discetomy and fusion', 'Chronic back pain (treated w regular injections)', 'Fatty liver disease', 'Chronic Hepatitis B', 'Essential HTN', 'Hiatal hernia with reflux', 'Allergic rhinitis', 'Psoriasis', 'History of hyponatremia during previous hospitalizations', 'Adjustment disorder with mixed anxiety/ depression', 'Erectile dysfunction', 'Gastritis', 'S/P closed scapula fracture', 'Adenomatous and benign colonic polyps'], 'family_history': 'N/C', 'present_illness': '. I have read and agree with the nightfloat admission note. In \nbrief, this is a ___ year old man with a history of alcohol \nabuse, chronic HBV, hyponatremia, spinal stenosis with frequent \nfalls and recent hernia repair who presented to the ED after a \nfall. He reports he was at a friend\'s house and consumed around \n8 beers (possibly more). He also was taking oxycodone for back \npain. Reports that he has been taking "stronger" opioids as \nprescribed by surgery since his hernia repair, although this is \nnot documented in OMR, and he feels that this happened because \nhe mixed alcohol with the stronger pain medications. When he \nwent to stand up, he lost his balance and fell backward. He hit \nhis head on the corner of a desk, but did not lose \nconsciousness. He denies preceding dizziness, lightheadedness, \nvertigo, nausea, diaphoresis, chest pain, palpitations, \nnumbness, weakness. States he often has falls secondary to his \nweakness from spinal stenosis, and that he often falls backward \n(has hit his head in past). Patient was sent to the ED by \nambulance. \n. \nPatient has h/o EtOH abuse. States he does not drink every day, \nbut that his drinking has been increasing since he had to stop \nworking and go on disability ___ spinal stenosis. Drinks at \nleast one case of beer per week, no hard liquor. Feels that he \ndoesn\'t need to drink every day, but that once he starts it is \ndifficult to stop. Has never tried to quit in the past. Denies \nh/o anxiety, tremor, diaphoresis, palpitations, hallucinations \nwhen abstaining from EtOH. However, per OMR was hospitalized at \n___ in ___ for delirium tremens and required intubation for \nairway protection ___ altered mental status. In addition, he had \na seizure ___ years ago when at his college ___ drinking \nheavily, with negative CT scan by neurology and found possibly \ndue to EtOH withdrawal. Patient also has a h/o opioid abuse in \ncollege. However he denies abusing his current pain medications \nand states he takes them exactly as prescribed. \n. \nOf note, pt also has h/o hyponatremia during past \nhospitalizations, although this has usually been mild (low 130s) \nand found likely ___ volume depletion. \n. \nIn the ED, initial VS: 97.7 72 118/82 15 97%. He had a head and \nC-spine CT which were both negative. His labs were pertinent for \nhyponatremia of 121 and EtOH of 225. He was started on normal \nsaline at 40 cc/hr over a planned 18 hours. Surgery was \nconsulted and felt there were no post-operative problems from \ninguinal hernia. Vitals on transfer: 98.3 83 138/73 16 94% RA. \nOn arrival to the floor, vital signs stable. Pt reporting some \noccipital pain where he hit his had, and requesting removal of \nc-collar. Also c/o chronic back pain. \n. \nThis morning, patient states he feels well other than occipital \npain and his chronic back pain. Denies anxiety, tremor, nausea, \npalpitations, agitation, hallucinations, diaphoresis. C-collar \nwas removed this AM.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'SM .'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS - Tc 98.1 Tm 98.1 BP 160/84 (127-160/73-84) P 83 (76-83) RR \n18 SaO2 94% RA \nGENERAL - pleasant elderly M in NAD, laying in bed and talking \ncomfortably \nHEENT - PERRLA, EOMI, MMM small hematoma over posterior head \nNECK - supple, no JVD, no LAD \nLUNGS - CTAB no crackles/wheezes/rhonchi \nHEART - RRR S1 S2, ___ systolic ejection murmur heard best at \nleft sternal border, radiating throughout precordium. No \nrubs/gallops. \nABDOMEN - soft/NT/ND, +BS \nEXTREMITIES - 1+ ___ edema, no clubbing/cyanosis. \nSKIN - right arm skin tear with clean dressing, right arm \nscrape/laceration below scapula with small hematoma. Small \ntelangiectasias on fact. No spider angiomata. \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, cerebellar exam \nintact, moving all extremities. No asterixis. \n.\nDISCHARGE PHYSICAL EXAM:\nVS - Tc 98.1 BP 127/84 P 83 RR 18 SaO2 96% RA \nGENERAL - pleasant elderly M in NAD, laying in bed and talking \ncomfortably \nHEENT - PERRLA, EOMI, MMM small hematoma over posterior head \nNECK - supple, no JVD, no LAD \nLUNGS - CTAB no crackles/wheezes/rhonchi \nHEART - RRR S1 S2, ___ systolic ejection murmur heard best at \nleft sternal border, radiating throughout precordium. No \nrubs/gallops. \nABDOMEN - soft/NT/ND, +BS \nEXTREMITIES - 1+ ___ edema, no clubbing/cyanosis. \nSKIN - right arm skin tear with clean dressing, right arm \nscrape/laceration below scapula with small hematoma. Small \ntelangiectasias on face. No spider angiomata. \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, cerebellar exam \nintact, moving all extremities. No asterixis. ', 'diagnoses': [{'icd_code': 'O001', 'desc': 'Tubal pregnancy'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6832', 'desc': 'Body mass index [BMI] 32.0-32.9, adult'}], 'summary': "ADMISSION LABS:\nWBC-5.3 RBC-3.01* Hgb-11.7* Hct-31.4* MCV-104*# MCH-38.7* \nMCHC-37.1* RDW-12.9 Plt ___\nGlucose-91 UreaN-6 Creat-0.5 Na-121* K-4.6 Cl-87* HCO3-25 \nAnGap-14\nASA-NEG ___ Acetmnp-NEG Bnzodzp-NEG Barbitr-NEG \nTricycl-NEG\nCalcium-8.0* Phos-3.2 Mg-1.1*\nALT-14 AST-30 AlkPhos-74 TotBili-0.3\n.\nDISCHARGE LABS:\nWBC-6.2 RBC-3.11* Hgb-12.1* Hct-33.3* MCV-107* MCH-39.0* \nMCHC-36.4* RDW-12.6 Plt ___\nGlucose-92 UreaN-10 Creat-0.7 Na-136 K-3.9 Cl-97 HCO3-32 \nAnGap-11\nCalcium-8.7 Phos-3.5 Mg-1.5*\n.\nCT C-SPINE WITHOUT CONTRAST (___): There is no evidence of \nacute cervical fracture. The patient is status post anterior \nspinal fusion from C5 to C7 with anterior plate and body screws \nand disc spacers with no obvious evidence of hardware \ncomplication; however, the distinction between the disc spacer \nand C7 end-plate is not very clear on some images. Prevertebral \nsoft tissues are well preserved. Multilevel degenerative changes \nare noted with minimal anterolisthesis of C3 on C4 and minimal \nretrolisthesis of C4 on C5. Endplate changes at T1 and T2 levels \nare noted, unchanged from ___. Moderate-severe neural \nforaminal narrowing is noted at multiple levels, most \nprominently on the right \nat C3-C4, and bilaterally at C4-C5 and C5-C6 levels. Extensive \ncarotid calcifications are noted at the bifurcation. Bilateral \nlung apices show evidence of bullae but no other acute findings \nare identified. \nIMPRESSION: \n1. No acute cervical fracture. See details regarding hardware \nabove. Spine \nsurgeon ___ the iamges to assess the adequacy of the \nhardware. \n2. Multilevel degenerative changes as noted above with \nmoderate-severe \nforaminal narrowing. If there is continued clinical concern, MR \ncan be \nconsidered if not contra-indicated. \n.\nCT HEAD WITHOUT CONTRAST: There is no evidence of acute \nintracranial hemorrhage, edema, mass \neffect, or shift of normally midline structures. The ventricles \nand sulci \nare prominent consistent with volume loss. There is no shift of \nnormally \nmidline structures. \nPeriventricular and subcortical low-attenuating regions are \nconsistent with \nsequelae of chronic small vessel ischemic disease. The \nvisualized paranasal \nsinuses are clear. There are scattered foci of increased \nattenuation in the \nsoft tissues of the left occipital and parietal regions which \nmay relate to \ntrauma. No obvious acute fracture is noted. Sphenoid sinus has 3 \nseptations, \nwith a minor one inserting on the right carotid groove medially. \nVascular \ncalcifications are noted. \n \nIMPRESSION: No acute intracranial hemorrhage or mass effect or \nacute \nfracture. Other details as above. \n___ year old man with a history of alcohol abuse, chronic HBV, \nhyponatremia, spinal stenosis with frequent falls and recent \nhernia repair who presented to the ED after a mechanical fall, \nfound to have hyponatremia. \n. \n# HYPONATREMIA: pt has h/o hyponatremia during past \nhospitalizations (to low ___ which has responded to normal \nsaline, making the diagnosis of hypovolemic hyponatremia most \nlikely in those cases. Had serum Na of 121 on admission; urine \nstudies show sodium<10 and urine osms 149 (Posm 280). These \nfindings, along with fact that patient appeared clinically \neuvolemic, indicated that hyponatremia was likely secondary to \nbeer potomania. His sodium was corrected with normal saline, \nincreasing to 127 after 5 hours. Correction of hyponatremia was \nlikely combination of pt's intrinsic homeostatic mechanisms and \nrepletion with NS. After this, fluids were held and patient's \nsodium improved to 136 with no intervention. Serial neuro checks \nnormal throughout. His citalopram was held during \nhospitalization as can worsen hyponatremia, then restarted on \ndischarge. Patient advised to discontinue EtOH use in the future \nto avoid recurrent hyponatremia. \n. \n# S/P FALL: Patient had a mechanical fall likely related to his \nspinal stenosis and worsened by his alcohol and oxycontin usage. \nHe had a negative CT head and c-spine. Pt describes history of \nfrequent falls, usually backward, and states he has hit his head \nbefore. As he did not lose consciousness, not concerned for \narrythmia, seizure, severe aortic stenosis or other causes of \nsyncope. ___ consult recommended continued use of rolling walker. \nPatient not interested in other home services. \n. \n# MACROCYTIC ANEMIA: pt has stable macrocytic anemia, with \nnormal B12 and folate recently checked by PCP. He is on B12 \nsupplements at home. Per PCP, most likely diagnosis is anemia of \nchronic disease. B12 and folate checked again during \nhospitalization and found to be normal.\n. \n# ALCOHOL ABUSE: has h/o alcohol abuse with prior episode of \nDT's requiring intubation for airways protection. H/O fatty \nliver per medical record. His alcohol use has become worse since \nhe stopped working. EtOH level was 225 on admission. Concern for \nwithdrawal during hospitalization, but did not score on CIWA at \nany point. LFTs WNL. Thiamine, folate and a multivitamin were \nstarted during hospitalization. Home B12 continued. Pt had \nsocial work consult for substance abuse and did not express \ninterest in quitting drinking. \n.\n# SPINAL STENOSIS: pt has severe spinal stenosis s/p several \nsurgeries and now physically disabled. He takes oxycontin for \nhis pain, and has h/o opioid abuse in past but not currently \nabusing it. He was discharged on his home dose of oxycontin \n(also taking for post-op pain s/p hernia repair). \n. \n# S/P INGUINAL HERNIA REPAIR: per surgery no acute issues. \n. \n# PROTEINURIA: documented in past PCP ___. Unclear etiology. \nOutpatient follow up recommended. \n. \n# DEPRESSION: citalopram held given hyponatremia; restarted on \ndischarge. \n. \n# ANXIETY: on clonazepam at home; continued during \nhospitalization. \n. \n# GASTRITIS, GERD: continued omeprazole \n. \n# HYPERTENSION: stable on home metoprolol and lisinopril. \nContinued during hospitalization. \n. \n# PSORIASIS: Continued home diprolene. "}}
{'final_diagnoses': ['1. Fall ', '2. Hyponatremia (low sodium)', '3. Alcohol abuse'], 'procedures': ['none'], 'visit_summary': "___ year old man with a history of alcohol abuse, chronic HBV, \nhyponatremia, spinal stenosis with frequent falls and recent \nhernia repair who presented to the ED after a mechanical fall, \nfound to have hyponatremia. \n. \n# HYPONATREMIA: pt has h/o hyponatremia during past \nhospitalizations (to low ___ which has responded to normal \nsaline, making the diagnosis of hypovolemic hyponatremia most \nlikely in those cases. Had serum Na of 121 on admission; urine \nstudies show sodium<10 and urine osms 149 (Posm 280). These \nfindings, along with fact that patient appeared clinically \neuvolemic, indicated that hyponatremia was likely secondary to \nbeer potomania. His sodium was corrected with normal saline, \nincreasing to 127 after 5 hours. Correction of hyponatremia was \nlikely combination of pt's intrinsic homeostatic mechanisms and \nrepletion with NS. After this, fluids were held and patient's \nsodium improved to 136 with no intervention. Serial neuro checks \nnormal throughout. His citalopram was held during \nhospitalization as can worsen hyponatremia, then restarted on \ndischarge. Patient advised to discontinue EtOH use in the future \nto avoid recurrent hyponatremia. \n. \n# S/P FALL: Patient had a mechanical fall likely related to his \nspinal stenosis and worsened by his alcohol and oxycontin usage. \nHe had a negative CT head and c-spine. Pt describes history of \nfrequent falls, usually backward, and states he has hit his head \nbefore. As he did not lose consciousness, not concerned for \narrythmia, seizure, severe aortic stenosis or other causes of \nsyncope. ___ consult recommended continued use of rolling walker. \nPatient not interested in other home services. \n. \n# MACROCYTIC ANEMIA: pt has stable macrocytic anemia, with \nnormal B12 and folate recently checked by PCP. He is on B12 \nsupplements at home. Per PCP, most likely diagnosis is anemia of \nchronic disease. B12 and folate checked again during \nhospitalization and found to be normal.\n. \n# ALCOHOL ABUSE: has h/o alcohol abuse with prior episode of \nDT's requiring intubation for airways protection. H/O fatty \nliver per medical record. His alcohol use has become worse since \nhe stopped working. EtOH level was 225 on admission. Concern for \nwithdrawal during hospitalization, but did not score on CIWA at \nany point. LFTs WNL. Thiamine, folate and a multivitamin were \nstarted during hospitalization. Home B12 continued. Pt had \nsocial work consult for substance abuse and did not express \ninterest in quitting drinking. \n.\n# SPINAL STENOSIS: pt has severe spinal stenosis s/p several \nsurgeries and now physically disabled. He takes oxycontin for \nhis pain, and has h/o opioid abuse in past but not currently \nabusing it. He was discharged on his home dose of oxycontin \n(also taking for post-op pain s/p hernia repair). \n. \n# S/P INGUINAL HERNIA REPAIR: per surgery no acute issues. \n. \n# PROTEINURIA: documented in past PCP ___. Unclear etiology. \nOutpatient follow up recommended. \n. \n# DEPRESSION: citalopram held given hyponatremia; restarted on \ndischarge. \n. \n# ANXIETY: on clonazepam at home; continued during \nhospitalization. \n. \n# GASTRITIS, GERD: continued omeprazole \n. \n# HYPERTENSION: stable on home metoprolol and lisinopril. \nContinued during hospitalization. \n. \n# PSORIASIS: Continued home diprolene. ", 'medications_prescribed': ['1. baclofen 10 mg Tablet Sig: One (1) Tablet PO TID (3 times a \nday).', '2. betamethasone dipropionate 0.05 % Cream Sig: One (1) Appl \nTopical BID (2 times a day).', '3. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', '4. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '5. cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily).', '6. cyanocobalamin (vitamin B-12) 500 mcg Tablet Sig: Two (2) \nTablet PO DAILY (Daily).', '7. multivitamin Tablet Sig: One (1) Tablet PO once a day.', '8. metoprolol tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', '9. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '10. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '11. folic acid 1 mg Tablet Sig: One (1) Tablet PO once a day.\nDisp:*30 Tablet(s)* Refills:*2*', '12. citalopram 40 mg Tablet Sig: One (1) Tablet PO once a day. ', '13. OxyContin 10 mg Tablet Extended Release 12 hr Sig: One (1) \nTablet Extended Release 12 hr PO every twelve (12) hours. ', '14. Ambien 10 mg Tablet Sig: One (1) Tablet PO at bedtime. ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': '24 hours of nausea and 10 hours of severe abdominal pain.', 'medical_history': ['gastric bypass surgery ___ - lost 225 lbs since, was \noriginally 360 lbs. done at ___ ', 'gastric ulcers', '"enlarged spleen" on imaging ___ ', 'L-eye corneal ulcer ___ contact use ', 'h/o cocaine abuse ', 's/p L lumpectomy (benign pathology) in ___ ', 's/p tonsilectomy ', 'hx of headaches - eval by neuro ___ ', 'depression', 'iron-deficiency anemia'], 'family_history': 'Mother - thyroid cancer, brain aneurysm. Father and brother \nhealthy.', 'present_illness': 'The patient is a ___ woman ___ years status post a gastric \nbypass in an outside institution with a known history of pouch \nulcers via history on endoscopy x2. Despite that she has \ncontinued smoking and she takes nonsteroidal anti-inflammatory \nmedications regularly.\n\nAt approximately 8:00 a.m. on the morning of admission, she \nexperienced sharp left lateral deep abdominal pain which then \nprogressed to her back and over the course of the day has become \nslightly more diffuse and is quite severe in nature. She \npresented to an outside hospital. She had a CT scan which showed \nfree air in her abdomen and some fluid in her pelvis. She was \nfebrile, had an elevated white count and tachycardiac. On \nabdominal exam, she had diffuse pain\nthroughout her abdomen. She did not have a rigid abdomen but she \ndid have guarding and rebound diffusely.\n\nAt this time she was taken to the operating room for exploratory \nlaparotomy.', 'medications': [{'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dorzolamide 2%/Timolol 0.5% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pilocarpine 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin (Prophylaxis)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.9', 'valuenum': 40.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50.2', 'valuenum': 50.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '39', 'valuenum': 39.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Tmax: 98.4 Tc: 98.1 HR: 85 BP: 99/65 RR: 18 O2: 96% on RA\n\nGeneral: Patient appears well\nNeuro: Pain well controlled\nCV: RRR\nPulm: CTAB\nAbd: Soft, non-tender, non-distended\nIncision: Staples removes, wound open to air with Steri-strips', 'diagnoses': [{'icd_code': 'C50911', 'desc': 'Malignant neoplasm of unspecified site of right female breast'}, {'icd_code': 'G92', 'desc': 'Toxic encephalopathy'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C7800', 'desc': 'Secondary malignant neoplasm of unspecified lung'}, {'icd_code': 'C773', 'desc': 'Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'I248', 'desc': 'Other forms of acute ischemic heart disease'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'Z87440', 'desc': 'Personal history of urinary (tract) infections'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'F0390', 'desc': 'Unspecified dementia, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'H409', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'H9190', 'desc': 'Unspecified hearing loss, unspecified ear'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'J329', 'desc': 'Chronic sinusitis, unspecified'}, {'icd_code': 'I808', 'desc': 'Phlebitis and thrombophlebitis of other sites'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'I890', 'desc': 'Lymphedema, not elsewhere classified'}, {'icd_code': 'E860', 'desc': 'Dehydration'}], 'summary': "___ 08:00AM BLOOD WBC-15.8* RBC-3.77* Hgb-9.2* Hct-28.4* \nMCV-75* MCH-24.3* MCHC-32.2 RDW-20.3* Plt ___\n___ 09:06PM BLOOD WBC-23.6*# RBC-4.10* Hgb-9.6* Hct-31.0* \nMCV-76* MCH-23.4* MCHC-30.9* RDW-20.1* Plt ___\n\n___ 10:37PM BLOOD Neuts-82.4* Lymphs-10.9* Monos-3.5 \nEos-3.0 Baso-0.2\n___ 09:06PM BLOOD Neuts-89.9* Lymphs-7.6* Monos-2.2 Eos-0.1 \nBaso-0.2\n___ 08:00AM BLOOD Plt ___\n___ 01:56AM BLOOD ___ PTT-30.4 ___\n___ 09:06PM BLOOD ___ PTT-28.2 ___\n___ 06:20AM BLOOD Glucose-87 UreaN-3* Creat-0.6 Na-137 \nK-4.2 Cl-98 HCO3-29 AnGap-14\n___ 08:25AM BLOOD Glucose-92 UreaN-4* Creat-0.4 Na-137 \nK-4.1 Cl-97 HCO3-25 AnGap-19\n___ 03:16AM BLOOD Glucose-94 UreaN-5* Creat-0.5 Na-134 \nK-4.0 Cl-99 HCO3-30 AnGap-9\n___ 01:56AM BLOOD Glucose-121* UreaN-5* Creat-0.5 Na-134 \nK-3.9 Cl-105 HCO3-24 AnGap-9\n___ 09:06PM BLOOD Glucose-117* UreaN-6 Creat-0.6 Na-134 \nK-3.6 Cl-102 HCO3-24 AnGap-12\nThe patient presented from an OSH with an ulcerated RNY site. \nShe was pre-op'd and taken to the OR for an exploratory \nlaparotomy, oversew of perforation,\nabdominal washout. She was then taken to the intensive care unit \ndue to the late hour in the evening and her preop septic \npicture. She was NPO with IVF/PCA/Foley/NGT/JP and abx. \n.\nThe patient's pain was poorly controlled with post operative \nmorphine PCA, and a Ketamine infusion was added. A pain consult \nwas obtained, and the Dilaudid PCA was increased to 0.5mg q6min \nno basal, max 5mg/hr and Ketamine was stopped.\n.\nShe was transferred to the floor on POD 2. The NGT was left in \nplace and the patient was maintained as NPO. On POD 5 a Swallow \nstudy was done indicating no leak. The NGT was removed at this \ntime and the patient's diet was advanced as tolerated from sips \nto regular. She tolerated this well. Her meds were changed to po \nand homes meds restarted. Her foley was removed with out any \nissues. JP output decreased and this was also removed along with \nher staples and steri strips were placed. \n.\nAll discharge paperwork was reviewed with the patient and all \nquestions answered. She will follow up with Dr. ___ in ___ \nweeks."}}
{'final_diagnoses': ['Perforation at the gastric pouch Roux-en-Y anastomosis.'], 'procedures': ['Exploratory laparotomy', 'oversew of perforation', 'abdominal washout'], 'visit_summary': "The patient presented from an OSH with an ulcerated RNY site. \nShe was pre-op'd and taken to the OR for an exploratory \nlaparotomy, oversew of perforation,\nabdominal washout. She was then taken to the intensive care unit \ndue to the late hour in the evening and her preop septic \npicture. She was NPO with IVF/PCA/Foley/NGT/JP and abx. \n.\nThe patient's pain was poorly controlled with post operative \nmorphine PCA, and a Ketamine infusion was added. A pain consult \nwas obtained, and the Dilaudid PCA was increased to 0.5mg q6min \nno basal, max 5mg/hr and Ketamine was stopped.\n.\nShe was transferred to the floor on POD 2. The NGT was left in \nplace and the patient was maintained as NPO. On POD 5 a Swallow \nstudy was done indicating no leak. The NGT was removed at this \ntime and the patient's diet was advanced as tolerated from sips \nto regular. She tolerated this well. Her meds were changed to po \nand homes meds restarted. Her foley was removed with out any \nissues. JP output decreased and this was also removed along with \nher staples and steri strips were placed. \n.\nAll discharge paperwork was reviewed with the patient and all \nquestions answered. She will follow up with Dr. ___ in ___ \nweeks.", 'medications_prescribed': ['Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed for pain for 2 weeks: Do not take \nmore than 4000 mg of Tylenol.\nDisp:*45 Tablet(s)* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 26, 'gender': 'F', 'symptoms': 'shortness of breath', 'medical_history': ['ONCOLOGIC HISTORY:\nFrom Doctor ___ note in ___ from ___: ___ was \npreviously treated for high risk stage II colon cancer with \nresection in ___ followed by adjuvant ___, as well \nas localized prostate cancer treated with brachytherapy. \nSurveillance PET-CT in ___ identified an FDG avid 4 cm \nliver lesion. Core biopsy on ___ ___ \nshowed poorly differentiated carcinoma, staining positive for \nCK7 and negative for CK20, TTF-1, CDF2, and PSA. Findings are \nmost consistent with a pancreaticobiliary primary. Mr. ___ \nunderwent evaluation for surgical resection, radiofrequency \nablation, and CyberKnife, but was not a candidate for these \nprocedures. During the course of this evaluation, repeat CT on \n___ showed increase in size of the left liver mass \nmeasuring 4.9 x 3.___s nodularity of the peritoneum \nand omental caking. Biopsy of omental nodule was also consistent \nwith adenocarcinoma of pancreaticbiliary or upper GI primary. He \nbegan gemcitabine chemotherapy ___. He will receive \ngemcitabine 800 mg/m2 days 1, 8, and 15 of a28-day cycle and we \nwill monitor for tolerance. ___ add oxaliplatin it tolerates \ngemcitabine well.\n.\nOTHER MEDICAL HISTORY:\n1. Hypertension.\n2. Coronary artery disease.\n3. Congestive heart failure.\n4. Atrial fibrillation.\n5. COPD on home O2 at night.\n6. Obstructive sleep apnea on CPAP.\n7. History of PEA arrest ___.\n8. History of colon cancer ___.\n9. History of prostate cancer treated with brachytherapy.\n10. History of skin basal cell carcinomas.\n11. History of skin squamous cell carcinomas.\n12. Cirrhosis of unclear etiology, likely NASH.\n13. Venous stasis.\n14. History of recurrent episodes of cellulitis.\n15. Hyperthyroidism.\n16. History of pneumonia.\n17. Osteoarthritis.'], 'family_history': "The patient's sister was diagnosed with lung cancer at ___ years. \nShe is a tobacco user and also has end-stage renal disease. A \npaternal grandmother had a cancer of\nunknown type. His mother had ___ disease and a stroke. His \nfather had vasculitis. Diabetes mellitus and coronary artery \ndisease also run in his family.", 'present_illness': 'The patient is a ___ year old male with multiple medical problems \nincluding CAD, COPD, and CHF and a distant history of colon \ncancer. He was recently diagnosed with a poorly differentiated \nadenocarcinoma of pancreatic versus cholangio origin and \npresents with acute kidney injury and reported shortness of \nbreath. He had his first cycle of gemcitabine on ___. Of \nnote, he had a recent admission for acute kidney injury \nattributed to prerenal azotemia. On ___ the patient felt more \nshort of breath than usual, and he used more of his home oxygen. \nHe usually uses 3L NC at night and intermittently as needed \nthroughout the day. On ___ the patient went to the \nchiropractor, who noted that his lips were cyanotic. The patient \nwent to the ___ ED. There, he was treated with \nsupplemental oxygen by NC, kayexelate for hyperkalemia, \noxycodone, azithromycin 500mg iv, and ipatropium and albuterol \nneubulizers.\n.\nThe patient was transferred to ___ ED for further care. Vitals \nwere 98.2, HR 92, 114/52, RR20, Sat 98%RA. He was treated with \nceftriaxone 1g iv.\n.\nUpon arrival to the floor, the patient was hemodynamically \nstable.\n.\n(+) Per HPI. In addition, he has had chronic abdominal pain for \nseveral weeks that is controlled with oxycodone. This has \nworsened recently and he has had to take more oxycodone than \nusual.\n(-) Denies fever, chills, night sweats, recent weight loss or \ngain. Denies headache, sinus tenderness, rhinorrhea or \ncongestion. Denies chest pain or tightness, palpitations. Denies \ncough or wheezes. Denies nausea, vomiting,\ndiarrhea. No recent change in bowel or bladder habits. No \ndysuria. Denies arthralgias or myalgias. Denies rashes or skin \nbreakdown. No numbness/tingling\nin extremities. All other review of systems negative.', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxytocin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Betamethasone Sodium Phos/Acet', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate (L&D)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prenatal Vitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prenatal Vitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Naloxone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate (L&D)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Naloxone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate (L&D)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '367', 'valuenum': 367.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.67', 'valuenum': 4.67, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.43', 'valuenum': 4.43, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '320', 'valuenum': 320.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '332', 'valuenum': 332.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '325', 'valuenum': 325.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.8', 'valuenum': 39.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Negative.'}, {'value': '0.440', 'valuenum': 0.44, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.027', 'valuenum': 0.027, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.10', 'valuenum': 0.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Negative.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.444', 'valuenum': 0.444, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.028', 'valuenum': 0.028, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '350', 'valuenum': 350.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.59', 'valuenum': 4.59, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '314', 'valuenum': 314.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T 97.7 BP 138/62, HR 86, RR 20, Sat 100% 3L NC\nGen: in no acute distress\nHEENT: extraocular movements intact, conjunctivae clear, sclerae \nanicteric, oropharynx moist and without lesions\nNeck: supple, large, unable to appreciate JVD\nCV: normal rate, irregularly irregular rhythm, normal S1/S2, no \nmurmur\nLungs: clear to ascultation bilaterally, no crackles or wheezes\nAbd: rotund, somewhat distended, nontympanitic nondistended, \nbowel sounds present, no hepatosplenomegaly\nExt: warm, well-perfused, no cyanosis. Trace edema bilat in LEs. \nVenous stasis changes in lower exts bilat.\nNeuro: oriented x 3, answering all questions appropriately, CN \nII-XII intact.', 'diagnoses': [{'icd_code': 'O114', 'desc': 'Pre-existing hypertension with pre-eclampsia, complicating childbirth'}, {'icd_code': 'Z6842', 'desc': 'Body mass index [BMI] 45.0-49.9, adult'}, {'icd_code': 'O2412', 'desc': 'Pre-existing type 2 diabetes mellitus, in childbirth'}, {'icd_code': 'O99214', 'desc': 'Obesity complicating childbirth'}, {'icd_code': 'Z370', 'desc': 'Single live birth'}, {'icd_code': 'Z3A34', 'desc': '34 weeks gestation of pregnancy'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'E6601', 'desc': 'Morbid (severe) obesity due to excess calories'}, {'icd_code': 'O34219', 'desc': 'Maternal care for unspecified type scar from previous cesarean delivery'}, {'icd_code': 'Z309', 'desc': 'Encounter for contraceptive management, unspecified'}], 'summary': "Admission Labs:\n___ 12:45AM BLOOD WBC-9.9# RBC-3.46* Hgb-10.0* Hct-28.2* \nMCV-82 MCH-29.0 MCHC-35.6* RDW-16.4* Plt ___\n___ 12:45AM BLOOD Neuts-90* Bands-6* Lymphs-2* Monos-2 \nEos-0 Baso-0 ___ Myelos-0\n___ 12:45AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-NORMAL \nMacrocy-NORMAL Microcy-1+ Polychr-NORMAL\n___ 12:45AM BLOOD ___ PTT-30.6 ___\n___ 12:45AM BLOOD Glucose-160* UreaN-64* Creat-2.8*# \nNa-130* K-5.7* Cl-96 HCO3-19* AnGap-21*\n___ 12:45AM BLOOD CK(CPK)-42*\n___ 12:45AM BLOOD CK-MB-2 cTropnT-0.02* proBNP-3793*\n___ 12:49AM BLOOD Lactate-2.2*.\nDischarge Labs:\n___ 08:10AM BLOOD WBC-3.8* RBC-3.23* Hgb-9.3* Hct-27.4* \nMCV-85 MCH-29.0 MCHC-34.0 RDW-15.9* Plt ___\n___ 11:20AM BLOOD ___ PTT-31.5 ___\n___ 08:10AM BLOOD Glucose-138* UreaN-36* Creat-1.0 Na-134 \nK-4.9 Cl-99 HCO3-28 AnGap-12\n___ 08:10AM BLOOD Calcium-9.3 Phos-2.6* Mg-2.0.\nCardiac Enzymes: ___ CK(CPK)-42*, ___ CK(CPK)-16*\n___ CK-MB-2 cTropnT-0.02* proBNP-3793*, CK-MB-2.\nECG ___: Atrial fibrillation with a mean ventriculare rate \nof 95. \nDiffuse non-diagnostic repolarization abnormalities. Compared to \nthe previous tracing of ___ there is no diagnostic change..\nCXR ___: Low lung volumes with atelectasis..\nCT Chest/Abd/Pelvis w/o Contrast ___: \n1. Findings consistent with peritoneal carcinomatosis, not \nsignificantly\nchanged from prior study, but slight increase in ascites.\n2. Multiple small pulmonary nodules, subjectively less prominent \nthan on\nprior chest CT.\n3. Heterogeneous appearing thyroid most consistent with \nmultinodular goiter; if clinically a concern, ultrasound could \nbe performed for further evaluation..\nTTE ___: The left atrium is markedly dilated. The right \natrium is markedly dilated. No atrial septal defect is seen by \n2D or color Doppler. There is mild symmetric left ventricular \nhypertrophy with normal cavity size. Regional left ventricular \nwall motion is normal. Left ventricular systolic function is \nhyperdynamic (EF>75%). There is no ventricular septal defect. \nwith normal free wall contractility. The aortic root is mildly \ndilated at the sinus level. The ascending aorta is mildly \ndilated. The aortic valve leaflets (3) are mildly thickened but \naortic stenosis is not present. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. Trivial \nmitral regurgitation is seen. The tricuspid valve leaflets are \nmildly thickened. Tricuspid regurgitation is present but cannot \nbe quantified. There is mild pulmonary artery systolic \nhypertension. There is a small pericardial effusion. There are \nno echocardiographic signs of tamponade. \nThe patient is a ___ year old male with multiple medical problems \nincluding CAD, COPD, and CHF and a distant history of colon \ncancer. He was recently diagnosed with a poorly differentiated \nadenocarcinoma of pancreatic versus cholangio origin and \npresented from an outside hospital on ___ with acute kidney \ninjury and reported shortness of breath. His brief hospital \ncourse follows, by problem:.\n#Acute Kidney Injury: Of note, the patient had a recent \nadmission with ___ attributed to prerenal azotemia, which had \nresolved with intravenous fluids. The patient's creatinine on \nadmission was 2.8. His renal failure was thought to be \nsecondary to intravascular depletion versus ATN/AIN. The patient \nhad received a dose of gemcitabine on ___, but this drug is \nnot traditionally associated with nephrotoxicity. No other \nrecent antibiotics or medicaction changes had been elicited in \nthe history. On hospital day 2, the patient's FENa was \ncalculated to be 1.5%. His diuretics and angiotensin receptor \nblocker were held. He was hydrated gently with intravenous \nfluids. His creatinine trended downwards and was 1.0 on \nhospital day 4, the day of discharge. \n.\n#Shortness of Breath: On admission, the patient was felt to have \na mild COPD exacerbation. There was verbal report of \ndesaturation to 88% on RA at the outside hospital. The patient \ndid not have a CHF clinical picture. He was asymptomatic upon \narrival to the hospital floor. His BNP was elevated but we were \nunsure of his baseline value. On hospital day 1, the patient \nwas started on oral prednisone, azithromycin, and ceftriaxone \nfor a COPD exacerbation. The patient remained asymptomatic and \nhe was taken off of these medications on hospital day three. \n.\n#CAD/CHF: The patient was maintained on his home aspirin dose. A \nTTE showed hyperdynamic left ventricular systolic function with \nan EF>75%. \n.\n#Atrial fibrillation: The patient was in afib on admission. He \nwas rate controlled and anticoagulated. His warfarin and \nmetoprolol were continued. \n.\n#Abdominal Pain: This pain was chronic and was deemed likely to \nbe secondary to primary disease process. He was maintained on \noxycodone prn for pain. His bowel regimen included lactulose \naround the clock. He required a Fleet enema to have a bowel \nmovement. \n.\n#Cirrhosis of unknown etiology: Treat as above.\n.\n#Hypertension: The patient's diuretics were held on admission. \nOn HD3, he was started on lasix 40mg daily. The patient's \nspironolactone was held on discharge, but he was restarted on \nhis olmesartan.\n.\n#Hyperthyroid: The patient's methimazole was continued. \n.\n# Prophylaxis: The patient was given heparin SC for DVT \nprophylaxis."}}
{'final_diagnoses': ['Acute kidney injury', 'COPD'], 'procedures': ['none'], 'visit_summary': "The patient is a ___ year old male with multiple medical problems \nincluding CAD, COPD, and CHF and a distant history of colon \ncancer. He was recently diagnosed with a poorly differentiated \nadenocarcinoma of pancreatic versus cholangio origin and \npresented from an outside hospital on ___ with acute kidney \ninjury and reported shortness of breath. His brief hospital \ncourse follows, by problem:.\n#Acute Kidney Injury: Of note, the patient had a recent \nadmission with ___ attributed to prerenal azotemia, which had \nresolved with intravenous fluids. The patient's creatinine on \nadmission was 2.8. His renal failure was thought to be \nsecondary to intravascular depletion versus ATN/AIN. The patient \nhad received a dose of gemcitabine on ___, but this drug is \nnot traditionally associated with nephrotoxicity. No other \nrecent antibiotics or medicaction changes had been elicited in \nthe history. On hospital day 2, the patient's FENa was \ncalculated to be 1.5%. His diuretics and angiotensin receptor \nblocker were held. He was hydrated gently with intravenous \nfluids. His creatinine trended downwards and was 1.0 on \nhospital day 4, the day of discharge. \n.\n#Shortness of Breath: On admission, the patient was felt to have \na mild COPD exacerbation. There was verbal report of \ndesaturation to 88% on RA at the outside hospital. The patient \ndid not have a CHF clinical picture. He was asymptomatic upon \narrival to the hospital floor. His BNP was elevated but we were \nunsure of his baseline value. On hospital day 1, the patient \nwas started on oral prednisone, azithromycin, and ceftriaxone \nfor a COPD exacerbation. The patient remained asymptomatic and \nhe was taken off of these medications on hospital day three. \n.\n#CAD/CHF: The patient was maintained on his home aspirin dose. A \nTTE showed hyperdynamic left ventricular systolic function with \nan EF>75%. \n.\n#Atrial fibrillation: The patient was in afib on admission. He \nwas rate controlled and anticoagulated. His warfarin and \nmetoprolol were continued. \n.\n#Abdominal Pain: This pain was chronic and was deemed likely to \nbe secondary to primary disease process. He was maintained on \noxycodone prn for pain. His bowel regimen included lactulose \naround the clock. He required a Fleet enema to have a bowel \nmovement. \n.\n#Cirrhosis of unknown etiology: Treat as above.\n.\n#Hypertension: The patient's diuretics were held on admission. \nOn HD3, he was started on lasix 40mg daily. The patient's \nspironolactone was held on discharge, but he was restarted on \nhis olmesartan.\n.\n#Hyperthyroid: The patient's methimazole was continued. \n.\n# Prophylaxis: The patient was given heparin SC for DVT \nprophylaxis.", 'medications_prescribed': ['1. Doxycycline Hyclate 100 mg Capsule Sig: One (1) Capsule PO \nQ12H (every 12 hours). ', '2. Furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '3. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___: resume prior dosing. ', '4. Lactulose Oral', '5. Methimazole 10 mg Tablet Sig: One (1) Tablet PO Q 24H (Every \n24 Hours). ', '6. Olmesartan 20 mg Tablet Sig: 0.5 Tablet PO qd (). ', '7. Ondansetron 8 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, \nRapid Dissolve PO Q8H (every 8 hours) as needed for nausea. ', '8. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO every ___ hours \nas needed for pain. ', '9. Polyethylene Glycol 3350 17 gram/dose Powder Sig: One (1) \npacket PO DAILY (Daily) as needed for constipation. ', '10. Prazosin 1 mg Capsule Sig: Two (2) Capsule PO DAILY (Daily). ', '11. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '12. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily). ', '13. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \n___ puff Inhalation every six (6) hours as needed for shortness \nof breath or wheezing.\nDisp:*1 inhaler* Refills:*0*']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 45, 'gender': 'M', 'symptoms': 'cough', 'medical_history': ['HTN', 'Nephrectomy', 'Hypothyroidism'], 'family_history': 'FAMILY HISTORY: Mother with asthma, denies DMII history', 'present_illness': "This is a ___ woman with hypertension hypothyroidism who \ncomes to the emergency department on ___ because of chronic \ndisagreement with her son and daughter-in-law who she lives with \nat home, the patient's physical complaint includes a cough for \n___ days duration productive of clear phlegm and when she coughs \nshe has incontinence of urine. She is complaining of reflux \nsymptoms which are chronic and are unchanged. The patient also \nreports that she is sleeping too much.\n\nShe is unhappy that she receives insufficient help at her house. \n She feels that her family should be doing her laundry for her. \nWhen I asked why she goes to the hospital emergency department \nmany times she says that she does this because she wants to get \nhelp with housing and assistance at her house. She said that \nher daughter-in-law closed a door blocking her from accessing \nthe laundry room on one occasion recently. She is requesting \nthat she stay here a few days to rest.\n\nThe emergency department consulted psychiatry, no acute \npsychiatric indications for hospitalization and no ___ \nindicated. No focal consolidation on chest x-ray ED labs \nnotable for a TSH of 39.\n\nWhen I discussed that there was no active medical issues other \nthan chronic hypothyroidism she showed me paperwork requesting \nthat I help coordinate her visit with the dentist office.", 'medications': [{'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '491', 'valuenum': 491.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CONTROLLED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '226', 'valuenum': 226.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69.5', 'valuenum': 69.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.96', 'valuenum': 2.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '347', 'valuenum': 347.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.8,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 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'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '165/86 74\nNontoxic not confused alert and oriented interviewed with a \n___ interpreter\nClear breath sounds bilaterally without rales or crackles or \nwheezes\nRegular S1 and S2 without murmurs\nSoft abdomen without tenderness on palpation or palpable \norganomegaly\nNo peripheral edema\nNo facial features consistent with myxedema or facial swelling\nThyroid not palpably enlarged\nMoves all extremities', 'diagnoses': [{'icd_code': '7464', 'desc': 'Congenital insufficiency of aortic valve'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '135', 'desc': 'Sarcoidosis'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '30521', 'desc': 'Cannabis abuse, continuous'}], 'summary': "___ 12:45AM BLOOD WBC-6.6 RBC-3.97 Hgb-9.7* Hct-33.3* \nMCV-84 MCH-24.4* MCHC-29.1* RDW-15.0 RDWSD-45.6 Plt ___\n___ 12:45AM BLOOD TSH-39*\n\n\n1. Persistent, unchanged cardiomegaly. Mild pulmonary vascular \ncongestion is \nimproved compared to prior with possible mild residual pulmonary \nedema. No \nlarge pleural effusions are noted. \n2. Low lung volumes without definite focal consolidation. \n\nekg compared with prior, q wave in III with chronic appearing \nTWI in III, chronic poor R wave progression\n___ woman who has had 3 days of cough without clinical \nevidence of pneumonia or bronchitis. Lab studies show that she \nis hypothyroid without evidence of clinical myxedema. I reached \nout to her primary care physician who is away and spoke with her \nnurse who covered the physician and informed me that the patient \nhas had numerous ED visits to local area hospitals including 5 \nvisits in the last month to ___ as well as \n___ and ___ for various \nphysical ailments and requests for assistance with housing. She \nvisited ___ ED and urgent care on ___ for low back pain. \nThe primary care office shared with me that in ___ her \nTSH was 3.26 and in ___ it was 24.8. It is unknown if the \npatient is compliant with use of her levothyroxine medication.\n\nI interviewed the patient with an ___ interpreter alongside \nthe nurse and the social worker. On review of clinical data \nthere was no findings of acute medical issue that necessitates \nongoing medical hospitalization. \n\nReview of the ___ medical record includes numerous \nvisits to ___ including earlier in ___ and involvement of \nsocial work and case management. Our social worker learned that \nthe ___ had closed the case. Social work \nwill reach out to ___ to inform them exam \nof the patient's presentation. The patient denied physical \nabuse and while she said she did not want to return to her son's \nhouse and is looking for alternative housing there was not a \nmedical reason for her to remain hospitalized. SW will also \nreach out to the ___ office about the status of \nher application as patient had paperwork indicating she had an \nappointment with their office today. \n\n#Hypothyroidism\nClinical symptoms include chronic fatigue and need for lots of \nsleep. Endocrine did not formally consult and I did not order \nIV levothyroxine. Home dose of levothyroxine is 100mcg and I \nwill replete her with an extra dose of levothyroxine 100 mcg \ntoday and prescribe her with 30 tablets of levothyroxine 100 \nmcg. She should f/u with PCP to recheck TSH and TFTs. It will \ntake some time (many weeks for TSH to normalize, but checking \nTSH in the next few weeks will allow evaluation of compliance \nwith levothyroxine (if it begins to decline) and to ensure she \nis not developing new clinical symptoms. \n\n#HTN:\nShe remained on lisinoipril and metoprolol succinate. She may \nbenefit from alternative to beta blocker if she is fatigued \nchronically. \n\nI informed patient I would not reschedule her dentist \nappointment for her. She also has f/u with ___ for chronic low \nback pain. Care connections has helped create follow up visit \nwith ___ office with ___ NP. \n\n>30min on discharge coordination/counselling"}}
{'final_diagnoses': ['hypothyroidism'], 'procedures': ['none'], 'visit_summary': "___ woman who has had 3 days of cough without clinical \nevidence of pneumonia or bronchitis. Lab studies show that she \nis hypothyroid without evidence of clinical myxedema. I reached \nout to her primary care physician who is away and spoke with her \nnurse who covered the physician and informed me that the patient \nhas had numerous ED visits to local area hospitals including 5 \nvisits in the last month to ___ as well as \n___ and ___ for various \nphysical ailments and requests for assistance with housing. She \nvisited ___ ED and urgent care on ___ for low back pain. \nThe primary care office shared with me that in ___ her \nTSH was 3.26 and in ___ it was 24.8. It is unknown if the \npatient is compliant with use of her levothyroxine medication.\n\nI interviewed the patient with an ___ interpreter alongside \nthe nurse and the social worker. On review of clinical data \nthere was no findings of acute medical issue that necessitates \nongoing medical hospitalization. \n\nReview of the ___ medical record includes numerous \nvisits to ___ including earlier in ___ and involvement of \nsocial work and case management. Our social worker learned that \nthe ___ had closed the case. Social work \nwill reach out to ___ to inform them exam \nof the patient's presentation. The patient denied physical \nabuse and while she said she did not want to return to her son's \nhouse and is looking for alternative housing there was not a \nmedical reason for her to remain hospitalized. SW will also \nreach out to the ___ office about the status of \nher application as patient had paperwork indicating she had an \nappointment with their office today. \n\n#Hypothyroidism\nClinical symptoms include chronic fatigue and need for lots of \nsleep. Endocrine did not formally consult and I did not order \nIV levothyroxine. Home dose of levothyroxine is 100mcg and I \nwill replete her with an extra dose of levothyroxine 100 mcg \ntoday and prescribe her with 30 tablets of levothyroxine 100 \nmcg. She should f/u with PCP to recheck TSH and TFTs. It will \ntake some time (many weeks for TSH to normalize, but checking \nTSH in the next few weeks will allow evaluation of compliance \nwith levothyroxine (if it begins to decline) and to ensure she \nis not developing new clinical symptoms. \n\n#HTN:\nShe remained on lisinoipril and metoprolol succinate. She may \nbenefit from alternative to beta blocker if she is fatigued \nchronically. \n\nI informed patient I would not reschedule her dentist \nappointment for her. She also has f/u with ___ for chronic low \nback pain. Care connections has helped create follow up visit \nwith ___ office with ___ NP. \n\n>30min on discharge coordination/counselling", 'medications_prescribed': ['1. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild ', '2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes ', '3. Atorvastatin 10 mg PO QPM ', '4. Citalopram 10 mg PO DAILY ', '5. Levothyroxine Sodium 100 mcg PO DAILY \nRX *levothyroxine 100 mcg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0 ', '6. Lisinopril 40 mg PO DAILY ', '7. Metoprolol Succinate XL 50 mg PO DAILY ', '8. Naproxen 250 mg PO Q12H ', '9. Senna 8.6 mg PO BID:PRN Constipation - First Line ']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 75, 'gender': 'M', 'symptoms': 'Chest pain/epigastric pain', 'medical_history': ['right breast cancer s/p lumpectomy (clear margins) and radiation \n___', 'fibrocystic breast disease', 'Irritable bowel syndrome', 'fybromyalgia', 'gastroesophageal reflux disease', 'asthma (on daily Prednisone)', 'tracheobrochomalacia - as above; triggered by exercise, yelling, \nweather changes; had a recent negative exercise stress test (due \nto work-up of recent chest discomfort) ', 'anxiety disorder', 'depression', 'insomnia', 'iron deficiency anemia', 'B12 deficiency anemia', 'Hysterectomy ___', 'umbilical hernia repair ___'], 'family_history': 'Mother was diagnosed with thyroid cancer\nFather was diagnosed with coronary artery disease in his ___ \n(s/p 3vCABG), also DM and prostate CA\nBrother has HTN', 'present_illness': "___ female with tracheobronchomalacia, severe acid \nreflux status post fundoplication, was having an endoscopy done \ntoday with placement of a pH probe for recalcitrant GERD. Per \nPt, she awoke from the procedure and started having severe \nmid-sternal chest pain radiating to her back; the pain has been \nconstant and stabbing since then. She denies any pleuritic pain. \nShe denies states that this feels very different from her acid \nreflux. She denies any nausea or vomiting. Pt was given aspirin \n325mg x 1 and taken to ED for evaluation directly after the \nprocedure. \n.\nIn the ED, initial VS were: 97.8 80 124/72 16 100% 2L. Her CXR \nwas normal, and troponins and EKG were unremarkable x 2. Pt was \ngiven Donnatol and Maalox without relief of pain. Case was \ndiscussed with GI fellow, ___ who suggested that this \ntype of pain is not uncommon after procedure. Pt was given the \noption to try pain medications at home but preferred to be \nadmitted and monitored instead. \n\nOn arrival to the floor, Pt's vitals were 97.6, 115/66, 65, 18, \n97% RA. Pt appeared comfortable.", 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole (Granules for DR Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.3', 'valuenum': 59.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.48', 'valuenum': 0.48, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.25', 'valuenum': 6.25, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely decreases this test.'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Benzodiazepine immunoassay screen does not reliably detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test. New reference interval as of ___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.6, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. 80 (these units) = 0.08 (% by weight).'}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '245', 'valuenum': 245.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 431.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '127', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-41', 'valuenum': -41.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-82', 'valuenum': -82.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-56', 'valuenum': -56.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Benzodiazepine immunoassay screen does not detect some drugs,. including Lorazepam, Clonazepam, and Flunitrazepam.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Methadone assay detects Methadone (not other Opiates/Opioids). Quetiapine (Seroquel) may cause a false positive result.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG. Opiate assay does not reliably detect synthetic opioids. such as Methadone, Oxycodone, Fentanyl, Buprenorphine, Tramadol,. Naloxone, Meperidine. See online Lab Manual for details.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-335', 'valuenum': -335.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-733', 'valuenum': -733.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-430', 'valuenum': -430.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-318', 'valuenum': -318.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-72', 'valuenum': -72.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-432', 'valuenum': -432.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '1.047', 'valuenum': 1.047, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.3', 'valuenum': 41.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.1', 'valuenum': 42.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.1', 'valuenum': 73.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75.0', 'valuenum': 75.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.2', 'valuenum': 50.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55.5', 'valuenum': 55.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '174', 'valuenum': 174.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 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'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.1', 'valuenum': 51.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '208', 'valuenum': 208.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.57', 'valuenum': 3.57, 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'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 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'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO ESTIMATE DUE TO PLATELET CLUMPS.'}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New 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None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'INITIAL PHYSICAL EXAM: \nVS - 97.6, 115/66, 65, 18, 97% RA \nGENERAL - well-appearing woman in NAD, comfortable, appropriate \n\nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD, no carotid bruits \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use. Scar on R back. \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft, non-distended, tender to palpation in \nepigastric area, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout \n.\nDISCHARGE FINAL EXAM\nVitals: Tmax 97.7 Tc 97.7 BP 115-118/63-66 HR 65-69 RR 18 SaO2 \n97% on Bipap 3LO2\nGENERAL - well-appearing woman in NAD, comfortable, appropriate, \nlying in bed \nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nNECK - supple, no thyromegaly, no JVD, no carotid bruits \nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use. Scar on R back. \nHEART - PMI non-displaced, RRR, no MRG, nl S1-S2 \nABDOMEN - NABS, soft, non-distended, tender to palpation in \nepigastric area, no masses or HSM, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - no rashes or lesions \nLYMPH - no cervical, axillary, or inguinal LAD \nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout ', 'diagnoses': [{'icd_code': 'I63032', 'desc': 'Cerebral infarction due to thrombosis of left carotid artery'}, {'icd_code': 'G8191', 'desc': 'Hemiplegia, unspecified affecting right dominant side'}, {'icd_code': 'R414', 'desc': 'Neurologic neglect syndrome'}, {'icd_code': 'I672', 'desc': 'Cerebral atherosclerosis'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}, {'icd_code': 'H53461', 'desc': 'Homonymous bilateral field defects, right side'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'F1010', 'desc': 'Alcohol abuse, uncomplicated'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'I700', 'desc': 'Atherosclerosis of aorta'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'R29810', 'desc': 'Facial weakness'}], 'summary': "___ 05:19PM BLOOD WBC-3.8* RBC-3.99* Hgb-10.8* Hct-33.5* \nMCV-84 MCH-27.0 MCHC-32.2 RDW-13.8 Plt ___\n___ 06:15AM BLOOD Glucose-87 UreaN-19 Creat-0.8 Na-141 \nK-4.4 Cl-105 HCO3-27 AnGap-13\n___ 06:15AM BLOOD ALT-25 AST-17 LD(LDH)-172 CK(CPK)-47 \nAlkPhos-55 TotBili-0.2\n___ 06:15AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 10:30PM BLOOD cTropnT-<0.01\n___ 05:19PM BLOOD cTropnT-<0.01\n___ 05:19PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 06:15AM BLOOD Albumin-4.1 Calcium-8.7 Phos-3.3 Mg-2.1\n\nCXR ___: The heart size is normal. A moderate size hiatal \nhernia is unchanged. Mediastinal and hilar contours are stable \nwithout evidence of pneumomediastinum. An electronic device \ncompatible with a pH probe is noted in the region of the mid \nesophagus. The pulmonary vascularity is not engorged. The \nlungs are clear. No focal consolidation, pleural effusion or \npneumothorax is present. No acute osseous abnormalities seen. \n \nIMPRESSION: \n \nNo acute cardiopulmonary abnormality. Moderate-sized hiatal \nhernia.\nMs. ___ is a ___ year old female with tracheobronchomalacia, \nsevere acid reflux status post fundoplication, who had pH probe \nplaced on ___, who subsequently presented with stabbing \nchest pain. \n\n#chest pain: The chest pain/epigastric pain differential \nincluded cardiac, pulmonary, or GI causes. A cardiac casue was \nhighly unlikely because patient had negative troponins and a \ncompletely normal ECG. A chest x-ray did not suggest acute \npulmonary process or air in the mediastinum and noted a hiatal \nhernia. Pt was not febrile and did not have leukocytosis to \nsuggest pneumonia. Pt had a recent upper endoscopy procedure \nwith placement of pH probe which is the most likely cause of her \ndiscomfort. She had more reproducible epigastric pain on exam. \nPt described this as being very different from her normal reflux \npain. Pt did not want to take any oral medications because she \nwas told in the ED that they would interfere with the probe \nfunction. er Dr. ___ pt's gastroenterologist, her PPI \nwas held in light of pH probe monitoring. But food and her other \nmeds (other than the PPI) could be taken without interfering \nwith the PH probe. Therefore, she was restarted on her home meds \nand given a regular diet. \n\n# tracheobronchomalacia: Pt was continued on advair and Bipap \n___ on 3L at home).\n\n# anxiety disorder: Pt was continued on home lorazepam. .\n\n# depression: Pt continued on venlafaxine 150mg BID. \n\n# fibromylagia: Pt was given her home dose of Oxycodone but did \nnot require her home dose of Morphine.\n\n# high TGs: Pt continued on fenofibrate when taking orals \n\n# CODE: FULL CODE "}}
{'final_diagnoses': ['Chest/epigastric pain', 'GERD', 'Fibromyalgia'], 'procedures': ['Upper endoscopy with placement of a pH probe'], 'visit_summary': "Ms. ___ is a ___ year old female with tracheobronchomalacia, \nsevere acid reflux status post fundoplication, who had pH probe \nplaced on ___, who subsequently presented with stabbing \nchest pain. \n\n#chest pain: The chest pain/epigastric pain differential \nincluded cardiac, pulmonary, or GI causes. A cardiac casue was \nhighly unlikely because patient had negative troponins and a \ncompletely normal ECG. A chest x-ray did not suggest acute \npulmonary process or air in the mediastinum and noted a hiatal \nhernia. Pt was not febrile and did not have leukocytosis to \nsuggest pneumonia. Pt had a recent upper endoscopy procedure \nwith placement of pH probe which is the most likely cause of her \ndiscomfort. She had more reproducible epigastric pain on exam. \nPt described this as being very different from her normal reflux \npain. Pt did not want to take any oral medications because she \nwas told in the ED that they would interfere with the probe \nfunction. er Dr. ___ pt's gastroenterologist, her PPI \nwas held in light of pH probe monitoring. But food and her other \nmeds (other than the PPI) could be taken without interfering \nwith the PH probe. Therefore, she was restarted on her home meds \nand given a regular diet. \n\n# tracheobronchomalacia: Pt was continued on advair and Bipap \n___ on 3L at home).\n\n# anxiety disorder: Pt was continued on home lorazepam. .\n\n# depression: Pt continued on venlafaxine 150mg BID. \n\n# fibromylagia: Pt was given her home dose of Oxycodone but did \nnot require her home dose of Morphine.\n\n# high TGs: Pt continued on fenofibrate when taking orals \n\n# CODE: FULL CODE ", 'medications_prescribed': ['DiphenhydrAMINE 25 mg PO Q12H:PRN to prevent itching', 'fenofibrate nanocrystallized *NF* 145 mg Oral QD', 'Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', 'Gabapentin 400 mg PO QAM', 'Gabapentin 800 mg PO QPM', 'Lorazepam 1 mg PO TID', 'Morphine Sulfate ___ 15 mg PO Q6H:PRN pain \ndo not drink alcohol or drive on this med', 'OxycoDONE (Immediate Release) 10 mg PO Q6H:PRN pain \ndo not drink alcohol or drive on this med', 'Venlafaxine 150 mg PO BID', 'Zolpidem Tartrate 10 mg PO HS']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'Fell at rehab.', 'medical_history': ['- heart failure', '- HTN', '- HLD', '- Aortic stenosis', "- Hodgkin's Lymphoma", '- arthritis', '- asthma', '- BPH s/p surgery', '- h/o bigeminy', '- h/o colon polyps', '- h/o thyroid cancer s/p thyroidectomy', '- insomnia', '- right knee arthritis'], 'family_history': 'Mother - esophageal cancer\nSisters - scleroderma\nSon - MI, congenital heart defect, deceased\nDaughter - breast cancer', 'present_illness': 'Mr. ___ is ___ with stage IV Hodgkin Lymphoma \n(undergoing chemotherapy, last treatment w/ Brentuximab on \n___, ___, aortic stenosis, A-fib on warfarin who was recently \nadmitted on ___ for CHF exacerbation. He was discharged \neuvolemic to rehab where he fell. He does not remember the \ndetails of his fall, but was found to have a right hip fracture \non imaging and he is transferred here for further management. \nHis TAVR workup is still pending.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE:STAT', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferric Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55.7', 'valuenum': 55.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '278', 'valuenum': 278.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56.4', 'valuenum': 56.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.3, . estimated GFR (eGFR) is likely between 40 and 49 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.29', 'valuenum': 2.29, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.2', 'valuenum': 21.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 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'valuenum': 12.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.7', 'valuenum': 60.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.1', 'valuenum': 21.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '340', 'valuenum': 340.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.99', 'valuenum': 2.99, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '62.7', 'valuenum': 62.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.2.'}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '366', 'valuenum': 366.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}], 'exams': '==========================\nADMISSION PHYSICAL\n==========================\n\nVS: T98.2, 127/67, 74, 20, 99RA\nWeight: 68.8kg\nGENERAL: Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with JVP of 8 cm.\nCARDIAC: RRR, loud ___ holosystolic murmur with radiation to \ncarotids.\nLUNGS: Res were unlabored, no accessory muscle use. No crackles, \nwheezes or rhonchi.\nABDOMEN: Soft, NTND. No HSM or tenderness.\nEXTREMITIES: No c/c/e. right hip ER, no external bruising, no \ntenderness to palpation\nSKIN: scattered ecchymosis\nPULSES: Distal pulses palpable and symmetric\n\n==========================\nDISCHARGE PHYSICAL\n==========================\n\nVS: 98.4 100/67 74 99%RA\nWt: 68.8kg\nGENERAL: more alert, conversive, still AO x 1 \nHEENT: moist mucous membranes\nNECK: JVP not elevated\nCARDIAC: irregular, S1, S2. No murmurs/rubs/gallops. No thrills, \nlifts. \nLUNGS: Resp were unlabored, no accessory muscle use. Lungs CTAB\nABDOMEN: Soft, NTND, normal active bowel sounds\nEXTREMITIES: no pitting edema, warm, surgical dressing removed, \n3 small incisions with staples present, wound free of drainage \nor erythema, surrounding bruising of right lateral thigh, \n+pulses, intact sensation, right thigh not tense', 'diagnoses': [{'icd_code': 'G893', 'desc': 'Neoplasm related pain (acute) (chronic)'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C7800', 'desc': 'Secondary malignant neoplasm of unspecified lung'}, {'icd_code': 'C7951', 'desc': 'Secondary malignant neoplasm of bone'}, {'icd_code': 'D680', 'desc': 'Von Willebrand disease'}, {'icd_code': 'F323', 'desc': 'Major depressive disorder, single episode, severe with psychotic features'}, {'icd_code': 'C7931', 'desc': 'Secondary malignant neoplasm of brain'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'F4001', 'desc': 'Agoraphobia with panic disorder'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'C73', 'desc': 'Malignant neoplasm of thyroid gland'}, {'icd_code': 'K5903', 'desc': 'Drug induced constipation'}, {'icd_code': 'Z515', 'desc': 'Encounter for palliative care'}, {'icd_code': 'T402X5A', 'desc': 'Adverse effect of other opioids, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'E875', 'desc': 'Hyperkalemia'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}], 'summary': '==========================\nADMISSION LABS\n==========================\n\n___ 08:21AM BLOOD WBC-5.6 RBC-4.10* Hgb-11.3* Hct-36.7* \nMCV-90 MCH-27.6 MCHC-30.8* RDW-18.2* RDWSD-59.3* Plt ___\n___ 08:21AM BLOOD Hypochr-1+ Anisocy-1+ Poiklo-1+ \nMacrocy-1+ Microcy-1+ Polychr-NORMAL Ovalocy-1+ Tear Dr-1+ \nAcantho-OCCASIONAL\n___ 08:21AM BLOOD ___ PTT-44.8* ___\n___ 08:21AM BLOOD Glucose-85 UreaN-30* Creat-1.7* Na-136 \nK-4.3 Cl-97 HCO3-28 AnGap-15\n___ 08:21AM BLOOD Calcium-8.9 Phos-3.9 Mg-2.2\n\n==========================\nDISCHARGE LABS\n==========================\n\n___ 06:15AM BLOOD WBC-5.4 RBC-3.07* Hgb-8.6* Hct-27.9* \nMCV-91 MCH-28.0 MCHC-30.8* RDW-16.8* RDWSD-54.6* Plt ___\n___ 06:15AM BLOOD ___ PTT-43.2* ___\n___ 06:15AM BLOOD Glucose-89 UreaN-36* Creat-1.3* Na-139 \nK-3.8 Cl-101 HCO3-26 AnGap-16\n___ 06:15AM BLOOD Albumin-2.9* Calcium-8.2* Phos-2.4* \nMg-2.3\n\n==========================\nOTHER IMPORTANT LABS\n==========================\n\n___ 07:20AM BLOOD Ret Aut-3.1* Abs Ret-0.08\n___ 07:13AM BLOOD ALT-7 AST-22 LD(LDH)-260* AlkPhos-51 \nTotBili-4.2* DirBili-0.6* IndBili-3.6\n___ 07:13AM BLOOD Hapto-82\n___ 07:20AM BLOOD VitB12-821 Folate-8.9\n___ 07:20AM BLOOD TSH-7.9*\n___ 07:20AM BLOOD T4-10.3\n___ 02:44PM BLOOD Type-ART pO2-286* pCO2-34* pH-7.52* \ncalTCO2-29 Base XS-5 Intubat-INTUBATED\n\n==========================\nIMAGING \n==========================\n\n___ CT SPINE WITHOUT CONTRAST\n\n1. No fracture. Multilevel degenerative changes, unchanged from \n___. \n2. Moderate to severe right neuroforaminal stenosis at C5-C6 and \nC6-C7.\n3. Bilateral small right greater than left pleural effusions, \nnew since ___, \npartially visualized.\n4. Opacity at the right lung apex may suggest infection or \naspiration.\n\n___ CT HEAD W/O CONTRAST\n\nNo fracture or intracranial hemorrhage. Chronic sinus disease \nwith stable\npostsurgical changes since ___ DX HIP & FEMUR\n\nAcute, comminuted and impacted intratrochanteric fracture of the \nproximal\nright femur. Subtle regularity of the right inferior pubic ramus \nraising the possibility of\na nondisplaced fracture.\n\n___ CHEST (SINGLE VIEW)\n\nProbable layering right pleural effusion. Dense retrocardiac \nopacity,\npotentially atelectasis versus infection.\n\n___ KNEE (2 VIEWS) RIGHT\n\nNo fracture or dislocation. Severe tricompartmental \ndegenerative changes.\n\n___ CT ABD & PELVIS W/O CON \n\n1. Hyperdensity in expansion of the right pectineus in the \nanteromedial thigh,\ncompatible with hematoma. No retroperitoneal hemorrhage \nidentified.\n2. Known fracture of the right femur, status post intramedullary \nnail fixation\nwith the expected postsurgical changes.\n3. Small to moderate bilateral simple pleural effusions, \nslightly increased\ncompared to ___. \n4. CT findings compatible with anemia.\n\n___ CT HEAD W/O CONTRAST \n \n1. No evidence of acute territorial infarct, hemorrhage, edema, \nor mass.\n2. Stable chronic sinus disease particular in the right sphenoid \nsinus.\n*******TRANSITIONAL ISSUES********\n-- DISCHARGED OFF DIURETICS as he was dehydrated-euvolemic off \nLasix. However, he was recently admitted for heart failure \nexacerbation. Please weigh patient daily and consider adding \nback lasix ___ PO daily if weight increasing; can call \nCardiology if concerns.\n-- DISCHARGED ON WARFARIN; must trend INR and adjust dose.\n-- follow up: Cardiology (CHF), Ortho (hip fracture), Oncology \n(lymphoma), TAVR Team (for further evaluation)\n-- limit narcotic and other deliriogenic medications as patient \ndeveloped delirium in hospital\n-- labs and INR next check: ___\n-- discharge weight: 151 lbs\n-- full code\n-- contact: ___, Wife/ HCP (___\n\nMr. ___ is a ___ year-old male with Hodgkin lymphoma stage \nIV on palliative chemotherapy (brentuximab, last dose ___ \nand severe aortic stenosis c/b valvular heart failure, atrial \nfibrillation on warfarin, who was admitted to ___ on ___ \nafter falling at ___ rehab after an ___ discharge for \nheart failure exacerbation which resulted in a right \nintertrochanteric fracture now s/p right short trochanteric \nfixation nail. \n\nPlease refer to ___ discharge summary for a more complete \nassessment of Mr. ___ chronic medical problems. \n\n#Hip fracture: Patient tolerated the operation well. His \npost-operative course was complicated by the need for two blood \ntransfusions. His anemia was likely from post-surgical bleeding, \nhematoma of the right pectineus muscle, and poor bone marrow \nresponse to blood loss given his advanced age and known \nlymphoma. Given his fall on anticoagulation, CT scanning of his \nhead and abdomen were also performed, which were negative for \nacute pathology. He also developed delirium, which was improved \nat the time of discharge after limiting narcotic pain medication \nand discontinuing zolpidem. His pain was well controlled with \nacetaminophen around the clock and minimal low dose narcotics \nfor breakthrough pain Physical therapy recommended a discharge \nto rehab for further recovery. \n\n#Heart failure: Patient was recently discharged ___ for a \nheart failure exacerbation and upon readmission was euvolemic. \nHis diuresis was held during the hospitalization with little to \nno accumulation in excess volume and his BP remained stable. He \nwas discharge at a weight of 68.8kg. This will need to be \nclosely followed as an outpatient. \n\n#TAVR workup: On hold pending hip fracture recovery. \n\n# Delirium: pt had significant delirium during this \nhospitalization, for which the following was done:\n- Geriatrics consultation\n- Ambien discontinued\n- Oxycodone discontinued as pain was controlled with Tylenol\n- additional bowel medications prescribed\n- nonpharmacologic delirium precautions taken'}}
{'final_diagnoses': ['Primary diagnosis: Right intertrochanteric hip fracture', 'Secondary diagnosis: Hodgkin lymphoma stage IV, severe aortic stenosis, systolic heart failure, atrial fibrillation, chronic kidney disease stage II, hypothyroidism, benign prostatic hyperplasia, hypertension, dyslipidemia'], 'procedures': ['Right hip trochanteric fixation nail.'], 'visit_summary': '*******TRANSITIONAL ISSUES********\n-- DISCHARGED OFF DIURETICS as he was dehydrated-euvolemic off \nLasix. However, he was recently admitted for heart failure \nexacerbation. Please weigh patient daily and consider adding \nback lasix ___ PO daily if weight increasing; can call \nCardiology if concerns.\n-- DISCHARGED ON WARFARIN; must trend INR and adjust dose.\n-- follow up: Cardiology (CHF), Ortho (hip fracture), Oncology \n(lymphoma), TAVR Team (for further evaluation)\n-- limit narcotic and other deliriogenic medications as patient \ndeveloped delirium in hospital\n-- labs and INR next check: ___\n-- discharge weight: 151 lbs\n-- full code\n-- contact: ___, Wife/ HCP (___\n\nMr. ___ is a ___ year-old male with Hodgkin lymphoma stage \nIV on palliative chemotherapy (brentuximab, last dose ___ \nand severe aortic stenosis c/b valvular heart failure, atrial \nfibrillation on warfarin, who was admitted to ___ on ___ \nafter falling at ___ rehab after an ___ discharge for \nheart failure exacerbation which resulted in a right \nintertrochanteric fracture now s/p right short trochanteric \nfixation nail. \n\nPlease refer to ___ discharge summary for a more complete \nassessment of Mr. ___ chronic medical problems. \n\n#Hip fracture: Patient tolerated the operation well. His \npost-operative course was complicated by the need for two blood \ntransfusions. His anemia was likely from post-surgical bleeding, \nhematoma of the right pectineus muscle, and poor bone marrow \nresponse to blood loss given his advanced age and known \nlymphoma. Given his fall on anticoagulation, CT scanning of his \nhead and abdomen were also performed, which were negative for \nacute pathology. He also developed delirium, which was improved \nat the time of discharge after limiting narcotic pain medication \nand discontinuing zolpidem. His pain was well controlled with \nacetaminophen around the clock and minimal low dose narcotics \nfor breakthrough pain Physical therapy recommended a discharge \nto rehab for further recovery. \n\n#Heart failure: Patient was recently discharged ___ for a \nheart failure exacerbation and upon readmission was euvolemic. \nHis diuresis was held during the hospitalization with little to \nno accumulation in excess volume and his BP remained stable. He \nwas discharge at a weight of 68.8kg. This will need to be \nclosely followed as an outpatient. \n\n#TAVR workup: On hold pending hip fracture recovery. \n\n# Delirium: pt had significant delirium during this \nhospitalization, for which the following was done:\n- Geriatrics consultation\n- Ambien discontinued\n- Oxycodone discontinued as pain was controlled with Tylenol\n- additional bowel medications prescribed\n- nonpharmacologic delirium precautions taken', 'medications_prescribed': ['1. Bisacodyl 10 mg PO/PR DAILY:PRN constipation', '2. Metoprolol Tartrate 6.25 mg PO BID', '3. Polyethylene Glycol 17 g PO DAILY:PRN constipation', '4. Senna 17.2 mg PO HS', '5. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild', '6. Allopurinol ___ mg PO DAILY', '7. Amiodarone 200 mg PO DAILY', '8. Ascorbic Acid ___ mg PO DAILY', '9. Cyanocobalamin 100 mcg PO DAILY', '10. Docusate Sodium 100 mg PO BID:PRN constipation ', '11. Flovent HFA (fluticasone) 220 mcg/actuation inhalation 1 \npuff daily ', '12. Fluticasone Propionate NASAL 1 SPRY NU DAILY:PRN allergies', '13. Levothyroxine Sodium 112 mcg PO DAILY', '14. Nystatin Oral Suspension 5 mL PO QID:PRN thrush', '15. Pravastatin 40 mg PO QPM', '16. Vitamin D 1000 UNIT PO DAILY', '17. Warfarin 3 mg PO 3X/WEEK (___)', '18. Warfarin 2 mg PO 4X/WEEK (___)', '19.Outpatient Lab Work\nICD10: I50.9, I48.1']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 48, 'gender': 'M', 'symptoms': 'Fever, skeletal muscle pain, weakness', 'medical_history': ['Rheumatoid arthritis', 'Mixed connective tissue disease'], 'family_history': 'No history of cardiac or pulmonary disease', 'present_illness': 'Pt is a ___ PMHx overlap autoimmune condition with \nfeatures consistent with antisynthetase syndrome, rheumatoid \narthritis and an undifferentiated connective tissue disease NOS \n(associated with interstitial lung disease and h/o cryptogenic \nPNA) on immunosuppression (rituximab, cellcept and prednisone) \np/w ongoing history of myalgias, joint pains along with recent \nonset sore throat, fevers, non-productive cough.\n The patient reports that he first developed subjective fevers \non ___ days prior to admission. He was seen in \n___ where he reported feeling very weak with \nsevere polyarticular joint pain such that he was unable to work. \n He says at the time he had developed significant diffuse back \npain as well. His CK at that time was elevated 3768 (baseline \n___. Given concern for a worsening myositis, his home \nprednisone was increased to 60 mg daily and he was planned for \nrituximab/steroid infusions as an outpatient.\n The patient was seen in ___ the day of admission \nto get a combination the rituximab/steroid infusion. Upon \narrival in the Pheresis unit, his skinny was "ruddy and warm to \ntouch." The patient reported subjective chills and myalgias \nover the past 24 hrs and new sore throat x 2 days which was \nworse that morning. He also reported new RUQ abdominal pain and \nmyalgias in his thighs which he has never had before. He denied \nany other localizing symptoms of new/worsening cough, chest \npain, diarrhea, n/v, dysuria. He has no new rashes. He has had \nintermittent headache sometimes with subjective fevers though \nendorses no new photophobia/phonophobia. He also denies any \nrecent travel and no sick contacts; he has no h/o IVDU or spinal \nsurgeries. As he was ill-appearing, his rituximab/solumedrol \ninfusion was deferred and he was referred to the ED for further \neval.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pamidronate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QIDACHS', 'doses_per_24_hrs': 4.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone-Salmeterol (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Oncology)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '57.6', 'valuenum': 57.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.4', 'valuenum': 73.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '17.5', 'valuenum': 17.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.80', 'valuenum': 5.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3470', 'valuenum': 3470.0, 'valueuom': '#/uL', 'ref_range_lower': 2200.0, 'ref_range_upper': 8250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 1.63, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 1.61, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 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'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '81.9', 'valuenum': 81.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '397', 'valuenum': 397.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.8', 'valuenum': 17.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.49', 'valuenum': 2.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80.0', 'valuenum': 80.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '436', 'valuenum': 436.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.57', 'valuenum': 2.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': "ADMISSION PHYSICAL EXAM:\n\nVitals: 98.2, 100/44, 104, 18, 96% on RA\nGeneral: Alert, oriented, no acute distress \nHEENT: MMM, NCAT, EOMI, mild erythema of oropharynx, no purulent \nexudates\nNeck: Supple, JVP not elevated, no LAD \nCV: regular, tachycardic, nml S1 and S2, no m/r/g\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi, no labored respirations \nAbdomen: soft, nondistended, TTP of RUQ, no suprapubic \ntenderness \nGU: No foley \nBack: diffuse TTP of mid-line spine and paraspinal muscles \nextending from cervical to sacral regions\nExt: Warm, well perfused, 2+ pulses, non pitting edema of BUE\nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred. No nuchal rigidity, negative Brudzinski\nDerm: residual rash over upper thighs (per patient, improved \nfrom prior) \n\nDISCHARGE PHYSICAL EXAM:\nVitals: 99.0 100/47 70 18 99% RA\nGeneral: NAD, lying in bed comfortably\nHEENT: MMM, NCAT, EOMI, oropharnyx with white plaques scattered \nthroughout, tongue coated\nNeck: Supple, JVP not elevated, no LAD \nCV: regular rate and rhythm, +S1 and S2, no m/r/g\nLungs: CTAB, no wheezing or rhonchi\nAbdomen: soft, nondistended, nt, no HSM \nGU: no foley\nExt: Warm, well perfused, 2+ pulses, 1+ pedal edema, edema much \nimproved in UE's\nNeuro: CNII-XII intact, AOx4, moves all extremities purposefully\nDerm: faint, dark rash over extensors bilaterally, stable", 'diagnoses': [{'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': '1890', 'desc': 'Malignant neoplasm of kidney, except pelvis'}, {'icd_code': '1983', 'desc': 'Secondary malignant neoplasm of brain and spinal cord'}, {'icd_code': '1985', 'desc': 'Secondary malignant neoplasm of bone and bone marrow'}, {'icd_code': '1970', 'desc': 'Secondary malignant neoplasm of lung'}, {'icd_code': '6822', 'desc': 'Cellulitis and abscess of trunk'}, {'icd_code': '1982', 'desc': 'Secondary malignant neoplasm of skin'}, {'icd_code': '74749', 'desc': 'Other anomalies of great veins'}, {'icd_code': '5651', 'desc': 'Anal fistula'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "ADMISSION LABS:\n\n___ 07:34PM URINE HOURS-RANDOM\n___ 07:34PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 07:34PM URINE BLOOD-SM NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-7.0 \nLEUK-NEG\n___ 07:34PM URINE RBC-1 WBC-1 BACTERIA-FEW YEAST-NONE \nEPI-<1\n___ 07:34PM URINE MUCOUS-RARE\n___ 11:45AM LACTATE-1.9\n___ 11:40AM GLUCOSE-75 UREA N-16 CREAT-0.6 SODIUM-136 \nPOTASSIUM-4.1 CHLORIDE-103 TOTAL CO2-24 ANION GAP-13\n___ 11:40AM ALT(SGPT)-321* AST(SGOT)-187* CK(CPK)-9058* \nALK PHOS-59 TOT BILI-0.4\n___ 11:40AM ALBUMIN-2.9*\n___ 11:40AM CRP-37.4*\n___ 11:40AM WBC-17.8* RBC-5.23 HGB-14.4 HCT-44.7 MCV-86 \nMCH-27.5 MCHC-32.2 RDW-14.8 RDWSD-44.8\n___ 11:40AM NEUTS-85* BANDS-5 LYMPHS-3* MONOS-2* EOS-4 \nBASOS-0 ___ METAS-1* MYELOS-0 AbsNeut-16.02* AbsLymp-0.53* \nAbsMono-0.36 AbsEos-0.71* AbsBaso-0.00*\n___ 11:40AM PLT SMR-NORMAL PLT COUNT-220\n___ 11:40AM ___ PTT-27.2 ___\n\nIMAGING: \nCXR ___:\nIMPRESSION: \n1. No acute focal consolidation, pleural effusion, or \npneumothorax. \n2. Increased bibasilar interstitial markings, due to chronic \nlung disease, as described on the prior CT chest. \n\nEKG ___:\nNSR\n\nABDOMINAL ULTRASOUND ___:\nIMPRESSION: \n1. No evidence of cholecystitis. \n2. Splenomegaly measuring up to 17 cm. \n3. Normal liver with two small hemangiomas. \n\nTTE ___:\nIMPRESSION: Preserved biventricular systolic function. No \nclinically significant valvular disease. Mild pulmonary artery \nsystolic hypertension. Very small focal pericardial effusion. \n\nMRI THORACIC AND LUMBAR ___:\nIMPRESSION: \n1. No evidence of diskitis or osteomyelitis. \n2. Normal MRI of the thoracic spine. \n3. Small, diffuse disk bulges at L3-L4 and L4-L5 with no spinal \ncanal \nstenosis.\n\nCXR PA/LAT ___:\nIMPRESSION: \nMild pulmonary edema superimposed on chronic interstitial lung \ndisease. \nPossible superimposed infection, likely viral. \n\nMicro:\nCMV Viral Load (Final ___: \n CMV DNA detected, less than 137 IU/mL. \n Performed by Cobas Ampliprep / Cobas Taqman CMV Test. \n Linear range of quantification: 137 IU/mL - 9,100,000 \nIU/mL. \n Limit of detection 91 IU/mL. \n This test has been verified for use in the ___ patient \npopulation. \n Reported to and read back by ___ ___ 10:28AM \n___. \n\nBlood Culture, Routine (Final ___: NO GROWTH. \n\n \nDISCHARGE LABS: \n\n___ 07:00AM BLOOD WBC-14.0* RBC-4.97 Hgb-13.5* Hct-43.1 \nMCV-87 MCH-27.2 MCHC-31.3* RDW-16.0* RDWSD-48.7* Plt ___\n___ 07:00AM BLOOD Glucose-72 UreaN-14 Creat-0.5 Na-139 \nK-4.1 Cl-105 HCO3-27 AnGap-11\n___ 01:00PM BLOOD CK(CPK)-___*\n___ 07:00AM BLOOD Calcium-7.9* Phos-4.6* Mg-1.8\nPt is a ___ PMHx overlap autoimmune condition with features \nconsistent with antisynthetase syndrome, rheumatoid arthritis \nand an undifferentiated connective tissue disease NOS \n(associated with interstitial lung disease and h/o cryptogenic \nPNA) on immunosuppression (rituximab, cellcept and prednisone) \np/w ongoing history of myalgias, joint pains along with recent \nonset sore throat, fevers, non-productive cough.\n\n#EXACERBATION ANTI-SYNTHETASE SYNDROME with inflammatory \nmyositis\n presented with ongoing history of myalgias, joint pains along \nwith recent onset sore throat, fevers, non-productive cough, \nfound to have a pretty significant rhabdomyolysis and spiking \nhigh fevers on admission. A rapid response was called on the pt \nfor hypotension on the morning after admission. He was started \non Vancomycin + CTX then quickly broadened to Vancomycin, \nMeropenem and Clindamycin on ___. On ___, it \nseemed more likely this was caused by an exacerbation of his \nrheumatologic disease so these abx were discontinued per ID \nrecs. Both Rheum and ID were following and recommended scores of \ntests as part of a complete infectious v. rheumatologic work-up. \nOf note, his Parvovirus DNA, Influenza PCR, HIV were negative \nand CRP remained around 85. The treatment of the pt's resulting \nrhabdomyolysis is detailed below. He was started on Rituximab \nand pulse-dose steroids (1gm daily X 3 days) on ___. ID \nhad also recommended starting Azithromycin on ___ which \nwe did but then stopped it on ___ given his significant \nclinical improvement on steroids and lack of clear infectious \nsource. The pt was continued on 60mg of prednisone following \npulse dose steroids, and had significant improvement in his \nmuscle pain and rashes on his extensors. The pt will continue \n60mg prednisone until he follows up with rheumatology.\n\n#RHABDOMYOLYSIS\nIn terms of Rhabdomyolysis, received aggressive fluid hydration \nand electrolyte repletion with checks BID. His kidney function \nhas remained stable with creatinine remaining around 0.6-0.7 \nthroughout his admission. CK finally began to downtrend on ___ \nand ___ and remained stable around 5000 at discharge. He \nalso had a troponinemia in the setting of his rhabdo,had a TTE \nthat showed no significant cardiac dysfunction (we were \noriginally concerned about a viral myocarditis) and Cards saw \nhim and did not recommend Cardiac MRI. \n\n#Thrush\nIn the setting of high dose steroid and rituximab infusion, the \npt developed oral thrush with dysphagia believed to be related \nto esophageal involvement. He was started empirically on \nnystatin swish and swallow and loaded with fluconazole and \ncontinued for a 14d course.\n\n*****TRANSITIONAL ISSUES*****\nTRANSITIONAL ISSUES: \n#ANTI-SYNTHETASE SYNDROME:\nClose follow up with your regular ___ clinic to discuss \nmaintenance prednisone dose as well as daily and scheduled \nimmunosuppressive medications. Discharge medication includes \ncontinued steroid dose of 60mg daily, final course to be \ndetermined by rheumatology \n#The patient was restarted on PCP ppx with bactrim DS QOD, \nplease re-evaluate the need for this with future steroid taper \nor cessation\n#Patient developed dysphasia and oral thrush started on \nfluconazole with plan for maintenance dose of 200 mg daily for \n21 days and for at least 2 weeks following resolution of \nsymptoms. D1= ___"}}
{'final_diagnoses': ['Primary Diagnosis: Exacerbation of Anti-Synthetase \nSyndrome/Mixed Connective Tissue Disorder with inflammatory \nmyositis', 'Thrush', 'Rhabdomyolysis'], 'procedures': ['none'], 'visit_summary': "Pt is a ___ PMHx overlap autoimmune condition with features \nconsistent with antisynthetase syndrome, rheumatoid arthritis \nand an undifferentiated connective tissue disease NOS \n(associated with interstitial lung disease and h/o cryptogenic \nPNA) on immunosuppression (rituximab, cellcept and prednisone) \np/w ongoing history of myalgias, joint pains along with recent \nonset sore throat, fevers, non-productive cough.\n\n#EXACERBATION ANTI-SYNTHETASE SYNDROME with inflammatory \nmyositis\n presented with ongoing history of myalgias, joint pains along \nwith recent onset sore throat, fevers, non-productive cough, \nfound to have a pretty significant rhabdomyolysis and spiking \nhigh fevers on admission. A rapid response was called on the pt \nfor hypotension on the morning after admission. He was started \non Vancomycin + CTX then quickly broadened to Vancomycin, \nMeropenem and Clindamycin on ___. On ___, it \nseemed more likely this was caused by an exacerbation of his \nrheumatologic disease so these abx were discontinued per ID \nrecs. Both Rheum and ID were following and recommended scores of \ntests as part of a complete infectious v. rheumatologic work-up. \nOf note, his Parvovirus DNA, Influenza PCR, HIV were negative \nand CRP remained around 85. The treatment of the pt's resulting \nrhabdomyolysis is detailed below. He was started on Rituximab \nand pulse-dose steroids (1gm daily X 3 days) on ___. ID \nhad also recommended starting Azithromycin on ___ which \nwe did but then stopped it on ___ given his significant \nclinical improvement on steroids and lack of clear infectious \nsource. The pt was continued on 60mg of prednisone following \npulse dose steroids, and had significant improvement in his \nmuscle pain and rashes on his extensors. The pt will continue \n60mg prednisone until he follows up with rheumatology.\n\n#RHABDOMYOLYSIS\nIn terms of Rhabdomyolysis, received aggressive fluid hydration \nand electrolyte repletion with checks BID. His kidney function \nhas remained stable with creatinine remaining around 0.6-0.7 \nthroughout his admission. CK finally began to downtrend on ___ \nand ___ and remained stable around 5000 at discharge. He \nalso had a troponinemia in the setting of his rhabdo,had a TTE \nthat showed no significant cardiac dysfunction (we were \noriginally concerned about a viral myocarditis) and Cards saw \nhim and did not recommend Cardiac MRI. \n\n#Thrush\nIn the setting of high dose steroid and rituximab infusion, the \npt developed oral thrush with dysphagia believed to be related \nto esophageal involvement. He was started empirically on \nnystatin swish and swallow and loaded with fluconazole and \ncontinued for a 14d course.\n\n*****TRANSITIONAL ISSUES*****\nTRANSITIONAL ISSUES: \n#ANTI-SYNTHETASE SYNDROME:\nClose follow up with your regular ___ clinic to discuss \nmaintenance prednisone dose as well as daily and scheduled \nimmunosuppressive medications. Discharge medication includes \ncontinued steroid dose of 60mg daily, final course to be \ndetermined by rheumatology \n#The patient was restarted on PCP ppx with bactrim DS QOD, \nplease re-evaluate the need for this with future steroid taper \nor cessation\n#Patient developed dysphasia and oral thrush started on \nfluconazole with plan for maintenance dose of 200 mg daily for \n21 days and for at least 2 weeks following resolution of \nsymptoms. D1= ___", 'medications_prescribed': ['1. Alendronate Sodium 70 mg PO QFRI \nRX *alendronate 70 mg/75 mL 75 mL by mouth every ___ \nRefills:*1', '2. Clobetasol Propionate 0.05% Ointment 1 Appl TP BID ', '3. Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*0', '4. Vitamin D 50,000 UNIT PO 1X/WEEK (___) ', '5. Calcarb 600 With Vitamin D (calcium carbonate-vitamin D3) 600 \nmg(1,500mg) -200 unit oral BID \nRX *calcium carbonate-vitamin D3 [Calcarb 600 With Vitamin D] \n600 mg calcium (1,500 mg)-200 unit 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*0', '6. PredniSONE 60 mg PO DAILY \nRX *prednisone 20 mg 3 tablet(s) by mouth every day Disp #*180 \nTablet Refills:*0', '7. Fluconazole 200 mg PO Q24H \nRX *fluconazole 200 mg 1 tablet(s) by mouth once a day Disp #*14 \nTablet Refills:*0', '8. Sulfameth/Trimethoprim DS 1 TAB PO EVERY OTHER DAY \nContinue taking this medication every other day to prevent \ninfections \nRX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by \nmouth every other day Disp #*30 Tablet Refills:*0', '9. Ibuprofen 400 mg PO Q6H:PRN pain \nRX *ibuprofen [Advil] 200 mg 2 tablet(s) by mouth Q8H:PRN Disp \n#*25 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 53, 'gender': 'F', 'symptoms': 'Abdominal pain', 'medical_history': ['HTN', 'Anemia', 'Atrial fibrillation', 'chronic diastolic heart failure', 'colonic adenoma', 'aortic stenosis', 'BPH'], 'family_history': '___', 'present_illness': '___ had colonoscopy day prior to admition. Later that day he \ndeveloped\nintense abdominal pain and his abdomen was distended and firm. \nThe pain is\ncentered at his umbilicus. On day of admission his pain is \nstill severe but\nhis abdomen is softer. He states he is passing some gas. He \nhas not had outright vomiting but he has been spitting up. NGT \nplaced with > 1L output in ED.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Venlafaxine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'On Admission:\n\nPE: 99 71 160/86 24 100 \nUncomfortable\nRRR\nCTAB\nAbd - distended but soft, moderately ttp, RLQ incision, \ninducible\nRIH with valsalva\nExt - warm, no edema\n\nOn Discharge:\nVS: T 97.8, HR 81, BP 117/65, RR 18, 97% RA\nGEN: NAD\nCV: RRR\nLUNGS: CTAB\nABD: Soft, nontender, nondistended\nEXT: Warm, no c/c/e', 'diagnoses': [{'icd_code': '2189', 'desc': 'Leiomyoma of uterus, unspecified'}, {'icd_code': '6262', 'desc': 'Excessive or frequent menstruation'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '78442', 'desc': 'Dysphonia'}, {'icd_code': 'V4572', 'desc': 'Acquired absence of intestine (large) (small)'}, {'icd_code': 'V1851', 'desc': 'Family history of colonic polyps'}, {'icd_code': '28802', 'desc': 'Cyclic neutropenia'}, {'icd_code': 'V168', 'desc': 'Family history of other specified malignant neoplasm'}, {'icd_code': '29699', 'desc': 'Other specified episodic mood disorder'}], 'summary': "___ 04:45PM WBC-9.1 RBC-4.85 HGB-15.0 HCT-45.5 MCV-94 \nMCH-31.0 MCHC-33.0 RDW-15.7*\n___ 04:45PM GLUCOSE-163* UREA N-19 CREAT-1.6* SODIUM-144 \nPOTASSIUM-4.3 CHLORIDE-106 TOTAL CO2-26 ANION GAP-16\n___ 07:00PM PTT-72.0*\n\n___ 03:12AM BLOOD WBC-8.8 RBC-4.39* Hgb-13.8* Hct-40.8 \nMCV-93 MCH-31.5 MCHC-33.9 RDW-15.9* Plt ___\n___ 03:12AM BLOOD Glucose-166* UreaN-18 Creat-1.9* Na-146* \nK-4.4 Cl-109* HCO3-27 AnGap-14\n___ 07:40AM BLOOD ___ PTT-60.7* ___\n\n___ EKG: \nAtrial fibrillation with moderate ventricular response. \nOccasional ventricular premature beats. Borderline left axis \ndeviation with possible left anterior fascicular block. Right \nbundle-branch block. ST-T wave abnormalities likely related to \nleft ventricular hypertrophy but cannot rule out underlying \nmyocardial ischemia. \n\n___ ABD XRAYS:\nIMPRESSION: Findings concerning for partial/early small-bowel \nobstruction \nversus less likely small bowel ileus. Recommend clinical \ncorrelation and \nconsider CT for further evaluation.\n\n___ ABD CT:\nIMPRESSION: 1. Findings concerning for small-bowel obstruction \nwith transition point in the right lower quadrant. \n2. Cholelithiasis. \n3. Prominent Schmorl's node vs compression deformity of the \nsuperior endplate of the L5 vertebral body, age indeterminate. \n4. Colonic diverticulosis with no acute diverticulitis.\nThe patient was admitted ___ to the ___ Surgical Service \nfor evaluation and treatment of partial small bowel obstruction. \nThe patient was initially made NPO with IVF and an NGT and foley \nwere placed to carefully monitor his ins and outs. He under \nwent serial abdominal exams and his pain controlled with \nintermitten IV medications. \n\nNeuro: The patient received intermitent morphine with good \neffect and adequate pain control. Patient did not require much \nand was without pain on discharge. \n\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored and he was \nstarted on his home heart medications. \n\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Ambulation was \nencouraged throughout hospitalization.\n\nGI/GU/FEN: On HD #2 his NGT and foley were discontinued. He was \nadvanced slowly to sips then clears diet. On HD#3 his diet was \nadvanced to regular as he reported and demonstrated return of \nproper bowel function. Electrolytes were routinely followed, and \nrepleted when necessary.\n\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required. His warfarin was held \nand he was placed on a heparin drip. When taking POs he was \nrestarted on his home warfarin and his PTT and INR were \nmonitored and adjusted appropriately. \n\nProphylaxis: The patient received heparin and venodyne boots \nwere used during this stay; was encouraged to ambulate as soon \nas possible.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and with out pain \nwas well controlled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan."}}
{'final_diagnoses': ['Partial small bowel obstruction'], 'procedures': ['None'], 'visit_summary': "The patient was admitted ___ to the ___ Surgical Service \nfor evaluation and treatment of partial small bowel obstruction. \nThe patient was initially made NPO with IVF and an NGT and foley \nwere placed to carefully monitor his ins and outs. He under \nwent serial abdominal exams and his pain controlled with \nintermitten IV medications. \n\nNeuro: The patient received intermitent morphine with good \neffect and adequate pain control. Patient did not require much \nand was without pain on discharge. \n\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored and he was \nstarted on his home heart medications. \n\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Ambulation was \nencouraged throughout hospitalization.\n\nGI/GU/FEN: On HD #2 his NGT and foley were discontinued. He was \nadvanced slowly to sips then clears diet. On HD#3 his diet was \nadvanced to regular as he reported and demonstrated return of \nproper bowel function. Electrolytes were routinely followed, and \nrepleted when necessary.\n\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required. His warfarin was held \nand he was placed on a heparin drip. When taking POs he was \nrestarted on his home warfarin and his PTT and INR were \nmonitored and adjusted appropriately. \n\nProphylaxis: The patient received heparin and venodyne boots \nwere used during this stay; was encouraged to ambulate as soon \nas possible.\n\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ndiet, ambulating, voiding without assistance, and with out pain \nwas well controlled. The patient received discharge teaching and \nfollow-up instructions with understanding verbalized and \nagreement with the discharge plan.", 'medications_prescribed': ['1. Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___. ', '2. Amlodipine 2.5 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '3. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime). ', '4. Diltiazem HCl 240 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily). ', '5. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO once a day.']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 51, 'gender': 'F', 'symptoms': 'Altered mental status', 'medical_history': ['COPD', 'HTN', 'GERD', 'Dementia', 'glaucoma', 'hiatal hernia'], 'family_history': 'Father - MI in ___', 'present_illness': '___ hx dementia and COPD not on home O2 presents to ED with \naltered mental status. The patient lives independently at an \nelderly housing facility and was found wandering naked in the \nhallways confused. Her daughter reports that she has been \nincreasingly drowsy and confused throughout the day and had \nn/v/d. She is ambulatory, answers questions, and follows \ncommands at baseline. Has baseline forgetfulness, but has not \nworsened recently. \n\nDaughter was not aware of headache, abdominal pain, BRBPR, \nmelena, chest pain, shortness of breath, or cough. No LOC, \nheadstrike, asymmetrical weakness. Pt was unable to provide \nfurther details of her presentation. \n\nDaughter states that she has had very clear discussions with \npatient about goals of care, and would like a workup for a \nreversible condition such as an infectious condition. Pt is \nDNR/DNI, does not want pressors, surgeries, or invasive \nprocedures. Can have gentle sedation if agitated, but no deep \nsedation or general anesthesia.\n\nIn the ED, initial VS were T= 98.8, HR=68, BP=177/69, RR=26, \nPox=87 on RA. \nExam notable for altered mental status. \nLabs showed', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'OD', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin 0.5% Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OD', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS - 97.8 139 / 55 46 18 95 RA \nGENERAL: NAD, AOx3 \n___: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, \ndry mucous membranes, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: no cyanosis, clubbing or edema, moving all 4 \nextremities with purpose \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII grossly intact, has baseline left facial droop \nunchanged from prior \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes', 'diagnoses': [{'icd_code': '8028', 'desc': 'Closed fracture of other facial bones'}, {'icd_code': '8020', 'desc': 'Closed fracture of nasal bones'}, {'icd_code': 'E8881'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '4556', 'desc': 'Unspecified hemorrhoids without mention of complication'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}], 'summary': "Admission:\n\n___ 10:50PM ___ PTT-27.5 ___\n___ 10:50PM PLT COUNT-182\n___ 10:50PM NEUTS-87.8* LYMPHS-7.7* MONOS-3.5* EOS-0.0* \nBASOS-0.3 IM ___ AbsNeut-13.90* AbsLymp-1.22 AbsMono-0.55 \nAbsEos-0.00* AbsBaso-0.04\n___ 10:50PM WBC-15.8* RBC-4.84 HGB-13.7 HCT-41.0 MCV-85 \nMCH-28.3 MCHC-33.4 RDW-15.5 RDWSD-48.1*\n___ 10:50PM ALBUMIN-4.0\n___ 10:50PM LIPASE-22\n___ 10:50PM ALT(SGPT)-12 AST(SGOT)-25 ALK PHOS-95 TOT \nBILI-1.0\n___ 10:50PM GLUCOSE-141* UREA N-16 CREAT-0.7 SODIUM-138 \nPOTASSIUM-4.3 CHLORIDE-101 TOTAL CO2-18* ANION GAP-23*\n___ 11:03PM LACTATE-2.1*\n___ 09:55PM OTHER BODY FLUID FluAPCR-NEGATIVE \nFluBPCR-NEGATIVE\n___ 11:03PM ___ PO2-50* PCO2-26* PH-7.49* TOTAL \nCO2-20* BASE XS--1\n\nMICRO: \nUrine culture pending\nblood cx pending\n\nIMAGING: \n___ CXR\nNo acute cardiopulmonary abnormality\n\n___ CT A/P\n1. No acute intra-abdominal or pelvic process to explain \npatient's symptoms. \n2. Diverticulosis, with no evidence of acute diverticulitis. \n\nDischarge:\n\n___ 10:12AM BLOOD WBC-9.1 RBC-4.48 Hgb-13.0 Hct-38.0 MCV-85 \nMCH-29.0 MCHC-34.2 RDW-15.8* RDWSD-48.7* Plt ___\n___ 10:12AM BLOOD Glucose-89 UreaN-17 Creat-0.8 Na-138 \nK-3.1* Cl-101 HCO3-27 AnGap-___\nhx dementia and COPD not on home O2 presents to ED with \naltered mental status. The patient lives independently at an \nelderly housing facility and was found wandering naked in the \nhallways confused. Currently with improved mental status, AAOx3.\n\n# Toxic metabolic encephalopathy\nPt baseline is verbal, ambulatory, although forgetful given \ndementia.\nLeukocytosis w/ WBC 15.8 suggesting infection. No new drugs, no \nelectrolyte abnormalities to explain change in mental status. \nSource likely abdominal given n/v/diarrhea, although CT A/P \nunrevealing. N/v/diarrhea currently resolved. UA neg. CXR w/o \ne/o PNA. s/p 1 dose of vanc and 2 doses of cefepime. WBC \ndowntrended. Flu swab negative. Now AAOx2-3, attentive. \nAntibiotics were stopped ___. \n\n# Anion gap metabolic acidosis\nAG 19 on admission. Likely ___ to combination of starvation \nketosis I/s/o nausea/ poor PO and lactic acidosis. Lactate 2.1. \nResolved on discharge.\n\nChronic issues:\n# COPD: Not on home O2. Per daughter, baseline sats in low ___. \nShe was continued on home nebs.\n\n# GERD: Has hiatal hernia. Continued omeprazole.\n\n# Hypertension: Continue lisinopril. \n\n# Dementia: Able to perform most ADLs independently"}}
{'final_diagnoses': ['Toxic metabolic encephalopathy', 'Anion gap metabolic acidosis', 'COPD'], 'procedures': ['none'], 'visit_summary': 'hx dementia and COPD not on home O2 presents to ED with \naltered mental status. The patient lives independently at an \nelderly housing facility and was found wandering naked in the \nhallways confused. Currently with improved mental status, AAOx3.\n\n# Toxic metabolic encephalopathy\nPt baseline is verbal, ambulatory, although forgetful given \ndementia.\nLeukocytosis w/ WBC 15.8 suggesting infection. No new drugs, no \nelectrolyte abnormalities to explain change in mental status. \nSource likely abdominal given n/v/diarrhea, although CT A/P \nunrevealing. N/v/diarrhea currently resolved. UA neg. CXR w/o \ne/o PNA. s/p 1 dose of vanc and 2 doses of cefepime. WBC \ndowntrended. Flu swab negative. Now AAOx2-3, attentive. \nAntibiotics were stopped ___. \n\n# Anion gap metabolic acidosis\nAG 19 on admission. Likely ___ to combination of starvation \nketosis I/s/o nausea/ poor PO and lactic acidosis. Lactate 2.1. \nResolved on discharge.\n\nChronic issues:\n# COPD: Not on home O2. Per daughter, baseline sats in low ___. \nShe was continued on home nebs.\n\n# GERD: Has hiatal hernia. Continued omeprazole.\n\n# Hypertension: Continue lisinopril. \n\n# Dementia: Able to perform most ADLs independently', 'medications_prescribed': ['Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID', 'Lisinopril 2.5 mg PO DAILY', 'Lumigan (bimatoprost) 0.01 % ophthalmic ASDIR', 'Omeprazole 40 mg PO DAILY', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation inhalation DAILY', 'telmisartan 80 mg oral DAILY', 'Timolol Maleate 0.25% 1 DROP BOTH EYES BID', 'Tiotropium Bromide 1 CAP IH DAILY']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Rash', 'medical_history': ['CKD', 'HTN', 'HLD'], 'family_history': 'Not known', 'present_illness': 'Mr. ___ is a ___ y/o M w/ hx of CKD, HTN, HLD who \npresents\nwith a rash.\n\nAbout two days ago he presented to the ED with 5-days of leg\nredness chills and low grade fever (99-100). He also had \nendorsed\nweakness and poor appetite at that time but no other \naccompanying\nsymptoms. He was diagnosed with cellulitis and discharged on 10\nday course of cefpodoxime with plans for close PCP ___.\n\nHowever, over the following two days his family noted that he \nwas\nlooking worse and more lethargic. They also recorded a temp of\n38.5C. He was then noted to develop a non-blanching rash across\nhis forehead. He has no known hx of drug allergy and denied any\nitching, difficulty breathing or swelling. He also noted that\nover the past 24 hours he had increased urinary frequency but no\ndysuria.\n\nIn the ED, initial vitals: \n100 | 82 | 143/55 | 18 | 97% RA \n\n- Exam notable for: \nWarm, dry. Scattered 1 x 1 cm nonblanching papular erythematous\nrash at forehead, abdomen, upper extremities. Erythema at left\nankle. Blanching, warm. Full painless range of motion of left\nankle. Palpable DP and ___ pulses. 1+ pitting edema left ankle\nextending to distal shin\n\n- Labs notable for: \n \\13.2/ 131 | 99 | 51\n6.3 ---- 159 -------------< 136\n /40.1\\ 5.5 | 15 | 2.9\n\nWhole blood K+ 4.6\nUA non-inflammatory\n\n- Imaging notable for: \nCXR:\nThere are slightly low lung volumes. Heart size is upper limits\nof normal. There is some tortuosity of thoracic aorta, \nunchanged.\nThere are patchy bibasilar opacities at the lung bases medially\nwhich may represent early infiltrate or atelectasis. ___ \nto\nresolution is recommended. There are no pneumothoraces or large\npleural effusions. Bilateral humeral heads articulate with the\nacromion consistent with rotator cuff rupture. \n\n- Patient was given: \n___ 12:42 IV CeFAZolin ___ Started \n___ 12:50 IV CeFAZolin 1 g ___ Stopped (___) \n\n\n___ 14:11 IV Vancomycin ___ Started \n___ 15:21 IV Vancomycin 1000 mg ___ Stopped\n(1h ___ \n\n- Consults: \nNone', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.45', 'valuenum': 1.45, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '62.1', 'valuenum': 62.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.11', 'valuenum': 0.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.32', 'valuenum': 0.32, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.10', 'valuenum': 1.1, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.95', 'valuenum': 4.95, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50.6', 'valuenum': 50.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely between 52 and 62 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.32', 'valuenum': 3.32, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.3', 'valuenum': 50.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.6', 'valuenum': 48.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 103.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.43', 'valuenum': 3.43, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '286', 'valuenum': 286.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n=======================\nVS: ___ 1807 Temp: 97.8 PO BP: 158/74 R Lying HR: 71 RR: 20\nO2 sat: 97% O2 delivery: Ra \nGENERAL: Pleasant, lying in bed comfortably \nHEENT: Dry mucous membrane\nCARDIAC: RRR, no murmurs, rubs, or gallops \nLUNG: Appears in no respiratory distress, clear to auscultation\nbilaterally, no crackles, wheezes, or rhonchi \nABD: soft, nontender, nondistended, \nEXT: Warm, well perfused, 1+ pitting edema to shins\nPULSES: 2+ radial pulses, 2+ ___ pulses, 2+ DP pulses \nNEURO: Alert, oriented, CN II-XII intact, motor and sensory\nfunction grossly intact \nSKIN: Nonblanching patchy rash on forehead and top of head as\nwell as small papules across chest/abdomen. Erythematous rash\nwith warmth of anterior left ankle and dorsal aspect of foot; no\npurulence or fluctuance.\n\nDISCHARGE PHYSICAL EXAM:\n=======================\n___ Temp: 97.8 PO BP: 131/74 L Lying HR: 68 RR: 20 O2\nsat: 97% O2 delivery: Ra \nGENERAL: Pleasant, lying comfortably in bed \nHEENT: NCAT, EOMI, PERRLA, oropharynx without erythema or\nexudate, otherwise normal, no cervical LAD, coalesced,\nnon-blanching patchy rash over scalp with minimal scale, not\npruritic or painful \nCARDIAC: normal S1/S2 with regular rate/rhythm, no murmurs, \nrubs,\nor gallops \nLUNG: Appears in no respiratory distress, end expiratory wheezes\nbilaterally but c/w upper airway sounds \nABD: Normal bowel sounds, soft, nontender, nondistended, no\nhepatomegaly, no splenomegaly \nEXT: Warm, well perfused, no left lower extremity edema, left\nankle erythema has resolved, without purulence, not tender to\npalpation\nPULSES: 2+ radial pulses, 2+ ___ pulses, 2+ DP pulses \nNEURO: Alert, oriented, CN II-XII grossly intact, motor and\nsensory function grossly intact \nSKIN: Patchy non-blanching rash on scalp, improved erythematous\ndiffuse rash on back, non-pruritic, non-painful', 'diagnoses': [{'icd_code': 'T8142XA', 'desc': 'Infection following a procedure, deep incisional surgical site, initial encounter'}, {'icd_code': 'T8131XA', 'desc': 'Disruption of external operation (surgical) wound, not elsewhere classified, initial encounter'}, {'icd_code': 'Y838', 'desc': 'Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'B9562', 'desc': 'Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere'}, {'icd_code': 'M00062', 'desc': 'Staphylococcal arthritis, left knee'}, {'icd_code': 'M868X6', 'desc': 'Other osteomyelitis, lower leg'}, {'icd_code': 'M25162', 'desc': 'Fistula, left knee'}, {'icd_code': 'S82042E', 'desc': 'Displaced comminuted fracture of left patella, subsequent encounter for open fracture type I or II with routine healing'}, {'icd_code': 'S76192D', 'desc': 'Other specified injury of left quadriceps muscle, fascia and tendon, subsequent encounter'}, {'icd_code': 'W000XXD', 'desc': 'Fall on same level due to ice and snow, subsequent encounter'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}], 'summary': "ADMISSION LABS:\n==============\n___ 11:33AM BLOOD WBC-6.3 RBC-4.15* Hgb-13.2* Hct-40.1 \nMCV-97 MCH-31.8 MCHC-32.9 RDW-14.4 RDWSD-50.9* Plt ___\n___ 11:33AM BLOOD Neuts-72.7* Lymphs-16.5* Monos-9.1 \nEos-0.0* Baso-0.6 Im ___ AbsNeut-4.55 AbsLymp-1.03* \nAbsMono-0.57 AbsEos-0.00* AbsBaso-0.04\n___ 11:33AM BLOOD Plt ___\n___ 11:33AM BLOOD Glucose-136* UreaN-51* Creat-2.9* Na-131* \nK-5.5* Cl-99 HCO3-15* AnGap-17\n___ 11:33AM BLOOD ALT-30 AST-72* AlkPhos-97 TotBili-0.3\n___ 11:33AM BLOOD Albumin-3.3*\n___ 02:16PM BLOOD K-4.6\n\nINTERMEDIATE LABS:\n==============\n___ 04:21AM BLOOD WBC-7.9 RBC-3.64* Hgb-11.4* Hct-36.0* \nMCV-99* MCH-31.3 MCHC-31.7* RDW-14.5 RDWSD-52.6* Plt ___\n___ 04:21AM BLOOD Plt ___\n___ 04:21AM BLOOD Glucose-93 UreaN-59* Creat-3.4* Na-138 \nK-5.2 Cl-102 HCO3-22 AnGap-14\n___ 04:21AM BLOOD Calcium-8.1* Phos-4.7* Mg-2.5\n\nDISCHARGE LABS:\n==============\n___ 04:40AM BLOOD WBC-7.9 RBC-3.60* Hgb-11.3* Hct-36.6* \nMCV-102* MCH-31.4 MCHC-30.9* RDW-14.6 RDWSD-54.9* Plt ___\n___ 04:40AM BLOOD Plt ___\n___ 04:40AM BLOOD Glucose-103* UreaN-49* Creat-2.7* Na-140 \nK-6.4* Cl-107 HCO3-21* AnGap-12\n___ 04:40AM BLOOD Calcium-8.8 Phos-4.1 Mg-2.6\n___ 09:18AM BLOOD ___ Comment-GREEN TOP\n___ 09:18AM BLOOD K-5.9*\n___ 5:58 am BLOOD CULTURE\n___ 01:46AM BLOOD K-5.5*\n\nMICRO\n=====\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n___ 9:00 am BLOOD CULTURE 2 OF 2. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH.\n\n___ 2:10 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH.\nTRANSITIONAL ISSUES\n==================\n[ ] discharge K 5.5\n[ ] will have labs drawn by ___.\n\nSUMMARY\n========\nMr. ___ is a ___ y/o M w/ hx of CKD, HTN, HLD who\nwas admitted for cellulitis after initial treatment with \ncefpodoxime appeared to cause a rash and fevers. He was changed \nto Bactrim and then IV clindamycin for a 7 day course of \nantibiotics with some improvement in his cellulitis. However, he \ndeveloped a new acute kidney injury thought to be due to the \nBactrim that improved prior to discharge. He also went into \natrial fibrillation for a brief period of time, which resolved \nwith fluids, and he was discharged in normal sinus rhythm. \n\nACUTE ISSUES:\n============\n# Cellulitis: Patient had been seen in the ED for left ankle \ncellulitis and was started on cefpodoxime. However he developed \na rash and fever so was admitted for further management. He was \ntrialed on Bactrim ___, but his cellulitis worsened, so he \nwas changed to IV clindamycin through ___. Throughout his \nadmission, he was afebrile, CBC was without leukocytosis, and \nblood cultures were negative. His ankle was erythematous but \nnever swollen, painful, and never had restricted range of \nmovement. Ankle XR showed no bony involvement. Triamcinolone \nointment was started per Derm recs to reduce erythema in his \nfoot and ankle.\n\n#New atrial fibrillation, resolved: Patient became tachycardic \nwith PVCs briefly on ___ and was found to be in atrial \nfibrillation on EKG. He denied chest pain palpitations, \nshortness of breath, and denied history of previous afib. He \nconverted to NSR after receiving a 500cc LR bolus, and it was \nfelt his afib was due to the stress of the cellulitis. A TTE ___ \nshowed normal EF, mild AR, mild MR. ___ was held \ndue to his increased risk of bleed, but he was monitored on tele \nthroughout his admission.\n\n# Milaria: Patient developed a maculopapular rash on his back \nand chest and arms that became more confluent during his \nadmission. It was initially thought to be due to the cefpodoxime \nbut did not resolve after stopping the cefpodoxime. Derm was \nconsulted and felt it was a heat rash, or milaria. He was \ntreated by keeping his back dry and cool. The rash was never \npainful or pruritic.\n\n# Seborrheic Dermatitis: Patient developed non-blanching patchy \nrash that is not painful or pruritic across scalp. Rash \ninitially thought to be drug rash due to cefpodoxime. However, \nrash still present despite d/c'ing cefpodoxime, and rash did not \nworsen. Derm was consulted and believed it is most consistent \nwith seborrheic dermatitis. He was treated with ketoconazole \nshampoo three times a week.\n\n___: Patient experienced increase in creatinine from 2.7 \n(baseline 2.3-2.5) to max of 3.5 after Bactrim use and \ndiscontinuation. UA showed no leuks, sediment was bland with no \nmuddy brown casts, urine eos negative, urine protein to \ncreatinine ratio 0.3. Home Lasix was held. Renal consulted and \nnot concerned for pre-renal or intrinsic process, more concerned \nfor post-Bactrim use and diuresis. Renal U/S ruled out \npost-obstructive process, showed normal kidney size and normal \nflow within renal arteries. The creatinine rose over several \ndays but improved on its own. At discharge, patient's creatinine \nwas 2.7.\n\n# Hyperkalemia: Toward end of hospital stay, patient developed \nhyperkalemia to 6.4 ___ut with repeat whole blood K as \nhigh as 5.9. There was a value of 8.8 that was thought to be \nspurious as resultant level was 4.9. For the K of 8.8 he was \ngiven lasix, calcium gluconate, insulin and dextrose. EKG \nwithout acute changes. Thought to be due to renal function from \nBactrim use vs underlying chronic kidney disease. Patient \nmentioned that he follows with nephrology at ___, \nand the hyperkalemia has been noted before. He was unconcerned, \nbut we requested he avoid foods high in potassium and to get \n___ labs. Dietary modifications were given to home health \nnurse and wife. He was discharged with 40mg of Potassium. \n\nCHRONIC ISSUES:\n=============\n# HTN: continued home amlodipine and atenolol\n\n# CODE: full\n# CONTACT: (daughter) ___\n\nAgree with discharge summary as documented. 35 minutes were \nspent in discharge preparation."}}
{'final_diagnoses': ['Cellulitis', 'Acute Kidney Injury', 'Seborrheic Dermatitis', 'Miliaria', 'Atrial fibrillation', 'Hypertension'], 'procedures': ['None'], 'visit_summary': "TRANSITIONAL ISSUES\n==================\n[ ] discharge K 5.5\n[ ] will have labs drawn by ___.\n\nSUMMARY\n========\nMr. ___ is a ___ y/o M w/ hx of CKD, HTN, HLD who\nwas admitted for cellulitis after initial treatment with \ncefpodoxime appeared to cause a rash and fevers. He was changed \nto Bactrim and then IV clindamycin for a 7 day course of \nantibiotics with some improvement in his cellulitis. However, he \ndeveloped a new acute kidney injury thought to be due to the \nBactrim that improved prior to discharge. He also went into \natrial fibrillation for a brief period of time, which resolved \nwith fluids, and he was discharged in normal sinus rhythm. \n\nACUTE ISSUES:\n============\n# Cellulitis: Patient had been seen in the ED for left ankle \ncellulitis and was started on cefpodoxime. However he developed \na rash and fever so was admitted for further management. He was \ntrialed on Bactrim ___, but his cellulitis worsened, so he \nwas changed to IV clindamycin through ___. Throughout his \nadmission, he was afebrile, CBC was without leukocytosis, and \nblood cultures were negative. His ankle was erythematous but \nnever swollen, painful, and never had restricted range of \nmovement. Ankle XR showed no bony involvement. Triamcinolone \nointment was started per Derm recs to reduce erythema in his \nfoot and ankle.\n\n#New atrial fibrillation, resolved: Patient became tachycardic \nwith PVCs briefly on ___ and was found to be in atrial \nfibrillation on EKG. He denied chest pain palpitations, \nshortness of breath, and denied history of previous afib. He \nconverted to NSR after receiving a 500cc LR bolus, and it was \nfelt his afib was due to the stress of the cellulitis. A TTE ___ \nshowed normal EF, mild AR, mild MR. ___ was held \ndue to his increased risk of bleed, but he was monitored on tele \nthroughout his admission.\n\n# Milaria: Patient developed a maculopapular rash on his back \nand chest and arms that became more confluent during his \nadmission. It was initially thought to be due to the cefpodoxime \nbut did not resolve after stopping the cefpodoxime. Derm was \nconsulted and felt it was a heat rash, or milaria. He was \ntreated by keeping his back dry and cool. The rash was never \npainful or pruritic.\n\n# Seborrheic Dermatitis: Patient developed non-blanching patchy \nrash that is not painful or pruritic across scalp. Rash \ninitially thought to be drug rash due to cefpodoxime. However, \nrash still present despite d/c'ing cefpodoxime, and rash did not \nworsen. Derm was consulted and believed it is most consistent \nwith seborrheic dermatitis. He was treated with ketoconazole \nshampoo three times a week.\n\n___: Patient experienced increase in creatinine from 2.7 \n(baseline 2.3-2.5) to max of 3.5 after Bactrim use and \ndiscontinuation. UA showed no leuks, sediment was bland with no \nmuddy brown casts, urine eos negative, urine protein to \ncreatinine ratio 0.3. Home Lasix was held. Renal consulted and \nnot concerned for pre-renal or intrinsic process, more concerned \nfor post-Bactrim use and diuresis. Renal U/S ruled out \npost-obstructive process, showed normal kidney size and normal \nflow within renal arteries. The creatinine rose over several \ndays but improved on its own. At discharge, patient's creatinine \nwas 2.7.\n\n# Hyperkalemia: Toward end of hospital stay, patient developed \nhyperkalemia to 6.4 ___ut with repeat whole blood K as \nhigh as 5.9. There was a value of 8.8 that was thought to be \nspurious as resultant level was 4.9. For the K of 8.8 he was \ngiven lasix, calcium gluconate, insulin and dextrose. EKG \nwithout acute changes. Thought to be due to renal function from \nBactrim use vs underlying chronic kidney disease. Patient \nmentioned that he follows with nephrology at ___, \nand the hyperkalemia has been noted before. He was unconcerned, \nbut we requested he avoid foods high in potassium and to get \n___ labs. Dietary modifications were given to home health \nnurse and wife. He was discharged with 40mg of Potassium. \n\nCHRONIC ISSUES:\n=============\n# HTN: continued home amlodipine and atenolol\n\n# CODE: full\n# CONTACT: (daughter) ___\n\nAgree with discharge summary as documented. 35 minutes were \nspent in discharge preparation.", 'medications_prescribed': ['Ketoconazole Shampoo 1 Appl TP 3X/WEEK (___) \nRX *ketoconazole 2 % apply as directed three times per week \nRefills:*0 ', 'Triamcinolone Acetonide 0.1% Ointment 1 Appl TP TID \nRX *triamcinolone acetonide 0.1 % apply to ankle three times a \nday Refills:*0 ', 'Furosemide 40 mg PO DAILY', 'Allopurinol ___ mg PO DAILY', 'amLODIPine 5 mg PO DAILY', 'Atenolol 25 mg PO DAILY', 'Calcitriol 0.25 mcg PO EVERY OTHER DAY', 'diclofenac sodium 1 % topical DAILY:PRN pain', 'Gemfibrozil 600 mg PO DAILY', 'Senna 8.6 mg PO BID', 'Outpatient Lab Work\nplease check chemistry by ___\n276.7 hyperkalemia\nfax to ___. \nAddress: ___ ROOM ___, ___, ___\nPhone: ___\nFax: ___']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 73, 'gender': 'F', 'symptoms': '"worsening abdominal pain."', 'medical_history': ['1. Non-insulin-dependent diabetes mellitus, diagnosed in ___.', '2. ? dyslipidemia.', '3. Overweight.', '4. ___ bx proven cirrhosis', '5. GERD.', '6. Seasonal allergies.', '7. Babesiois'], 'family_history': '-Father with bladder cancer\n-mother h/o bronchitis\n-siblings are healthy', 'present_illness': 'This is a ___ yo M with a PMHx of recently diagnosed \nhepatosplenic T-cell lymphoma, NIDDM, NASH cirrhosis by bx who \np/w worsening abdominal pain and fevers.\n.\nIt is notable that the patient had been admitted to ___ from \n___ and was discharged on ___ with new diagnosis of \nhepatosplenic lymphoma. The patient completed 2 cycles of EPOCH \nchemotherapy and repeat scan prior to his second round of \nchemotherapy showed some decrease in size of lymph nodes \ncompared to previous. His course was complicated by fevers with \nbroad spectrum abx coverage without an obvious source of \ninfection. He also had a presumptive dx of colitis with \nabdominal pain which resolved after treatment with \ncefipime/flagyl and vanco. The patient was sent home ___ on \nno abx.\n.\nThe patient is a somewhat poor historian but he reports he has \nbeen having sporadic fevers and he is unsure of his last fever. \nAfter speaking to his Oncogist, she reported that the patient \nhad a Tm of 103. The patient denies cough or dysuria. He does \ncomplain of lack of sleep for days.\n.\nHe also reports what he calls new abdominal pain, despite \nreports in the discharge summary of abdominal pain over the last \nmonth. He currently reports ___ pain which he reports \nstarted yesterday. He also reports increasing abdominal \ndistention but denies sob or n/v. Lasr BM was solid and \norange/brown in color.\n.\nThe patient went to the clinic to see Dr. ___ in her \nclinic, was found to have leveated Bilirubin, fever, underwent \nan abdominal US and was admitted from there.\n.\n10 point ROS is otherwise negative except her HPI', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '290', 'valuenum': 290.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '273', 'valuenum': 273.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '302', 'valuenum': 302.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.11', 'valuenum': 4.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45.9', 'valuenum': 45.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "Admission PE ___:\nVS: ___ 72 20 99 RA\nGeneral: AAOX3, NAD\nHEENT: MMM, OP clear\nNeck: no obvious lad or thryoid masses\nCV: RRR, no RMG\nLungs: CTAB no WRR\nAbdomen: distended, voluntary guarding, mild fluid wave, no \nobvious focal lesions, no peritoneal signs\nExtremities: WWP, 3+ pitting edema in BLE to knee, pulses 1+ and \nequal\nDerm: no obvious rashes\nNeuro: strength, sensation, MS, CN's wnl\nPsyc: mood and affect wnl\n\nDischarge PE ___:\nVITALS - T 97.6 HR 70 BP 112/64 RR 18 SaO2 100% on RA\nGENERAL - Cachectic appearing elderly gentleman who is sitting \nby the window eating cereal in no acute distress.\nHEENT - No lymphadenopathy apprecaited. Oropharynx clear. MMM.\nCARDIAC - RRR, no m/r/g.\nLUNGS - Clear to auscultation bilaterally.\nABDOMEN - Pain on deep palpation of right abdomen. No guarding \nor rebound. Bowel sounds normoactive.", 'diagnoses': [{'icd_code': 'I447', 'desc': 'Left bundle-branch block, unspecified'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F19980', 'desc': 'Other psychoactive substance use, unspecified with psychoactive substance-induced anxiety disorder'}, {'icd_code': 'R002', 'desc': 'Palpitations'}, {'icd_code': 'T465X5A', 'desc': 'Adverse effect of other antihypertensive drugs, initial encounter'}, {'icd_code': 'Y92099', 'desc': 'Unspecified place in other non-institutional residence as the place of occurrence of the external cause'}, {'icd_code': 'I700', 'desc': 'Atherosclerosis of aorta'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'M179', 'desc': 'Osteoarthritis of knee, unspecified'}], 'summary': "ADMISSION LABS:\n___ 08:00AM BLOOD WBC-8.8# RBC-2.79* Hgb-9.3* Hct-26.9* \nMCV-96 MCH-33.2* MCHC-34.5 RDW-18.9* Plt Ct-33*\n___ 08:00AM BLOOD Neuts-85* Bands-0 Lymphs-14* Monos-0 \nEos-1 Baso-0 ___ Myelos-0\n___ 08:00AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-2+ \nMacrocy-1+ Microcy-NORMAL Polychr-1+ Tear Dr-1+\n___ 08:00AM BLOOD ___\n___ 08:00AM BLOOD Glucose-151* UreaN-17 Creat-0.6 Na-133 \nK-3.6 Cl-100 HCO3-27 AnGap-10\n___ 08:00AM BLOOD ALT-51* AST-53* LD(LDH)-262* AlkPhos-135* \nTotBili-2.7*\n___ 08:00AM BLOOD Calcium-8.1*\n___ 08:00AM BLOOD b2micro-3.2*\n___ 05:43AM BLOOD EBV PCR, QUANTITATIVE, WHOLE BLOOD-Test \n \n___ 12:00AM BLOOD BABESIA MICROTI DNA PCR-Test Name \n___ 12:00AM BLOOD HERPES 6 DNA PCR, QUANTITATIVE-Test Name \n___ 12:00AM BLOOD EBV PCR, QUANTITATIVE, WHOLE BLOOD-Test \n \n___ 05:37AM BLOOD b2micro-4.7*\n___ 12:00AM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE \nHBcAb-POSITIVE IgM HBc-NEGATIVE\n___ 12:00AM BLOOD 25VitD-24*\n___ 12:00AM BLOOD PTH-25\n___ 05:11AM BLOOD Hapto-50\n___ 06:00AM BLOOD Hapto-58\n___ 06:00AM BLOOD ALT-30 AST-30 LD(LDH)-235 AlkPhos-169* \nTotBili-1.3\n___ 06:00AM BLOOD ALT-27 AST-30 LD(LDH)-277* CK(CPK)-41* \nAlkPhos-151* TotBili-1.1\n___ 04:29AM BLOOD ALT-26 AST-29 LD(___)-287* AlkPhos-161* \nTotBili-1.2\n___ 05:43AM BLOOD ALT-25 AST-31 LD(___)-285* AlkPhos-173* \nTotBili-1.0\n___ 05:03AM BLOOD ALT-33 AST-47* LD(___)-347* AlkPhos-200* \nTotBili-1.0\n___ 03:43PM BLOOD LD(___)-348*\n___ 06:39AM BLOOD ALT-33 AST-41* LD(___)-404* AlkPhos-188* \nTotBili-0.9\n___ 06:22AM BLOOD ALT-36 AST-49* LD(___)-316* AlkPhos-193* \nTotBili-1.0\n___ 05:37AM BLOOD ALT-31 AST-38 LD(___)-312* AlkPhos-190* \nTotBili-1.4\n___ 06:00AM BLOOD ALT-30 AST-39 LD(___)-321* AlkPhos-197* \nTotBili-1.3\n___ 12:00AM BLOOD ALT-24 AST-34 LD(___)-276* AlkPhos-149* \nTotBili-1.1\n___ 12:00AM BLOOD ALT-45* AST-90* LD(___)-278* AlkPhos-172* \nTotBili-1.0\n___ 12:00AM BLOOD ALT-68* AST-95* LD(___)-262* AlkPhos-217* \nTotBili-1.0\n___ 12:00AM BLOOD ALT-70* AST-73* LD(___)-250 AlkPhos-241* \nTotBili-1.0\n___ 12:00AM BLOOD ALT-103* AST-87* LD(___)-230 AlkPhos-302* \nTotBili-1.2\n___ 12:00AM BLOOD ALT-82* AST-55* LD(___)-214 AlkPhos-269* \nTotBili-1.2\n___ 12:00AM BLOOD ALT-68* AST-45* LD(___)-196 AlkPhos-265* \nTotBili-1.3\n___ 12:00AM BLOOD ALT-63* AST-48* LD(___)-208 AlkPhos-277* \nTotBili-1.6*\n___ 06:28AM BLOOD ___ Ct-80*\n___ 12:00AM BLOOD Parst S-NEGATIVE\n\nDISCHARGE LABS:\n___ 12:00AM BLOOD WBC-2.6* RBC-2.92* Hgb-10.1* Hct-29.7* \nMCV-102* MCH-34.7* MCHC-34.1 RDW-20.6* Plt ___\n___ 12:00AM BLOOD Neuts-64 Bands-0 ___ Monos-9 Eos-8* \nBaso-1 ___ Myelos-0\n___ 12:00AM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-1+ \nMacrocy-3+ Microcy-1+ Polychr-1+ Ovalocy-1+ Schisto-1+ Tear \nDr-OCCASIONAL\n___ 12:00AM BLOOD Plt Smr-LOW Plt ___\n___ 01:31PM BLOOD ___\n___ 12:00AM BLOOD Glucose-201* UreaN-16 Creat-0.7 Na-131* \nK-4.1 Cl-93* HCO3-29 AnGap-13\n___ 12:00AM BLOOD ALT-35 AST-35 LD(___)-182 AlkPhos-188* \nTotBili-1.4\n___ 12:00AM BLOOD Albumin-3.6 Calcium-9.1 Phos-3.3 Mg-2.0\n\nPeritoneal fluid:\n___ 03:39PM ASCITES TotPro-1.3 Glucose-156 LD(___)-76 \nAmylase-8 TotBili-0.4 Albumin-LESS THAN \n___ 03:39PM ASCITES WBC-490* RBC-1115* Polys-27* Lymphs-25* \nMonos-4* Macroph-44*\n\nCSF:\n___ 07:15PM CEREBROSPINAL FLUID (CSF) TotProt-31 Glucose-66 \nLD(LDH)-27\n___ 07:15PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-2* Polys-2 \n___ ___ 07:15PM CEREBROSPINAL FLUID (CSF) ADENOVIRUS PCR-Test \nName \n___ 07:15PM CEREBROSPINAL FLUID (CSF) HERPES 6 PCR-Test \nName \n___ 07:15PM CEREBROSPINAL FLUID (CSF) HERPES SIMPLEX VIRUS \nPCR-Test Name \n___ 07:15PM CEREBROSPINAL FLUID (CSF) ___ VIRUS (JCV) DNA \nQUANTITATIVE PCR-Test Name \n\n___:\n___ 08:45PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ 11:25AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-4* pH-7.0 Leuks-NEG\n___ 06:14AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-2* pH-6.5 Leuks-NEG\n___ 02:15PM URINE Hours-RANDOM UreaN-718 Creat-149 Na-60 \nK-43 Cl-54\n\nCARDIOLOGY:\nECHO ___:\nThe left atrium is mildly dilated. Left ventricular wall \nthicknesses are normal. The left ventricular cavity size is \nnormal. Overall left ventricular systolic function is normal \n(LVEF 60%). Right ventricular chamber size and free wall motion \nare normal. The aortic valve leaflets (3) appear structurally \nnormal with good leaflet excursion and no aortic stenosis or \naortic regurgitation. The mitral valve appears structurally \nnormal with trivial mitral regurgitation. There is no mitral \nvalve prolapse. There is mild pulmonary artery systolic \nhypertension. There is no pericardial effusion. Compared with \nthe findings of the prior study (images reviewed) of ___, the findings are similar. \n\nRADIOLOGY:\nLiver US ___ \nREPORT: The liver is of normal echotexture, but its contours are \nsomewhat irregular. No discrete liver masses are seen. Portal \nvein is patent with hepatopetal flow. The gallbladder is thick \nwalled, normal appearance, but appearances are not reflective of \nacute cholecystitis. \n \nThere is sludge in the gallbladder. Common hepatic duct \nmeasures less than 3 mm. There is mild-to-moderate ascites, \nmost prominent in the left upper quadrant and lower quadrant. \nThere is massive splenomegaly measuring 23 cm. The ascites has \nincreased over the prior ultrasound, probably stable from the \n___ CT. The other findings including the gallbladder are \nunchanged from prior studies, most likely ___ ultrasound. \n\nCXR ___\nIMPRESSION: \nNew bibasilar atelectasis and small bilateral effusions. The \npossibility of a lower lobe pneumonic infiltrate -- ? on the \nleft -- cannot be excluded. \n\nPelvic U/S ___\nIMPRESSION: Three small lymph nodes lacking fatty hila. No \ndrainable \ncollection in right inguinal region. \n\nMR of the head w/ contrast ___:\nIMPRESSION: No acute intracranial abnormality. The study and \nthe report were reviewed by the staff radiologist. \n \nCT torso w/ contast ___:\nIMPRESSION: \n1. Acute right main and upper, middle, and lower segmental \npulmonary \nembolism. \n2. No short-interval change in adenopathy and splenomegally \nsince ___. \n3. Liver cirrhosis with small to moderate ascites \n4. No abscess or other obvious source of infection. \n\nLower Extremity doppler ___\nIMPRESSION: \n1. No evidence of DVT. \n2. Left ___ cyst containing echogenic internal debris. \n\nCXR ___:\nFINDINGS: As compared to the previous radiograph, the lung \nvolumes remain low. Unchanged course and position of the left \nPICC line. A pre-existing minimal atelectasis at the lung bases \nhas completely resolved. The lung volumes, however, remain low, \nthere is no evidence of pleural effusions or focal parenchymal \nopacities suggesting pneumonia.\n\nCT head without contrast ___\nIMPRESSION: \n1. No evidence of acute intracranial process. \n2. Retention cyst in the left posterior ethmoid air cells. \n3. Chronic findings as dictated above. \n \nDiagnostic paracentesis ___\nIMPRESSION: Successful diagnostic ultrasound-guided \nparacentesis yielding 20 cc of yellow ascitic fluid, which was \nsent to the laboratory for chemistry, cell count, and culture.\nMr. ___ is a ___ yo M with recently diagnosed hepatosplenic \nlymphoma with bone marrow involvement s/p 2 cycles of DA-EPOCH \nwho was discharge the day prior to admission who represented to \nclinic with worsening abdominal pain and found to have a \nneutropenic fever and new onset hyperbilirubinemiema and thrush.\n\n#Hepatosplenic T-cell lymphoma- patient had prior prolonged \nhospitalization for fevers of unknown source which lead to the \ndiagnosis of hepatosplenic lymphoma. During the previous \nadmission he was treated with 2 cycles of DaEPOCH which were \nwell-tolerated. Fevers at the time were cyclical and without a \nsource and therefore attributed to lymphoma. These fevers \nrecurred during this admission (despite being on broad coverage \ninitially) coupled with abdominal pain, rising bilirubin levels, \nand absence of obstruction on U/S and therefore believed to be \ndue to increasing tumor burden as evidenced by work-up. Patient \nwas administered Campath/Cladarbine on ___ in attempt to \ndecrease tumor burden and patient tolerated this therapy well. \nHe continued to have fevers/rigors after discontinuation of \nprednisone, and was placed on a 20mg/day dose. Patient to \nrecieve next cycle of chemo per oncology with planned \nre-admission on ___. Of note, he received one dose of \nprophylactic IT MTX on ___.\n\n#Neutropenic fever- patient admitted with neutropenic fever and \nabdominal pain. Given his history of ascites and cirrhosis he \nhad a RUQ u/s that showed mild-moderate ascites but this was \nunable to be tapped initially until ___ and illlustrated no \nevidence of SBT. Initially started on cefepime (___) to \ncover intraabdominal source as well as micafungin given his \nthrush. Found to have VRE on ___ treated with daptomycin \n(___) and meropenem added on ___ to cover for \npossible SBP. Fevers resolved on ___. Continued to rigor, \ndespite being afebrile and hemodynamically stable secondary to \nhis lymphoma. Ceftriaxone was added on ___ over concern of \nCNS infection and SBP, however work up was negative. He was \ngiven neupogen twice a week to maintain WBC counts. Fevers \nimproved on 20mg of prednisone daily. \n\n#Fever (non-neutropenic)without a source on ___: Initially \nstarted on Ceftriaxone for empiric coverage but discontinued on \n___. Infectious work up was completely negative including \nascitic fluid, CSF, and blood/urine studies. Source likely due \nto tumor burden(patient's fevers correlate to discontinuation of \nsteroids), unlikely abdominal as asictic fluid analysis did not \nreveal evidence of SBT, and B2 microglobulin levels were \nelevated illustrating lymphatic disease. \n\n#Pulmonary embolus: patient found to have very large pulmonary \nembolus in right main artery after CT torso performed for \npersistent fevers, rigors. CT torso illustrated PE with \ninvolvement of right upper and right lower branches. ECHO did \nnot illustrate right heart strain and Lower extremity dopplers \nwere negative for DVT. Patient continued to be hemodynamically \nstable throughout hospital course. Initially treated with \nheparin drip and transitioned to lovenox to 100mg QD. Daily \ndosing was chosen to simplify patient's regimen given his \ninability to learn to self-administer Lovenox. Lovenox will be \nadministered by ___ upon discharge.\n\n# Cirrhosis: He has associated splenomegaly, and multiple \nstigmata of cirrhosis on external exam. Likely secondary to \ninfiltrative process. Decreased syntethic function was evidenced \nby low albumin, thrombocytopenia and coagulopathy with INR \n~1.3-1.7, and low fibrinogen. Liver enzymes remained elevated \nand fluctuated with disease course. Evaluated by hepatology, \nplaced on lactulose for confusion, Aldactone 100 mg, fluid \nrestricted to 2L, and started on Lamuvadine for Hep B \nprophylaxis given history of hep B for prophylaxis. \n\n#Hypophosphatemia: Secondary to vitamin D deficiency, patient \nstarted on 400 U of vitamin D. Parathyroid hormone levels were \nnormal.\n\n#Hyponatremia- Patient's sodium has been trending down over the \npast several days. Urine analysis is consistent with SIADH. \nStarted on aldactone. Low sodium diet and fluid restriction, and \nthis resolved.\n\n#Abdominal Pain- patient has had some intermittent shooting \nabdominal pain.Likely associated with hepatosplenic T-cell \nlymphoma. Placed on oxycontin 20 mg PO Q12hrs, and oxycodone \n10mg to be given Q4hrs PRN and at bedtime, IV diluadid on board \nfor break through pain. Adequate pain control has now been \naschieved with this regimen.\n\n#Lower extremity edema: Likely secondary to cirrhosis and \ndecreased synthetic function of the Liver. Lower extremity \ndopplers were negative for DVT. Patient was fluid restricted and \ngiven 40mg of lasix daily in addition to compression stockings. \nEdema significantly improved throughout hospital course.\n\n# Thrombocytopenia: This is likely secondary to splenic \nsequestration secondary cirrhosis vs. decreased synthesis \nsecondary to bone marrow infiltrations. Platelet count was 13 on \n___ but recovered ___ hospital course. No active \nbleeding during hosptal course. Platelets have been trending up \nover several days, threshold for platelet infusion was less than \n30K given intrinsic coagulopathy and lovenox use.\n\n# Nystagmus/ confusion. Interestingly noted to have nystagmus, \nnoted left side smokiness after chemo; MRI/CT head with no acute \nprocess. Patient underwent a diagnostic LP to evaluate for \nevidence of CNS lymphoma, and received prophylactic IT MTX \nchemotherapy administration. CSF analysis showed no evidence of \nmalignant cells. Confusion resolved when fevers resolved.\n\n#Psychosocial issue/ADD: Patient's discharge is complicated by \nthe fact that the patient has trouble understanding a \ncomplicated medication schedule coupled with the need of \nfrequent appointments and his distance from ___. His family \nwill be unable to attend to him 24hrs/day, and a ___ will only \nbe present once day. Transportation approved via social work, \nhowever needs two week notice for out of city services.\n\n# DM2- on metformin at home, currently on sliding scale. \nAggrevated by current concominant steroid use. BID finger \nsticks/glucose monitoring was employed and patient placed on \ninsulin sliding scale.\n\nTransitional Issues:\n[ ] continue neupogen biweekly/PRN\n[ ] continue bactrim and acyclovir ppx at home \n[ ] Next cycle of cladarbine/campath on ___ per Dr. ___\n[ ] monitor platelts, transfuse <30 given lovenox use\n[ ] trend bili\n[ ] trend ___\n[ ] hold Lasix for hyponatremia\n[ ] hold aldactone for hyponatremia\n[ ] Continue on low sodium diet\n[ ] If serum Na<125 hepatology recs tolvaptan 15 mg PO daily\n[ ] Monitor PTT\n[ ] Continue lovenox ___ SC daily\n[ ] Will need ___ to help administer shots.\n[ ] Continue on Vitamin D 400U daily\n\nABX: Previously on: Cefepime (D1 = ___, Micafungin (D1 = \n___, ___ (___) Ceftriaxone (D1 \n___"}}
{'final_diagnoses': ['Neutropenic Fever', 'VRE', 'Pulmonary Embolism', 'Hepatosplenic Lymphoma'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ yo M with recently diagnosed hepatosplenic \nlymphoma with bone marrow involvement s/p 2 cycles of DA-EPOCH \nwho was discharge the day prior to admission who represented to \nclinic with worsening abdominal pain and found to have a \nneutropenic fever and new onset hyperbilirubinemiema and thrush.\n\n#Hepatosplenic T-cell lymphoma- patient had prior prolonged \nhospitalization for fevers of unknown source which lead to the \ndiagnosis of hepatosplenic lymphoma. During the previous \nadmission he was treated with 2 cycles of DaEPOCH which were \nwell-tolerated. Fevers at the time were cyclical and without a \nsource and therefore attributed to lymphoma. These fevers \nrecurred during this admission (despite being on broad coverage \ninitially) coupled with abdominal pain, rising bilirubin levels, \nand absence of obstruction on U/S and therefore believed to be \ndue to increasing tumor burden as evidenced by work-up. Patient \nwas administered Campath/Cladarbine on ___ in attempt to \ndecrease tumor burden and patient tolerated this therapy well. \nHe continued to have fevers/rigors after discontinuation of \nprednisone, and was placed on a 20mg/day dose. Patient to \nrecieve next cycle of chemo per oncology with planned \nre-admission on ___. Of note, he received one dose of \nprophylactic IT MTX on ___.\n\n#Neutropenic fever- patient admitted with neutropenic fever and \nabdominal pain. Given his history of ascites and cirrhosis he \nhad a RUQ u/s that showed mild-moderate ascites but this was \nunable to be tapped initially until ___ and illlustrated no \nevidence of SBT. Initially started on cefepime (___) to \ncover intraabdominal source as well as micafungin given his \nthrush. Found to have VRE on ___ treated with daptomycin \n(___) and meropenem added on ___ to cover for \npossible SBP. Fevers resolved on ___. Continued to rigor, \ndespite being afebrile and hemodynamically stable secondary to \nhis lymphoma. Ceftriaxone was added on ___ over concern of \nCNS infection and SBP, however work up was negative. He was \ngiven neupogen twice a week to maintain WBC counts. Fevers \nimproved on 20mg of prednisone daily. \n\n#Fever (non-neutropenic)without a source on ___: Initially \nstarted on Ceftriaxone for empiric coverage but discontinued on \n___. Infectious work up was completely negative including \nascitic fluid, CSF, and blood/urine studies. Source likely due \nto tumor burden(patient's fevers correlate to discontinuation of \nsteroids), unlikely abdominal as asictic fluid analysis did not \nreveal evidence of SBT, and B2 microglobulin levels were \nelevated illustrating lymphatic disease. \n\n#Pulmonary embolus: patient found to have very large pulmonary \nembolus in right main artery after CT torso performed for \npersistent fevers, rigors. CT torso illustrated PE with \ninvolvement of right upper and right lower branches. ECHO did \nnot illustrate right heart strain and Lower extremity dopplers \nwere negative for DVT. Patient continued to be hemodynamically \nstable throughout hospital course. Initially treated with \nheparin drip and transitioned to lovenox to 100mg QD. Daily \ndosing was chosen to simplify patient's regimen given his \ninability to learn to self-administer Lovenox. Lovenox will be \nadministered by ___ upon discharge.\n\n# Cirrhosis: He has associated splenomegaly, and multiple \nstigmata of cirrhosis on external exam. Likely secondary to \ninfiltrative process. Decreased syntethic function was evidenced \nby low albumin, thrombocytopenia and coagulopathy with INR \n~1.3-1.7, and low fibrinogen. Liver enzymes remained elevated \nand fluctuated with disease course. Evaluated by hepatology, \nplaced on lactulose for confusion, Aldactone 100 mg, fluid \nrestricted to 2L, and started on Lamuvadine for Hep B \nprophylaxis given history of hep B for prophylaxis. \n\n#Hypophosphatemia: Secondary to vitamin D deficiency, patient \nstarted on 400 U of vitamin D. Parathyroid hormone levels were \nnormal.\n\n#Hyponatremia- Patient's sodium has been trending down over the \npast several days. Urine analysis is consistent with SIADH. \nStarted on aldactone. Low sodium diet and fluid restriction, and \nthis resolved.\n\n#Abdominal Pain- patient has had some intermittent shooting \nabdominal pain.Likely associated with hepatosplenic T-cell \nlymphoma. Placed on oxycontin 20 mg PO Q12hrs, and oxycodone \n10mg to be given Q4hrs PRN and at bedtime, IV diluadid on board \nfor break through pain. Adequate pain control has now been \naschieved with this regimen.\n\n#Lower extremity edema: Likely secondary to cirrhosis and \ndecreased synthetic function of the Liver. Lower extremity \ndopplers were negative for DVT. Patient was fluid restricted and \ngiven 40mg of lasix daily in addition to compression stockings. \nEdema significantly improved throughout hospital course.\n\n# Thrombocytopenia: This is likely secondary to splenic \nsequestration secondary cirrhosis vs. decreased synthesis \nsecondary to bone marrow infiltrations. Platelet count was 13 on \n___ but recovered ___ hospital course. No active \nbleeding during hosptal course. Platelets have been trending up \nover several days, threshold for platelet infusion was less than \n30K given intrinsic coagulopathy and lovenox use.\n\n# Nystagmus/ confusion. Interestingly noted to have nystagmus, \nnoted left side smokiness after chemo; MRI/CT head with no acute \nprocess. Patient underwent a diagnostic LP to evaluate for \nevidence of CNS lymphoma, and received prophylactic IT MTX \nchemotherapy administration. CSF analysis showed no evidence of \nmalignant cells. Confusion resolved when fevers resolved.\n\n#Psychosocial issue/ADD: Patient's discharge is complicated by \nthe fact that the patient has trouble understanding a \ncomplicated medication schedule coupled with the need of \nfrequent appointments and his distance from ___. His family \nwill be unable to attend to him 24hrs/day, and a ___ will only \nbe present once day. Transportation approved via social work, \nhowever needs two week notice for out of city services.\n\n# DM2- on metformin at home, currently on sliding scale. \nAggrevated by current concominant steroid use. BID finger \nsticks/glucose monitoring was employed and patient placed on \ninsulin sliding scale.\n\nTransitional Issues:\n[ ] continue neupogen biweekly/PRN\n[ ] continue bactrim and acyclovir ppx at home \n[ ] Next cycle of cladarbine/campath on ___ per Dr. ___\n[ ] monitor platelts, transfuse <30 given lovenox use\n[ ] trend bili\n[ ] trend ___\n[ ] hold Lasix for hyponatremia\n[ ] hold aldactone for hyponatremia\n[ ] Continue on low sodium diet\n[ ] If serum Na<125 hepatology recs tolvaptan 15 mg PO daily\n[ ] Monitor PTT\n[ ] Continue lovenox ___ SC daily\n[ ] Will need ___ to help administer shots.\n[ ] Continue on Vitamin D 400U daily\n\nABX: Previously on: Cefepime (D1 = ___, Micafungin (D1 = \n___, ___ (___) Ceftriaxone (D1 \n___", 'medications_prescribed': ['1. Acyclovir 400 mg PO Q8H', '2. Docusate Sodium 100 mg PO BID', '3. Lorazepam 0.5-1 mg PO Q6H', '4. Omeprazole 20 mg PO DAILY', '5. OxycoDONE (Immediate Release) 5 mg PO Q4-6HRS PRN pain', '6. Senna 1 TAB PO BID:PRN constipation', '7. Artificial Tears ___ DROP BOTH EYES PRN puritis/dry eyes \nRX *Artificial Tears 1 drop daily Disp #*2 Bottle Refills:*0', '8. Enoxaparin Sodium 100 mg SC DAILY \nRX *enoxaparin 100 mg/mL inject subcutaneously daily Disp #*30 \nSyringe Refills:*2', '9. Furosemide 40 mg PO DAILY \nRX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*2', '10. Lactulose 30 mL PO TID \nTitrate to 3 BMs daily. ___ MD if change in mental status. \nRX *lactulose 20 gram/30 mL 30 mL by mouth three times a day \nDisp #*2700 Milliliter Refills:*0', '11. LaMIVudine 100 mg PO DAILY \nRX *Epivir HBV 100 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*2', '12. Multivitamins 1 CAP PO DAILY \nRX *Daily Multi-Vitamin 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*2', '13. Oxycodone SR (OxyconTIN) 20 mg PO Q12H Pain \nHold for sedation or RR less than 12 \nRX *OxyContin 20 mg 1 tablet(s) by mouth every 12 hours Disp \n#*60 Tablet Refills:*2', '14. PredniSONE 10 mg PO DAILY \nTapered dose - DOWN \nRX *prednisone 5 mg 3 tablet(s) by mouth daily Disp #*90 Tablet \nRefills:*2', '15. Simethicone 40-80 mg PO TID abd distension/bloating \nPt may refuse. \nRX *simethicone 80 mg 1 tablet by mouth three times a day Disp \n#*90 Tablet Refills:*0', '16. Spironolactone 100 mg PO DAILY \nRX *spironolactone 100 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*2', '17. Sulfameth/Trimethoprim DS 1 TAB PO MWF \nPlease give on ___, ___, ___ \nRX *Bactrim DS 800 mg-160 mg 1 tablet(s) by mouth every other \nday Disp #*12 Tablet Refills:*2', '18. Vitamin D 400 UNIT PO DAILY low vitamin D \nRX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*2', '19. Ondansetron 8 mg PO Q6-8HRS PRN nausea', '20. MetFORMIN (Glucophage) 1000 mg PO BID DM', '21. lancets *NF* 0 unit MISCELLANEOUS BID']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 50, 'gender': 'M', 'symptoms': 'bloating', 'medical_history': ['- Hepatitis C cirrhosis (chronic HCV genotype 1a, IL28 CT); \nLiver biopsy ___ showed stage 4 fibrosis, grade 2 \ninflammation. No varices as of ___, no encephalopathy, no \nascites. Decompensated with hyperbilirubinemia.', '- DMII on glipizide (A1c 6.5)', '- HTN', '- COPD/Asthma (FEV1 53% predicted, nml FEV1/FVC ratio)', '- Seizure disorder', '- Schizoaffective disorder', '- Hepatitis C cirrhosis (chronic HCV genotype 1a, IL28 CT); \nLiver biopsy ___ showed stage 4 fibrosis, grade 2 \ninflammation. No varices as of ___, no encephalopathy, no \nascites. Decompensated with hyperbilirubinemia.', '- DMII on glipizide- last A1c 6.5 in ___. Metformin \ndiscontinued in ___ due to lactic acidosis.', '- HTN', '- COPD/Asthma- Last seen by Dr ___ in ___, and started on a \nprednisone taper for persistent cough since admission in ___. \nHer FVC is 1.61 liters, 54% predicted, FEV1 is 1.26 liters, 53% \nof predicted, and FEV1/FVC ratio is normal.', '- Seizure disorder', '- Schizoaffective disorder- psychiatrist Dr ___ ___'], 'family_history': 'Mother: HTN, DM, asthma\nFather: ___ disorder \nNephew, niece: ___', 'present_illness': 'Ms. ___ is a ___ hx Hepatitis C cirrhosis (MELD 27, no \nhistory of ascites, varices, SBP, or hepatic encephalopathy), \nHTN, COPD, DM2, seizure disorder, schizoaffective disorder who \npresented with complaints of abdominal bloating. Most recently, \n___ she was admitted after prolonged epistaxis c/b \naspiration and found to have VRE UTI. Thereafter, she was \ndischarged on linezolid, which she has been taking at home. She \nreports adherence to her discharge diuretic regimen, but reports \nthat she has increased abdominal bloating. She reports, while \ncrying, that she is very sad to be readmitted so soon after \ndischarge. \n\nShe denied melena, BRBPR, CP, SOB, syncope, presyncope, \nabdominal pain. She also denied dysuria, urinary \nfrequency/urgency.\n\n- Labs were significant for Hgb 7.4 from recent baseline ~8.5. \nINR 2.1 at baseline. Chemistries with hyponatremia, baseline. \nLFTs w AST/ALT/Bili at baseline. Hepatology was consulted who \nrecommended BID PPI, NPO and admission for possible EGD. A prior \nEGD ___ was without varices. \n\nIn the ED initial vitals were: 98.4 103 131/56 20 98% RA. \nVSS on transfer to the medicine ward.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bengay', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.6', 'valuenum': 36.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.35', 'valuenum': 4.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79.6', 'valuenum': 79.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.65', 'valuenum': 4.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '249', 'valuenum': 249.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '352', 'valuenum': 352.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '271', 'valuenum': 271.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 292.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.9', 'valuenum': 40.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.86', 'valuenum': 4.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '258', 'valuenum': 258.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.59', 'valuenum': 4.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVitals - 98.2 140/72 116 22 97%RA Wt 91kg \nGeneral: crying and expressing sadness about her readmission \nHEENT: icteric sclera \nCV: regular tachycardia ___ SEM \nLungs: CTA bilaterally \nAb: Positive BS, distended (increased abdominal girth since my \nlast exam during her prior recent admission on ___, \nnontender \nExt: 2+ pitting edema to the mid thighs \nNeuro: negative asterixis, no focal deficits, AOx3 \nSkin: no petichiae, some palmar erythema and spider angiomas \nnoted\n\nDISCHARGE PHYSICAL EXAM:\nVitals - Tmax 98.5 Tc 98.5 BP 131/73, HR 101, RR 19, o2sat 97% \nRA wt 92.8 kg\nGeneral: NAD\nHEENT: icteric sclera \nCV: regular tachycardia ___ SEM \nLungs: CTAB\nAb: Positive BS, distended, nontender \nExt: 1+ pitting edema to bilateral knees \nNeuro: negative asterixis, no focal deficits, AOx3 \nSkin: no petichiae, some palmar erythema and spider angiomas \nnoted', 'diagnoses': [{'icd_code': '42821', 'desc': 'Acute systolic heart failure'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': 'LABS ON ADMISSION:\n===================\n___ 09:50AM UREA N-11 CREAT-0.8 SODIUM-125* POTASSIUM-4.2 \nCHLORIDE-95* TOTAL CO2-27 ANION GAP-7*\n___ 09:50AM ALT(SGPT)-60* AST(SGOT)-84* ALK PHOS-220* TOT \nBILI-10.3*\n___ 09:50AM IRON-169*\n___ 09:50AM VIT ___ FERRITIN-100\n___ 09:50AM WBC-6.6 RBC-2.07* HGB-7.6* HCT-24.0* MCV-116* \nMCH-36.6* MCHC-31.6 RDW-17.6*\n___ 09:50AM PLT COUNT-77*\n___ 09:50AM ___ PTT-41.4* ___\n___ 02:55AM ___ PTT-41.5* ___\n___ 02:23AM ___ TEMP-36.7\n___ 02:23AM LACTATE-1.5\n___ 02:10AM GLUCOSE-181* UREA N-11 CREAT-0.8 SODIUM-125* \nPOTASSIUM-4.0 CHLORIDE-94* TOTAL CO2-24 ANION GAP-11\n___ 02:10AM ALT(SGPT)-59* AST(SGOT)-84* ALK PHOS-218* TOT \nBILI-9.9*\n___ 02:10AM LIPASE-49\n___ 02:10AM ALBUMIN-2.4*\n___ 02:10AM WBC-6.9 RBC-1.98* HGB-7.4* HCT-23.6* MCV-119* \nMCH-37.3* MCHC-31.4 RDW-18.8*\n___ 02:10AM NEUTS-69.1 ___ MONOS-6.6 EOS-2.4 \nBASOS-0.3\n___ 02:10AM PLT COUNT-82*\n___ 05:20AM BLOOD Folate-GREATER TH\n___ 09:50AM BLOOD ___ Ferritn-100\n\nLABS ON DISCHARGE:\n===================\n___ 05:20AM BLOOD WBC-5.7 RBC-2.03* Hgb-7.5* Hct-23.2* \nMCV-114* MCH-36.9* MCHC-32.3 RDW-19.9* Plt Ct-67*\n___ 05:20AM BLOOD Plt Ct-67*\n___ 05:20AM BLOOD ___\n___ 05:20AM BLOOD Ret Aut-4.3*\n___ 05:20AM BLOOD Glucose-193* UreaN-14 Creat-0.7 Na-126* \nK-3.9 Cl-93* HCO3-23 AnGap-14\n___ 05:20AM BLOOD TotBili-15.0*\n___ 05:20AM BLOOD ALT-47* AST-80* AlkPhos-132* \nTotBili-12.7* DirBili-6.8* IndBili-5.9\n___ 05:20AM BLOOD Calcium-9.4 Phos-2.6* Mg-1.9\n\nMICROBIOLOGY:\n=============\n___: Blood cultures with no growth.\nHELICOBACTER PYLORI ANTIBODY TEST (Pending)\n\nSTUDIES:\n========\n___: Colonoscopy \nImpression: Superficial erosions with surrounding erythema in \nthe whole colon compatible with mild colitis (biopsy)\nOtherwise normal colonoscopy to cecum \nRecommendations: Await biopsy results. Transfuse as needed based \non signs and symptoms of bleeding. Repeat screening colonoscopy \nin ___ years time. \n\n___: EGD: \nImpression: Mucosa suggestive of ___ esophagus \nErythema, congestion and mosaic appearance in the fundus and \nstomach body compatible with portal gastropathy \nErythema and erosion in the antrum \nFood in the fundus \nOtherwise normal EGD to third part of the duodenum\nRecommendations: Evaluate h.pylori status. \nAvoid NSAIDS. \nIncrease omeprazole to 20mg bid. \nCheck iron studies, consider oral iron therapy. \nOutpatient screening colonoscopy.\nMs ___ is a ___ year old woman with Hepatitis C cirrhosis \n(MELD 27, no history of ascites, varices, SBP, or hepatic \nencephalopathy), and recent discharge on ___ (treated for \nUCx + for VRE from ___, and hypoxia after likely nosebleed \naspiration) who presented to the ED on ___ complaining of \nbloating, and who was admitted for concern of anemia/possible \nGIB, a fall in Hct from 25 to 20.8, but without evidence of \nactive bleeding on EGD or colonoscopy. She was transfused with \none unit pRBCs and was stable at the time of discharge, without \nCP, SOB, syncope, presyncope, or abdominal pain. \n\n#Acute blood loss anemia: She denies epistaxis since her prior \ndischarge on ___, hematemesis, melena, and BRBPR. EGD showed \nportal gastropathy and ___. Colonoscopy showed superficial \nerosions and mild colitis with no signs of active bleeding. She \nwas hemodynamically stable, although her Hct fell 26->20.8, but \nstabilized after 1 unit pRBCs. Retic count appropriately \nelevated, supportive the diagnosis of blood loss anemia. These \nfindings, taken together, are perhaps suggestive of GIB that has \nnow resolved. By the time of discharge, she was having a \nregular, low sodium diet and 1500 mL fluid restriction, and \nfeeling well. She will continue on omeprazole PO, and has a H. \npylori serum antibody test pending. \n\n#VRE UTI: Diagnosed on last admission, with no signs of sepsis. \nNo symptoms. \nContinue linezolid till ___ per ID recs. \n\n#Hep C Cirrhosis: c/b ascites, bilirubinemia, volume overload, \nhyponatremia. Labs at recent baselines; Na up to 126-130 in the \ndays prior to discharge. Currently euvolemic relative to her \npresentation, and I suspect some imprecision in her weight \nmeasurement. Though her weight is up 1 kg since admission, her \nphysical exam findings are reassuring that she is euvolemic on \ndischarge. \n\n#Hyponatremia: chronic, at baseline, ___ volume overload from \ncirrhosis. Na of 126-130 in the days prior to discharge, at \nrecent baseline. \n\n#COPD/asthma: Not an active issue during this admission. Home \nmedications were continued.\n#Seizure d/o: Not an active issue during this admission. Home \nmedications were continued. \n#Schizoaffective d/o: Not an active issue during this \nadmission. Home medications were continued.'}}
{'final_diagnoses': ['Hepatitis C Cirrhosis', 'Portal gastropathy', '___ esophagus'], 'procedures': ['Esophagogastroduodenoscopy (EGD)', 'Colonoscopy'], 'visit_summary': 'Ms ___ is a ___ year old woman with Hepatitis C cirrhosis \n(MELD 27, no history of ascites, varices, SBP, or hepatic \nencephalopathy), and recent discharge on ___ (treated for \nUCx + for VRE from ___, and hypoxia after likely nosebleed \naspiration) who presented to the ED on ___ complaining of \nbloating, and who was admitted for concern of anemia/possible \nGIB, a fall in Hct from 25 to 20.8, but without evidence of \nactive bleeding on EGD or colonoscopy. She was transfused with \none unit pRBCs and was stable at the time of discharge, without \nCP, SOB, syncope, presyncope, or abdominal pain. \n\n#Acute blood loss anemia: She denies epistaxis since her prior \ndischarge on ___, hematemesis, melena, and BRBPR. EGD showed \nportal gastropathy and ___. Colonoscopy showed superficial \nerosions and mild colitis with no signs of active bleeding. She \nwas hemodynamically stable, although her Hct fell 26->20.8, but \nstabilized after 1 unit pRBCs. Retic count appropriately \nelevated, supportive the diagnosis of blood loss anemia. These \nfindings, taken together, are perhaps suggestive of GIB that has \nnow resolved. By the time of discharge, she was having a \nregular, low sodium diet and 1500 mL fluid restriction, and \nfeeling well. She will continue on omeprazole PO, and has a H. \npylori serum antibody test pending. \n\n#VRE UTI: Diagnosed on last admission, with no signs of sepsis. \nNo symptoms. \nContinue linezolid till ___ per ID recs. \n\n#Hep C Cirrhosis: c/b ascites, bilirubinemia, volume overload, \nhyponatremia. Labs at recent baselines; Na up to 126-130 in the \ndays prior to discharge. Currently euvolemic relative to her \npresentation, and I suspect some imprecision in her weight \nmeasurement. Though her weight is up 1 kg since admission, her \nphysical exam findings are reassuring that she is euvolemic on \ndischarge. \n\n#Hyponatremia: chronic, at baseline, ___ volume overload from \ncirrhosis. Na of 126-130 in the days prior to discharge, at \nrecent baseline. \n\n#COPD/asthma: Not an active issue during this admission. Home \nmedications were continued.\n#Seizure d/o: Not an active issue during this admission. Home \nmedications were continued. \n#Schizoaffective d/o: Not an active issue during this \nadmission. Home medications were continued.', 'medications_prescribed': ['1. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN SOB, wheezing', '2. Aripiprazole 30 mg PO DAILY', '3. DiphenhydrAMINE ___ mg PO DAILY:PRN allergies', '4. FoLIC Acid 1 mg PO DAILY', '5. Gabapentin 600 mg PO QAM', '6. Gabapentin 800 mg PO HS', '7. Benzonatate 100 mg PO TID:PRN Cough', '8. Ipratropium Bromide Neb 1 NEB IH Q12H:PRN SOB, wheezing', '9. Lactulose 30 mL PO TID', '10. LaMOTrigine 100 mg PO BID', '11. Lidocaine 5% Patch 1 PTCH TD QAM', '12. Linezolid ___ mg PO Q12H', '13. Montelukast 10 mg PO DAILY', '14. Multivitamins 1 TAB PO DAILY', '15. Nicotine Patch 21 mg TD DAILY', '16. Omeprazole 40 mg PO BID\nRX *omeprazole 40 mg 1 capsule(s) by mouth twice a day Disp #*60 \nCapsule Refills:*0', '17. Oxymetazoline 1 SPRY NU BID:PRN nose bleed \nRX *oxymetazoline [Afrin (oxymetazoline)] 0.05 % 1 spray nasally \ntwice a day Disp #*1 Spray Refills:*0', '18. Tiotropium Bromide 1 CAP IH DAILY', '19. Ursodiol 300 mg PO TID', '20. Zolpidem Tartrate 5 mg PO HS:PRN insomnia', '21. Furosemide 40 mg PO DAILY', '22. GlipiZIDE XL 2.5 mg PO DAILY', '23. Spironolactone 100 mg PO DAILY', '24. Ferrous Sulfate 325 mg PO DAILY \nRX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth \nonce a day Disp #*30 Tablet Refills:*0']}
Generate a treatment plan with clinical reasoning for this case:
{'patient_profile': {'age': 46, 'gender': 'F', 'symptoms': 's/p fall- SAH, L acetabular fx, L2+L3 transverse process \nfractures, question of T and L spine compression fractures', 'medical_history': ['AAA repair ___ years earlier', 'Thyroidectomy ___ years earlier', 'Advanced COPD', 'AFib treated with coumadin', 'CAD and pacemaker placement'], 'family_history': 'Unknown', 'present_illness': '___ year-old man with history of CAD s/p IMI, afib s/p pacemaker \non coumadin, COPD, laryngeal CA, who was admitted to the TICU \nwith SAH after a fall, and is now transferred to the MICU for \nmanagement of respiratory failure. Briefly, he had a mechanical \nfall on ___ and subsequently sustained a SAH, transverse \nprocess fracture at L2/L3, a compression fracture of \nT3/T12/L1/L4, and a left acetabular fracture. His SAH and \nfractures were thought to be non-operable per neurosurgery and \northo, respectively. His course in the TICU was also remarkable \nfor respiratory distress and ?new hypoxia on the day after \nadmission (he was 98%2L on the day of admission per review of \nthe notes), for which he was placed on a face mask, started on \nsolumedrol, nebs, and azithromycin empirically for a presumed \nCOPD exacerbation. This was weaned down to 2L NC on the day \nprior to transfer and he was satting 98%ra on the morning of \ntransfer with a plan to go to rehab today.\n.\nPer report, later this morning around 11 a.m., he was found to \nbe dyspneic, lethargic and breathing at a rate of 40. He was \nplaced on a nonrebreather and had O2 satts in the ___, HR 100s \n(afib), SBP 110. ABG was ___. He was thought to have \naspirated vs flash pulmonary edema and given lasix 40 mg IV x 1 \nwith good UOP. Of note, his family has been updated and he \nagrees to BiPAP but would want to be comfortable if this fails \n(after many conversations with patient and family).\n.\nHis hospital course has also been remarkable for delerium \nthought to be secondary to sundowning and narcotics, with \ngeriatrics consulted.', 'medications': [{'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'ALPRAZolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T: BP: P: R: 18 O2:\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops\nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno rebound tenderness or guarding, no organomegaly\nGU: no foley\nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema', 'diagnoses': [{'icd_code': '5589', 'desc': 'Other and unspecified noninfectious gastroenteritis and colitis'}, {'icd_code': '78901', 'desc': 'Abdominal pain, right upper quadrant'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': 'V8543', 'desc': 'Body Mass Index 50.0-59.9, adult'}], 'summary': 'ADMISSION LABS:\n.\n___ 06:05AM BLOOD WBC-17.9*# RBC-5.01# Hgb-14.6# Hct-44.8# \nMCV-89 MCH-29.1 MCHC-32.6 RDW-14.1 Plt ___\n___ 06:05AM BLOOD Neuts-93.8* Lymphs-3.5* Monos-2.5 Eos-0.1 \nBaso-0.1\n___ 06:05AM BLOOD ___ PTT-35.3* ___\n___ 06:05AM BLOOD Glucose-150* UreaN-24* Creat-1.8* Na-137 \nK-4.8 Cl-102 HCO3-25 AnGap-15\n___ 06:05AM BLOOD CK(CPK)-88\n___ 06:05AM BLOOD CK-MB-NotDone\n___ 06:05AM BLOOD cTropnT-<0.01\n___ 09:01AM BLOOD Calcium-8.9 Phos-3.5 Mg-2.0\n___ 06:05AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 04:14PM BLOOD Type-ART pO2-43* pCO2-35 pH-7.44 \ncalTCO2-25 Base XS-0\n___ 06:17AM BLOOD Lactate-1.6\n___ 04:14PM BLOOD freeCa-1.12\n.\n.\nPERTINENT STUDIES:\n.\nCT Chest ___. Multiple thoracolumbar compression deformities \nas described above. 2. Right transverse process fracture of L3 \nand L4. 3. Emphysema and multiple pulmonary nodules, one of \nwhich is not included in the field of view of the prior \nexamination, measuring 4 mm. Given risk\nfactors, a 12-month followup is recommended. 4. Multiple \nhepatic cysts. 5. Bilateral renal cysts\n\nCT Head ___ is asymmetric dense appearance of the right \nside of the tentorium and\nlateral to it indicating a possible suddural hemorrhage \nassociated. Close f/u to assess the stability of the above \nfindings is recommended.\n\nCT C-Spine ___ is asymmetry in the size of the disc \nspace at C4/5, wider anteriorly.\n(series 400b, im 19). Though this can relate to DJD and disc \nbulge, ligamentous injury needs to be excluded given the history \nof trauma and no prior studies. MR ___ spine can be performed for \nthe same.\n\n___ (___): LLE: partially occluded clot in greater saphenous, \nunchanged from prior; superficial femoral vein proximal \nthrombus. Possible thrombus . RLE: interval development of \npartially occlusive clot in greater saphenous at junction of \ncommon femoral.\n\nCT Head (___): 1. No evidence of new hemorrhage 2. Stable \nappearance of bilateral subdural hemorrhage layering along the \ntentorium cerebelli. Interval resolution of subarachnoid \nhemorrhage seen in the interpeduncular cistern. 3. Chronic \nsmall vessel ischemic changes.\n4. Prominent ventricles and sulci, unchanged.\n\nTTE (___): Mild symmetric left ventricular hypertrophy with \npreserved global and regional biventricular systolic function. \nModerate pulmonary hypertension.\nPatient was admitted to T/SICU from ER for management of his \ninjuries s/p mechanical fall, which included SAH, L acetabular \nfracture, L2L3 transverse process fractures, and thoracolumbar \ncompression injuries. Orthopaedics and Neurosurgery were \nconsulted for these injuries. Orthopaedics recommended \nnon-operative management of L hip fracture. Patient was to be \ntouch-down weight-bearing for 6 weeks and to follow-up in the \n___ clinic after this course of time. Neurosurgery \nrecommended normalization of his INR and repeat imaging of his \nhead in 6hours and 24 hours. No intervention was recommended \nfor vertebral fractures. His repeat head CTs revealed no \nchange. \n\nPatient had unstable respiratory status while in the ICU, which \nwas felt to be d/t COPD flair. He was treated with steroids, \nCPAP or BiPAP, and Azithromycin. He experienced some delirium \nand sundowning in the unit and geriatrics was consulted and \nrecommended afternoon haldol rather than standing doses and \ntylenol with breakthrough oxycodone rather than morphine \nstanding. \n\nOn HD4 patient had discussion with team regaring desire to be \nDNR/DNI and desire for care not to be escalated. Patient was \nweaned to 2L NC and transferred to floor. Physical therapy and \noccupational therapy evaluated the patient and hospice care was \nconsulted. Patient had a speech and swallow consult. 1:1 \nsupervision with crushed/pureed foods was recommended. \n\nOn HD5 patient became increasingly tachypneic and was \ntransferred back to the T/SICU for BiPAP. The decision was made \nto transfer patient from surgical intensive care unit to medical \nintensive care unit. \n\nDuring his MICU stay, the patient was placed on Bipap for \nhypoxic respiratory failure. He was placed empirically on \nantibiotics and was given IV steroids for a possible COPD \nexacerbation. He remained dyspneic with labored work of \nbreathing while on Bipap. LENIs were performed, which showed a \nnew DVT in his lower extremity. He was thus placed on a heparin \ndrip. He went into AFib with RVR and was started on a diltiazem \ndrip. He developed increased work of breathing in the setting \nof AFib with RVR and eventually expired from cardiopulmonary \narrest.'}}
{'final_diagnoses': ['s/p Fall', 'Subarachnoid hemorrhage', 'Transverse process fractures L2,3', 'Compression fracture T3,12; L1,4', 'Left acetabular fracture'], 'procedures': ['None'], 'visit_summary': 'Patient was admitted to T/SICU from ER for management of his \ninjuries s/p mechanical fall, which included SAH, L acetabular \nfracture, L2L3 transverse process fractures, and thoracolumbar \ncompression injuries. Orthopaedics and Neurosurgery were \nconsulted for these injuries. Orthopaedics recommended \nnon-operative management of L hip fracture. Patient was to be \ntouch-down weight-bearing for 6 weeks and to follow-up in the \n___ clinic after this course of time. Neurosurgery \nrecommended normalization of his INR and repeat imaging of his \nhead in 6hours and 24 hours. No intervention was recommended \nfor vertebral fractures. His repeat head CTs revealed no \nchange. \n\nPatient had unstable respiratory status while in the ICU, which \nwas felt to be d/t COPD flair. He was treated with steroids, \nCPAP or BiPAP, and Azithromycin. He experienced some delirium \nand sundowning in the unit and geriatrics was consulted and \nrecommended afternoon haldol rather than standing doses and \ntylenol with breakthrough oxycodone rather than morphine \nstanding. \n\nOn HD4 patient had discussion with team regaring desire to be \nDNR/DNI and desire for care not to be escalated. Patient was \nweaned to 2L NC and transferred to floor. Physical therapy and \noccupational therapy evaluated the patient and hospice care was \nconsulted. Patient had a speech and swallow consult. 1:1 \nsupervision with crushed/pureed foods was recommended. \n\nOn HD5 patient became increasingly tachypneic and was \ntransferred back to the T/SICU for BiPAP. The decision was made \nto transfer patient from surgical intensive care unit to medical \nintensive care unit. \n\nDuring his MICU stay, the patient was placed on Bipap for \nhypoxic respiratory failure. He was placed empirically on \nantibiotics and was given IV steroids for a possible COPD \nexacerbation. He remained dyspneic with labored work of \nbreathing while on Bipap. LENIs were performed, which showed a \nnew DVT in his lower extremity. He was thus placed on a heparin \ndrip. He went into AFib with RVR and was started on a diltiazem \ndrip. He developed increased work of breathing in the setting \nof AFib with RVR and eventually expired from cardiopulmonary \narrest.', 'medications_prescribed': ['1. Nitroglycerin 0.3 mg Tablet, Sublingual Sig: ___ Tablet, \nSublinguals Sublingual PRN (as needed) as needed for chest pain. \n', '2. Cyanocobalamin 100 mcg Tablet Sig: 0.5 Tablet PO DAILY \n(Daily). ', '3. Azithromycin 250 mg Tablet Sig: Two (2) Tablet PO Q24H (every \n24 hours) for 1 days.\nDisp:*2 Tablet(s)* Refills:*0*', '4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). ', "5. Milk of Magnesia 800 mg/5 mL Suspension Sig: Thirty (30) ML's \nPO twice a day as needed for constipation. ", '6. Levothyroxine 75 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '7. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO every ___ \nhours as needed for pain. ', '8. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO at bedtime as \nneeded for constipation.']}