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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 65, 'gender': 'F', 'symptoms': 'Abdominal Pain', 'medical_history': ['-Primary somastatinoma removed via Whipple in ___ by Dr. \n___ at ___. He presented with bilary obstruction, weight \nloss and pruritis', '-HTN', '- polio at age ___ such that his L leg was shorter than R ', '- s/p traumatic injury to his R eye when plowing the field at \nage ___. He is blind in that eye', '- s/p b/l hip replacement.'], 'family_history': 'His parents are both alive and in good health. Mother with HTN.', 'present_illness': '___ pt p/w b/l lower quadrant pain x 4 days. The pain has now \nlocalized to the right side. No nausea or vomiting. His pain was \nworse in the morning and persistent. No association with food \nand worse with laying down and sitting. He has a history of a \nprimary somastatinoma removed via Whipple approx ___ years ago. \nHas been fine since until 4 days PTP. He went to ___ 2 \nday prior to presentation and had CT which showed intra abd \nmass. Pt was told to come here because will need biopsy and \nwork-up. patient has fair amount of pain, but no nausea, \nvomiting, fevers, constipation or diarrhea. \nHis PCP had difficulty arranging for him to have this procedure \ndone as an outpatient and thus told the patient to go to the ED. \n His surgeon Dr. ___ at ___ had since retired. His PCP \ninsisted that he be admitted for a biopsy.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Baclofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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 via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H: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': 'Amlodipine', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': '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': '42.3', 'valuenum': 42.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, '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': '162', 'valuenum': 162.0, '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': '4.96', 'valuenum': 4.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES ALT.'}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST..'}, {'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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 232.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', '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': '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '210', 'valuenum': 210.0, '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': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}, {'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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 227.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, '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': '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': 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': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '1.011', 'valuenum': 1.011, '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}], 'exams': 'PAIN SCORE: ___\n\nVS T = 98.4 P = 57 BP = 145/89 RR 16 \nGENERAL: Well nourished male laying in bed. He is in NAD.\nNourishment: good\nGrooming: well groomed \nMentation: Alert speaking in full sentences \nEyes:NC/AT, R eye non-reactive,no scleral icterus noted \nEars/Nose/Mouth/Throat: no lesions noted in OP \nNeck: supple, no JVD or carotid bruits appreciated \nRespiratory: Lungs CTA bilaterally without R/R/W \nCardiovascular: RRR, nl. S1S2, no M/R/G noted \nGastrointestinal: Well healed horrizontal scar, soft, NT/ND, \nnormoactive bowel sounds, no masses or organomegaly noted. \nGenitourinary:deferred\nSkin: no rashes or lesions noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP and ___ pulses \nb/l. \nLymphatics/Heme/Immun: No cervical lymphadenopathy noted. \nNeurologic: \n-mental status: Alert, oriented x 3. Able to relate history \nwithout difficulty. \n-cranial nerves: II-XII intact \n-motor: normal bulk, strength and tone throughout. No abnormal \nmovements noted. \nPsychiatric: Appropriate. Very pleasant. \nACCESS: [X]PIV []CVL site ______\n\nFOLEY: []present [X]none \n\nTRACH: []present [X]none \n\nPEG:[]present [X]none [ ]site C/D/I \n\nCOLOSTOMY: :[]present [X]none [ ]site C/D/I ', 'diagnoses': [{'icd_code': '7213', 'desc': 'Lumbosacral spondylosis without myelopathy'}, {'icd_code': '591', 'desc': 'Hydronephrosis'}, {'icd_code': '25002', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, uncontrolled'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': 'V1301', 'desc': 'Personal history of urinary calculi'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '78909', 'desc': 'Abdominal pain, other specified site'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '72210', 'desc': 'Displacement of lumbar intervertebral disc without myelopathy'}], 'summary': "___ 04:50PM GLUCOSE-87 UREA N-11 CREAT-1.1 SODIUM-139 \nPOTASSIUM-4.7 CHLORIDE-99 TOTAL CO2-26 ANION GAP-19\n___ 04:50PM estGFR-Using this\n___ 04:50PM ALT(SGPT)-38 AST(SGOT)-43* ALK PHOS-100 TOT \nBILI-0.9\n___ 04:50PM LIPASE-28\n___ 04:50PM ALBUMIN-4.8\n___ 04:50PM URINE HOURS-RANDOM\n___ 04:50PM URINE GR HOLD-HOLD\n___ 04:50PM WBC-4.8 RBC-5.13 HGB-15.0 HCT-44.5 MCV-87 \nMCH-29.2 MCHC-33.6 RDW-14.6\n___ 04:50PM NEUTS-52.3 ___ MONOS-5.5 EOS-3.3 \nBASOS-1.0\n___ 04:50PM PLT COUNT-179\n___ 04:50PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 04:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n.\nAdmission abdominal CT\n-2.8 x 4.6 cm mass adjacent to the SMA likely represents a nodal \nconglomerate.\n- Multiple small hypodensities in the liver are incompletely \ncharacterized but could represent metastatic disease. \nCorrelation with prior imaging or a non- emergent multiphasic CT \nor MR of the abdomen may be obtained for\ncharacterization.\n.\nLABS: see below\n\n.\nEKG: none in our system\n\n.\nLAST ECHO: none in our system\n\n.\nCXR: none in our system\n\nCT SCAN:2.8 x 4.6 cm mass adjacent to the SMA likely represents \na nodal conglomerate. \nMultiple small hypodensities in the liver are incompletely \ncharacterized but \ncould represent metastatic disease. Correlation with prior \nimaging or a non- \nemergent multiphasic CT or MR of the abdomen may be obtained for \n\ncharacterization. \n\n.\nBLOOD/URINE CULTURE: NONE \n.\nOTHER DIAGNOSTICS: NONE\n___ year old male with HTN, h/o somastatioma s/p ___ \npresented with abdominal pain found to have an abdominal mass. \nThe abdominal mass was adjacent to the SMA, making an approach \nfor ___ guided biopsy high-risk. Therefore, surgery was \nconsulted, and they did not recommend biopsy at this time. They \nrecommended lab workup for the mass including tumor and \nneuroendocrine markers (e.g. CA ___, CEA,\nplasma chromogranin A, fasting plasma somatatostatin). \n\nDuring the hospitalization, pt's abdominal pain resolved and did \nnot recur. \n\nPt was eager for discharge, as he needed to attend the funeral \nof a family member in ___. Pt was provided a prescription \nfor laboratory work to be followed up by Dr. ___ (General \nSurgery) in follow up in clinic. Pt will need to call the office \nto schedule an appointment, given it is the weekend, and I am \nunable to schedule this currently. The results of the labs will \nbe sent to the PCP as well.\n.\nHTN: \nPt did not know the doses of his medications; therefore he was \ntreated with lisinopril and HCTZ during the hospitalization. He \nwill resume his previous home medications at discharge.\n.\nFEN: [ X]Oral [ ]Tube feeds [ ]Parenteral [] NPO \n\nDVT PROPHYLAXIS: [X]heparin sc []SCDs [ ]Ambulation\n\nDISPOSITION: [X ] Home \n\nCode Status: FULL CODE, discussed with patient"}}
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{'final_diagnoses': ['# Abdominal mass, NOS', '# Abdominal pain'], 'procedures': ['none'], 'visit_summary': "___ year old male with HTN, h/o somastatioma s/p ___ \npresented with abdominal pain found to have an abdominal mass. \nThe abdominal mass was adjacent to the SMA, making an approach \nfor ___ guided biopsy high-risk. Therefore, surgery was \nconsulted, and they did not recommend biopsy at this time. They \nrecommended lab workup for the mass including tumor and \nneuroendocrine markers (e.g. CA ___, CEA,\nplasma chromogranin A, fasting plasma somatatostatin). \n\nDuring the hospitalization, pt's abdominal pain resolved and did \nnot recur. \n\nPt was eager for discharge, as he needed to attend the funeral \nof a family member in ___. Pt was provided a prescription \nfor laboratory work to be followed up by Dr. ___ (General \nSurgery) in follow up in clinic. Pt will need to call the office \nto schedule an appointment, given it is the weekend, and I am \nunable to schedule this currently. The results of the labs will \nbe sent to the PCP as well.\n.\nHTN: \nPt did not know the doses of his medications; therefore he was \ntreated with lisinopril and HCTZ during the hospitalization. He \nwill resume his previous home medications at discharge.\n.\nFEN: [ X]Oral [ ]Tube feeds [ ]Parenteral [] NPO \n\nDVT PROPHYLAXIS: [X]heparin sc []SCDs [ ]Ambulation\n\nDISPOSITION: [X ] Home \n\nCode Status: FULL CODE, discussed with patient", 'medications_prescribed': ['Outpatient Lab Work\nPlease check: \nCA ___, CEA, plasma chromogranin A, fasting plasma \nsomatatatostatin. \nPlease forward results to:\nName: ___. \nLocation: ___\nAddress: ___, ___\nPhone: ___\nFax: ___\n.', 'Labs also to be f/u by Dr. ___ ___.', 'He does not know the doses of his medications\nramipril\nAmlodpine\nHCTZ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 54, 'gender': 'M', 'symptoms': 'Shortness of breath', 'medical_history': ['- severe COPD (FEV1 29%)', '- Lung cancer (likely NSCLC, no biopsy) s/p XRT (diagnosed ___, \nbut pulmonary nodules spanning back to ___', '- HTN', '- HLD', '- PUD/GERD', '- Anxiety', '- Anemia', '- OA', '- Osteopenia', '- Post herpetic neuralgia (s/p shingles ___'], 'family_history': 'She has no FH of lung disease but does endorse a FH of DM.', 'present_illness': 'Ms ___ is an ___ yo F with a hx of COPD, lung cancer s/p XRT, \nrecently admitted to ___ for COPD exacerbation and was \nreadmitted 1 day after discharge for worsening SOB. Patient \nreported that she felt "OK" on discharge, but not completely at \nbaseline. After she got home, she went to bed and felt very SOB \nall night, with mild non-productive cough. She reports that she \nused her usual 2L NC and nebs. The morning of admission, the SOB \nworsened and she started sneezing as well. She took took a \nclaritin which seemed to make the coughing worse. She denies \nfevers, chills, sputum. Her symptoms were refractory to \nnebulizer X2. She had been discharged with prednisone and \nazithromycin but had not filled the prescriptions yet. \n\nIn the ED, initial vitals were T 98.8 HR72 BP119/96 RR20 Sats \n100% 4L. She was given 40mg PO Prednisone as well as duonebs and \nher breathing improved. Her admission CXR was notable for \nflattened diaphragms w/o evidence of consolidation. On transfer \nto the floor, she was not in any acute distress.', 'medications': [{'medication': 'Clarithromycin', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate (Concentrated Oral Soln)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H: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': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% 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': 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': 'Spironolactone', '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': 'IV', 'frequency': 'Q3H: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': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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: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': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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 Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', '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': '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', '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': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '275', 'valuenum': 275.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '615', 'valuenum': 615.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '434', 'valuenum': 434.0, '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': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 191.0, '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': '904', 'valuenum': 904.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '136', 'valuenum': 136.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, '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': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, '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': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78.1', 'valuenum': 78.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '252', 'valuenum': 252.0, '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': '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': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, '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': '83', 'valuenum': 83.0, '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': '79.4', 'valuenum': 79.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': '17.7', 'valuenum': 17.7, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '556', 'valuenum': 556.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '445', 'valuenum': 445.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '973', 'valuenum': 973.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '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': '136', 'valuenum': 136.0, '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': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': 'ICTERIC SPECIMEN.'}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, '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': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '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': '18.0', 'valuenum': 18.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, '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': '0.5', 'valuenum': 0.5, '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': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '138', 'valuenum': 138.0, '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': '29.8', 'valuenum': 29.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ICTERIC.'}, {'value': '19.3', 'valuenum': 19.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '430', 'valuenum': 430.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '427', 'valuenum': 427.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '785', 'valuenum': 785.0, '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': '11.5', 'valuenum': 11.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '0.7', 'valuenum': 0.7, '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 0.7,. 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': 214.0, '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': '2064', 'valuenum': 2064.0, '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': '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': '5.1', 'valuenum': 5.1, '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': '29', 'valuenum': 29.0, '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': '2+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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', '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': '26.3', 'valuenum': 26.3, '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': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, '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': 'OCCASIONAL.'}, {'value': '145', 'valuenum': 145.0, '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': 'NORMAL.'}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '33.5', 'valuenum': 33.5, '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': '146', 'valuenum': 146.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 19.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'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': '6.9', 'valuenum': 6.9, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, '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': '29.2', 'valuenum': 29.2, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '404', 'valuenum': 404.0, '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': '736', 'valuenum': 736.0, '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': '7.3', 'valuenum': 7.3, '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': '___', 'valuenum': 23.1, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'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': 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': '3.2', 'valuenum': 3.2, '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': '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': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, 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'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LESS THAN 1.'}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '877', 'valuenum': 877.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '486', 'valuenum': 486.0, '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': '18.3', 'valuenum': 18.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': 150.0, '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': '133', 'valuenum': 133.0, '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': '286', 'valuenum': 286.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '939', 'valuenum': 939.0, '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': '491', 'valuenum': 491.0, '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': '18.7', 'valuenum': 18.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '___', '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': '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': '11', 'valuenum': 11.0, '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': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, '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': '29.9', 'valuenum': 29.9, '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': '93', 'valuenum': 93.0, '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': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.48', 'valuenum': 3.48, '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': 'Admission:\nVitals- 98.0F 141/58 73 16 100% 2L \nGeneral- Thin, elderly woman. Alert, oriented, no acute distress \n\nHEENT- Sclerae anicteric, MMM, oropharynx clear \nNeck- supple, JVP not elevated, no LAD \nLungs- CTAB no wheezes, rales, rhonchi noted. Has good air \nmovement \nCV- Distant heart sounds. 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, no clubbing, cyanosis or \nedema \nNeuro- CNs2-12 intact, motor function grossly normal\n\nDischarge:\n98.5 98.5 130s-180s/50s-80s ___ 94 2L \nGeneral- Sitting in bed wearing NC, NAD\nHEENT- Clear sclera, MMM\nNeck- Supple, No JVD\nLungs- Clear lungs bilaterally, No wheezes or rhonchi\nCV- RRR, normal S1 + S2, no MR\n___- ventral hernia, soft, non-tender, no rebound/guarding, \nnon-distended, bowel sounds present \nGU-No foley\nExt- warm, well perfused, 2+ pulses, \nNeuro- no focal deficits', 'diagnoses': [{'icd_code': '53200', 'desc': 'Acute duodenal ulcer with hemorrhage, without mention of obstruction'}, {'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '1550', 'desc': 'Malignant neoplasm of liver, primary'}, {'icd_code': '19889', 'desc': 'Secondary malignant neoplasm of other specified sites'}, {'icd_code': '78951', 'desc': 'Malignant ascites'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '2869', 'desc': 'Other and unspecified coagulation defects'}, {'icd_code': '07032', 'desc': 'Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta'}, {'icd_code': '04186', 'desc': 'Helicobacter pylori [H. pylori]'}, {'icd_code': 'V667'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': '7823', 'desc': 'Edema'}, {'icd_code': '78909', 'desc': 'Abdominal pain, other specified site'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '7295', 'desc': 'Pain in limb'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "Admission Labs:\n\n___ 03:50PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 03:50PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 03:50PM PLT COUNT-239\n___ 03:50PM NEUTS-85.7* LYMPHS-7.3* MONOS-6.2 EOS-0.7 \nBASOS-0.1\n___ 03:50PM WBC-6.5 RBC-3.28* HGB-8.9* HCT-30.8* MCV-94 \nMCH-27.1 MCHC-28.9* RDW-16.2*\n___ 03:50PM URINE GR HOLD-HOLD\n___ 03:50PM URINE UHOLD-HOLD\n___ 03:50PM URINE HOURS-RANDOM\n___ 03:50PM URINE HOURS-RANDOM\n___ 03:50PM GLUCOSE-108* UREA N-12 CREAT-0.8 SODIUM-143 \nPOTASSIUM-4.2 CHLORIDE-103 TOTAL CO2-35* ANION GAP-9\n\nDischarge labs:\n___ 07:10AM BLOOD Glucose-82 UreaN-12 Creat-0.8 Na-144 \nK-3.6 Cl-106 HCO3-33* AnGap-9\n___ 10:35AM BLOOD WBC-7.4 RBC-3.52* Hgb-9.4* Hct-32.8* \nMCV-93 MCH-26.7* MCHC-28.7* RDW-16.5* Plt ___\n\nECG ___ \nSinus rhythm. Occasional premature atrial contractions. Compared \n \nto the previous tracing of ___ ectopy is new. Intervals \nAxes : \nRate PR QRS QT/QTc P QRS T \n72 182 78 ___ 67 \n\nCHEST (PA & LAT) ___ \nFINDINGS: Frontal and lateral views of the chest were obtained. \n\nEvidence of patient's known large hiatal hernia is seen. The \ncardiac and mediastinal silhouettes are stable. Hilar contours \nare stable. No definite new focal consolidation is seen. There \nis no pleural effusion or pneumothorax. IMPRESSION: Known large \n\nhiatal hernia. No focal consolidation or pulmonary edema.\nMs. ___ is an ___ yo F with a hx of COPD, lung cancer s/p XRT, \nrecently admitted to ___ for COPD exacerbation and was \nreadmitted 1 day after discharge for worsening SOB. \n\n#COPD Exacerbation:\nPatient has h/o severe COPD on 2L home O2 and 10mg prednisone \nat baseline. On current admission, we concluded that the \npatient's symptoms were due to her progressive COPD with a new \ncontinuous oxygen requirement further complicated by seasonal \nallergies and chronic anemia. The patient had difficulty \naccepting this new oxygen requirement and would periodically \nremove the nasal canula resulting in acute SOB and desats to ___. She otherwise had an unremarkable exam through out her stay \nand was maintained on 2L NC, loratadine and her albuterol nebs. \nShe was continued on her prior discharge medications completing \na 5 day course of Azithromycin and 7 days of 40 mg prednisone \nwith a slow taper on discharge. Palliative care was consulted \nthis admission for patient/family coping and symptom management. \nA family meeting with the patient and her daughter was held on \n___ during which discussion centered upon the progressive \nnature of the disease and the need for continuous oxygen and \ncontinued symptoms management with outpatient providers. The \npatient is amenable to home or clinic based palliative care. New \nprescriptions for the patient were filled and delivered to her \nbedside prior to discharge, per her request.\n\n# Anemia, iron and B12 deficiency:\nCombination of iron deficiency anemia, B12 deficiency. Anemia \ndiagnosed on last admission was stable. HGB 8.9 on admission \n(baseline ___ several months prior).Prior iron studies showed \nlow ferritin 6.1 consistent with iron deficiency, as well as B12 \nDeficiency. PO iron and SC B12 supplementation were continued \nthis admission. At discharge her Hb was 9.4\n\n# Post-herpetic neuralgia. Continued home carbamazepine, \ngabapentin and duloxetine\n\n# Hypertension. Continued home verapamil\n\nTRANSITIONAL ISSUES:\n-Patient met with palliative care this admission and is \ninterested in home based or outpatient palliative care"}}
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{'final_diagnoses': ['COPD Exacerbation'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is an ___ yo F with a hx of COPD, lung cancer s/p XRT, \nrecently admitted to ___ for COPD exacerbation and was \nreadmitted 1 day after discharge for worsening SOB. \n\n#COPD Exacerbation:\nPatient has h/o severe COPD on 2L home O2 and 10mg prednisone \nat baseline. On current admission, we concluded that the \npatient's symptoms were due to her progressive COPD with a new \ncontinuous oxygen requirement further complicated by seasonal \nallergies and chronic anemia. The patient had difficulty \naccepting this new oxygen requirement and would periodically \nremove the nasal canula resulting in acute SOB and desats to ___. She otherwise had an unremarkable exam through out her stay \nand was maintained on 2L NC, loratadine and her albuterol nebs. \nShe was continued on her prior discharge medications completing \na 5 day course of Azithromycin and 7 days of 40 mg prednisone \nwith a slow taper on discharge. Palliative care was consulted \nthis admission for patient/family coping and symptom management. \nA family meeting with the patient and her daughter was held on \n___ during which discussion centered upon the progressive \nnature of the disease and the need for continuous oxygen and \ncontinued symptoms management with outpatient providers. The \npatient is amenable to home or clinic based palliative care. New \nprescriptions for the patient were filled and delivered to her \nbedside prior to discharge, per her request.\n\n# Anemia, iron and B12 deficiency:\nCombination of iron deficiency anemia, B12 deficiency. Anemia \ndiagnosed on last admission was stable. HGB 8.9 on admission \n(baseline ___ several months prior).Prior iron studies showed \nlow ferritin 6.1 consistent with iron deficiency, as well as B12 \nDeficiency. PO iron and SC B12 supplementation were continued \nthis admission. At discharge her Hb was 9.4\n\n# Post-herpetic neuralgia. Continued home carbamazepine, \ngabapentin and duloxetine\n\n# Hypertension. Continued home verapamil\n\nTRANSITIONAL ISSUES:\n-Patient met with palliative care this admission and is \ninterested in home based or outpatient palliative care", 'medications_prescribed': ['1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN dyspnea ', '2. Albuterol Inhaler 2 PUFF IH Q4H:PRN dyspnea ', '3. Carbamazepine Chewable Tabs 100 mg PO BID ', '4. Duloxetine 60 mg PO DAILY \nRX *duloxetine 60 mg 1 capsule(s) by mouth Daily Disp #*30 \nCapsule Refills:*0', '5. Fluticasone Propionate NASAL 2 SPRY NU DAILY ', '6. Omeprazole 20 mg PO BID ', '7. Tiotropium Bromide 1 CAP IH DAILY ', '8. TraZODone 25 mg PO HS:PRN insomnia ', '9. Verapamil SR 240 mg PO Q24H ', '10. PredniSONE 30 mg PO DAILY \nTapered dose - DOWN \nRX *prednisone 10 mg ___ tablet(s) by mouth Daily Disp #*15 \nTablet Refills:*0', '11. Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \nINHALATION BID ', '12. Cyanocobalamin 1000 mcg IM/SC 1X/WEEK (MO) \nRX *cyanocobalamin (vitamin B-12) [Vitamin B-12] 1,000 mcg/mL 1 \nmL SC Once per week Disp #*1 Vial Refills:*0', '13. Ferrous Sulfate 325 mg PO BID \nRX *ferrous sulfate 325 mg (65 mg iron) 1 tablet(s) by mouth \nTwice Daily Disp #*60 Tablet Refills:*0', '14. Gabapentin 300 mg PO Q12: PRN facial pain ', '15. Loratadine 10 mg PO DAILY \nRX *loratadine 10 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet \nRefills:*0', '16. Syringe 3cc/22Gx3/4 (syringe with needle (disp)) 3 mL 22 x \n___ miscellaneous Weekly \nUse as directed for B12 injections \nRX *syringe with needle (disp) [BD PrecisionGlide] 22 gauge X \n___ Use as directed Weekly Disp #*10 Syringe Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'F', 'symptoms': 'STEMI, shock', 'medical_history': ['CAD s/p MI in ___ had double stenting', 'Hernia repair ___ yrs ago', 'Hx of colonic polyps in ___', 'Tobacco abuse', 'BPH', 'Hematuria', 'Elev PSA'], 'family_history': 'Father died of an MI with CABGx3 ___ yrs old, was diabetic.\nMother was diabetic, died from unkonwn cancer\nGF died of MI at ___\nBrother with diabetes', 'present_illness': 'This is a ___ yo male with h/o CAD with MI in ___ (s/p two \nstents to ?RCA), hiperlipidemia, tobacco abuse who presented to \nOSH with chest discomfort while shoveling snow earlier today. \nIn ___ OSH ER, the EKG showed ST elevations in II, III and AVF, \nc/w an inferior STEMI. Pt was given heparin, ticagrelor 180mg \nloading dose and ASA 325 in the ER. Morphine and zofran were \nalso given for symptomatic relief. He was theen taken to the \ncath lab there for PCI. This was complicated by hypotension to \nSBP ___. Of note, this episode occurred 5 min after \nadministration of angiomax. Hypotension was then managed by \nstarting neo gtt and placing a balloon pump. He became \nhemodynamically stable that time and PCI was performed. Per \nreport, 4 stents were placed to the proximal RCA. ___ rec\'d \ntotal of 200 cc contrast and ___ cc IVF. Pt\'s pressor was \nchangedc from neo gtt to dopamine gtt. Dopamine was noted to be \ninfiltrated and thus was switched back to neo gtt. Pt was given \nregitine (alpha-adrenergic antagonist) for this and then \ntransferred to ___ for further care. Of note, it was observed \nafter the case that the patient was covered in an urticarial \nrash, was red and had periorbital edema. He was given pepcid \nand benadryl for concern for allergic reaction; he had no signs \nof symptoms of airway compromise at that time.\n\nFor further characterization of presentation, patient was well \nuntil morning of ___. He had just been out shoveling snow, \nafter which he went back into the house and developed chest pain \nwhich was very severe, compressive, in central chest area with \nno radiation. Associated symptoms were diaphoresis and \ndizziness. This prompted pt to call emergency team. He took \naspirin and SL nitro (may have been expired) prior to being \npicked up by EMS.\n\nOf note, pt is not compliant with meds due to financial reasons. \n Pt admits to not taking any meds for the last ___ years. Pt does \nstate that he has had a full cardiac workup recently, incl a \nstress test, which was all "negative".\n\nUpon arrival to ___ floor, pt is lying comfortabley in bed. Pt \nhas no complaints at this time. Denies chest pain, shortness of \nbreath, dizziness, itching, tongue or lip swelling. Endorses \ndifficulty urinating ___ BPH.', 'medications': [{'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Divalproex Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Naloxone HCl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID: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': 'Senna', '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': 'Expired', 'route': 'PO', 'frequency': 'ONCE', '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'AcetaZOLamide', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', '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': 'Furosemide', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vecuronium Bromide', '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', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', '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': 'Naloxone HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Valproic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': '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': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY: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': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', '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': 'Ropinirole HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Neutra-Phos', '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': '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': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ibuprofen Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Metoprolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Naloxone HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', '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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', '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': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, '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': '___', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___ 12:00A.'}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', '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 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, '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': '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': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '31.7', 'valuenum': 31.7, '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': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.6', 'valuenum': 88.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.4', 'valuenum': 19.4, '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': 4.2, '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '___', 'valuenum': 65.0, '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 56.0, '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': '36.8', 'valuenum': 36.8, '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, '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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '___', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'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': '12', 'valuenum': 12.0, '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': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': '57', 'valuenum': 57.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, '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': '70', 'valuenum': 70.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35.7', 'valuenum': 35.7, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___ 12:00A.'}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '175', 'valuenum': 175.0, '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': '___', 'valuenum': 265.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, 'flag': None, 'priority': 'ROUTINE', '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': '4.8', 'valuenum': 4.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', '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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, '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': '90', 'valuenum': 90.0, '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': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.51', 'valuenum': 3.51, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 68.0, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '___', 'valuenum': 54.0, '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': '36.8', 'valuenum': 36.8, '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': '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. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 66.0, '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': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.0', 'valuenum': 36.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/17.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'SPONTANEOUS.', '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': 'MOD', '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': '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': '5.0', 'valuenum': 5.0, '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': '1.009', 'valuenum': 1.009, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 75.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'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': '66', 'valuenum': 66.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.1', 'valuenum': 37.1, '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': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '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': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 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': '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': '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': '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': '32.5', 'valuenum': 32.5, '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': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, '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': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '___', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___ 12:00A.'}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, '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': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 75.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. 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'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, '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': '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '80', 'valuenum': 80.0, 'valueuom': 'ug/mL', 'ref_range_lower': 50.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': 65.0, '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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': '8', 'valuenum': 8.0, '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': 72.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'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': '74', 'valuenum': 74.0, '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': '9', 'valuenum': 9.0, '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 - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 73.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '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': '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': '0-2', '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': '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': '6.0', 'valuenum': 6.0, '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': '1.017', 'valuenum': 1.017, '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21-50', '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': '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': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 61.0, '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': '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': 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': '36.8', 'valuenum': 36.8, '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': '28.3', 'valuenum': 28.3, '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': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, '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': '___', 'valuenum': 93.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS. VERIFIED BY SMEAR. LARGE PLATELETS NOTED ON SMEAR.'}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '___', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___ 12:00A.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', '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 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '144', 'valuenum': 144.0, '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': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': 'VERIFIED.'}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': '112', 'valuenum': 112.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39.2', 'valuenum': 39.2, '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': 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': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '10', 'valuenum': 10.0, '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': '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': '46', 'valuenum': 46.0, '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': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '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': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': 58.0, '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': '___'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 42.0, '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': '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': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 68.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'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': '76', 'valuenum': 76.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.4', 'valuenum': 38.4, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 43.0, '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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 65.0, '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, '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': 'ART.', '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': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 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{'value': '63', 'valuenum': 63.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.7', 'valuenum': 38.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '30', 'valuenum': 30.0, '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': '___', 'valuenum': 4.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'L/min', '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': '10', 'valuenum': 10.0, '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': '65', 'valuenum': 65.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30/0.', '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': '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '189', 'valuenum': 189.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '135', 'valuenum': 135.0, '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': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '73', 'valuenum': 73.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.5', 'valuenum': 20.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '___', 'valuenum': 17.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___ 12:00A.'}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '31', 'valuenum': 31.0, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'L/min', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, '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': '74', 'valuenum': 74.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.7', 'valuenum': 37.7, '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': '5', 'valuenum': 5.0, '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': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 65.0, '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': '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': 35.0, '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': '38.6', 'valuenum': 38.6, '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': '2', 'valuenum': 2.0, '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': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': 55.0, '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': '___'}, {'value': '0', 'valuenum': 0.0, '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': '___', 'valuenum': 69.0, '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': '___', 'valuenum': 7.24, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.3', 'valuenum': 38.3, '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': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 68.0, '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': 7.21, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': '38.6', 'valuenum': 38.6, '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': '___'}], 'exams': 'Gen: NAD\nHEENT: xanthelasma present above both eyes, periorbital edema \nhas resolved, oropharynx is clear\nCV: RRR s1/s2 -mrg\nR: CTA b/l -w/r/r\nAbd: +BS soft NTND\nExt: -c/c/e', 'diagnoses': [{'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '5168', 'desc': 'Other specified alveolar and parietoalveolar pneumonopathies'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '45621', 'desc': 'Esophageal varices in diseases classified elsewhere, without mention of bleeding'}, {'icd_code': '04111', 'desc': 'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}, {'icd_code': 'V090'}, {'icd_code': '2874', 'desc': 'Secondary thrombocytopenia'}, {'icd_code': 'E9342', 'desc': 'Anticoagulants causing adverse effects in therapeutic use'}, {'icd_code': '9999', 'desc': 'Other and unspecified complications of medical care, not elsewhere classified'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '33394', 'desc': 'Restless legs syndrome (RLS)'}, {'icd_code': '29680', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '2518', 'desc': 'Other specified disorders of pancreatic internal secretion'}, {'icd_code': 'E9320', 'desc': 'Adrenal cortical steroids causing adverse effects in therapeutic use'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': '___ 03:55PM BLOOD WBC-19.8* RBC-5.40 Hgb-16.3 Hct-46.0 \nMCV-85 MCH-30.2 MCHC-35.4* RDW-13.0 Plt ___\n___ 10:18PM BLOOD WBC-17.4* RBC-5.00 Hgb-15.0 Hct-42.3 \nMCV-84 MCH-30.0 MCHC-35.6* RDW-13.0 Plt ___\n___ 06:48AM BLOOD WBC-16.1* RBC-4.46* Hgb-13.6* Hct-37.8* \nMCV-85 MCH-30.4 MCHC-36.0* RDW-13.1 Plt ___\n___ 05:56AM BLOOD WBC-12.3* RBC-4.02* Hgb-12.0* Hct-34.0* \nMCV-85 MCH-29.8 MCHC-35.2* RDW-13.2 Plt ___\n___ 05:10PM BLOOD Hct-36.1*\n___ 07:25AM BLOOD WBC-10.4 RBC-4.19* Hgb-12.3* Hct-35.7* \nMCV-85 MCH-29.4 MCHC-34.4 RDW-13.4 Plt ___\n___ 05:56AM BLOOD Neuts-77.3* ___ Monos-3.4 Eos-0.5 \nBaso-0.3\n___ 07:25AM BLOOD ___ PTT-23.9* ___\n___ 06:48AM BLOOD Glucose-122* UreaN-21* Creat-1.2 Na-138 \nK-4.8 Cl-106 HCO3-21* AnGap-16\n___ 05:56AM BLOOD Glucose-95 UreaN-23* Creat-1.0 Na-140 \nK-4.2 Cl-107 HCO3-26 AnGap-11\n___ 07:25AM BLOOD Glucose-98 UreaN-22* Creat-0.9 Na-138 \nK-4.3 Cl-104 HCO3-23 AnGap-15\n___ 03:55PM BLOOD ALT-26 AST-75* LD(___)-448* CK(CPK)-849* \nAlkPhos-71 TotBili-0.5\n___ 10:18PM BLOOD CK(CPK)-982*\n___ 06:48AM BLOOD ALT-22 AST-72* LD(LDH)-497* CK(CPK)-658* \nAlkPhos-56 TotBili-0.6\n___ 05:56AM BLOOD CK(CPK)-155\n___ 03:55PM BLOOD CK-MB-83* MB Indx-9.8* cTropnT-1.39*\n___ 10:18PM BLOOD CK-MB-77* MB Indx-7.8*\n___ 06:48AM BLOOD CK-MB-48* MB Indx-7.3* cTropnT-2.30*\n___ 05:56AM BLOOD CK-MB-8 cTropnT-0.96*\n___ 03:55PM BLOOD Triglyc-131 HDL-41 CHOL/HD-5.4 \nLDLcalc-154* LDLmeas-157*\n\n___ TTE:\nLeft ventricular wall thicknesses and cavity size are normal. \nThere is mild regional left ventricular systolic dysfunction \nwith inferior and inferolateral akinesis. The remaining segments \ncontract normally (LVEF = 40%). The right ventricular cavity is \nmildly dilated with mild global free wall hypokinesis. The \naortic valve leaflets (3) appear structurally normal with good \nleaflet excursion and no aortic stenosis or aortic \nregurgitation. The mitral valve leaflets are structurally \nnormal. An eccentric, posteriorly-directed jet of mild (1+) \nmitral regurgitation is seen. The estimated pulmonary artery \nsystolic pressure is normal. There is no pericardial effusion. \n\nIMPRESSION: Mild regional biventricular systolic dysfunction, \nc/w CAD. Mild eccentric mitral regurgitation, most c/w ischemic \n(tethering) mechanism. \n___ hx CAD with MI in ___ s/p 2 DES to RCA, HLP, tobacco abuse \nwho is now transferred from OSH with STEMI s/p 4 DES to RCA and \nhypotension.\n.\nShock: likely secondary to anaphylactic reaction to a medication \nused prior to episode (likely angiomax although also possibly \nticagrelor). Concern initially was for cardiogenic shock in \nsetting of large inferior STEMI (concern for RV infarct) however \nhis right heart cath and other hemodynamic measurements strongly \nargued against cardiogenic shock (PCWP low, SVR ~500, CO ~8L) \nbut rather supported some type of distributive vasodilatory \nshock. Upon arrival, he was weaned from dopamine fairly \nquickly. He did not have any urticaria upon arrival however his \nskin did have a sunburnt appearance and he did have periorbital \nedema. Angiomax has a known side effect of anaphylaxis in <1% \nof people, and the patient was stable until ___ minutes after \nbolus with angiomax. Due to his hemodynamic measurements, \nability to wean dopamine quickly after treatment for allergic \nreaction and clinical picture after cath (urticaria, periorbital \nedema) we felt that this was likely an anaphylactic reaction to \nangiomax or ticagrelor, and so treated with solumedrol, benadryl \nand pepcid ATC. His symptoms quickly abated after arrival, and \nthe next morning his balloon pump was weaned and removed. While \nuncertain, we instructed the patient to note that he has an \nanaphylactic reaction to either bivalirudin or ticagrelor in the \nfuture.\n.\nSTEMI: ST elevations in the inferior leads, cath showed \nocclusion in the location of his previous stents in the RCA. \nS/p 4 DES to RCA. He was hemodynamically stable after weaning \ntreatment for anaphylaxis. He had no evidence for arrhythmia or \nother post-MI complications. Started on prasugrel here, changed \nto plavix upon discharge due to financial concerns. He was \nstarted on a beta blocker which was uptitrated to goal HR ~60, \nincreased his statin to atorva 80 in spite of his history of \nmuscle cramps on 80mg (with plan to decr to 40 as outpt), \ncontinued on full strength aspirin. We strongly encouraged \nsmoking cessation and provided the patient with nicotine \npatches.\n.\nSystolic congestive heart failure: Inferior wall akinesis with \nEF 40%. Did not have issues with volume status during the \nadmission. Was started on lisinopril which was titrated to \nblood pressure. Did not start spironolactone at this point in \ntime, with plans to start as an outpatient if his repeat TTE in \n8 weeks showed persistent depressed EF.\n.'}}
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{'final_diagnoses': ['ST-elevation myocardial infarction', 'Anaphylactic shock due to either bivalirudin or ticagrelor'], 'procedures': ['Cardiac catheterization and intra-aortic balloon pump placement'], 'visit_summary': '___ hx CAD with MI in ___ s/p 2 DES to RCA, HLP, tobacco abuse \nwho is now transferred from OSH with STEMI s/p 4 DES to RCA and \nhypotension.\n.\nShock: likely secondary to anaphylactic reaction to a medication \nused prior to episode (likely angiomax although also possibly \nticagrelor). Concern initially was for cardiogenic shock in \nsetting of large inferior STEMI (concern for RV infarct) however \nhis right heart cath and other hemodynamic measurements strongly \nargued against cardiogenic shock (PCWP low, SVR ~500, CO ~8L) \nbut rather supported some type of distributive vasodilatory \nshock. Upon arrival, he was weaned from dopamine fairly \nquickly. He did not have any urticaria upon arrival however his \nskin did have a sunburnt appearance and he did have periorbital \nedema. Angiomax has a known side effect of anaphylaxis in <1% \nof people, and the patient was stable until ___ minutes after \nbolus with angiomax. Due to his hemodynamic measurements, \nability to wean dopamine quickly after treatment for allergic \nreaction and clinical picture after cath (urticaria, periorbital \nedema) we felt that this was likely an anaphylactic reaction to \nangiomax or ticagrelor, and so treated with solumedrol, benadryl \nand pepcid ATC. His symptoms quickly abated after arrival, and \nthe next morning his balloon pump was weaned and removed. While \nuncertain, we instructed the patient to note that he has an \nanaphylactic reaction to either bivalirudin or ticagrelor in the \nfuture.\n.\nSTEMI: ST elevations in the inferior leads, cath showed \nocclusion in the location of his previous stents in the RCA. \nS/p 4 DES to RCA. He was hemodynamically stable after weaning \ntreatment for anaphylaxis. He had no evidence for arrhythmia or \nother post-MI complications. Started on prasugrel here, changed \nto plavix upon discharge due to financial concerns. He was \nstarted on a beta blocker which was uptitrated to goal HR ~60, \nincreased his statin to atorva 80 in spite of his history of \nmuscle cramps on 80mg (with plan to decr to 40 as outpt), \ncontinued on full strength aspirin. We strongly encouraged \nsmoking cessation and provided the patient with nicotine \npatches.\n.\nSystolic congestive heart failure: Inferior wall akinesis with \nEF 40%. Did not have issues with volume status during the \nadmission. Was started on lisinopril which was titrated to \nblood pressure. Did not start spironolactone at this point in \ntime, with plans to start as an outpatient if his repeat TTE in \n8 weeks showed persistent depressed EF.\n.', 'medications_prescribed': ['aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily).\nDisp:*30 Patch 24 hr(s)* Refills:*2*', 'atorvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'metoprolol succinate 50 mg Tablet Extended Release 24 hr Sig: \nOne (1) Tablet Extended Release 24 hr PO DAILY (Daily).\nDisp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 64, 'gender': 'M', 'symptoms': 'tumor of corpus collosum', 'medical_history': ['Past medical history is significant for polysubstance abuse.', 'The\npatient required a cardiac valve replacement in ___ and \nsuffered\na stroke related to that.', 'By his own account, he has residual\nhemiparesis and visual problems, but continues to drive.', 'He also\nhas a history of squamous cell cancer of the skin with an\nexcision from his back.'], 'family_history': 'Family history is significant for diabetes in his mother who \ndied\nat age ___ and testicular cancer in his father who died at age \n___.', 'present_illness': "From preop visit with Dr. ___: He is a ___ \nright-handed gentleman who presents with complaints with \nincreasing confusion and disorientation\nparticularly when driving his car. The patient states that he\nrecently returned from a 10-day vacation on ___ where he \nwas\ndrinking heavily by his own admission. The patient felt that \nthe\ndisorientation was related to that, but it has not cleared\nsubstantially since returning to ___ and cutting back on his\nintake. These difficulties ultimately led to an evaluation. An\nMRI of the brain was obtained, which reveals an enhancing mass\naffecting the splenium of the corpus callosum. The patient's\nworkup for primary cancer has been negative. An LP was\nperformed, which was also nondiagnostic and so you are referring\nhim to me in order to perform a stereotactic biopsy with the \nhope\nof making a definitive diagnosis.", 'medications': [{'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS:PRN', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': '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': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Alteplase', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': 0.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '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': '___', 'valuenum': 30.1, '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': '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': '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': 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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 272.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 177.0, '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': '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': '4.5', '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': '5.2', 'valuenum': 5.2, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', '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': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '36.6', 'valuenum': 36.6, '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': '200', 'valuenum': 200.0, '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': '4.58', 'valuenum': 4.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '12.9', 'valuenum': 12.9, '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': '___', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'STAT', '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': 'STAT', 'comments': '___'}, {'value': '14', 'valuenum': 14.0, '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': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '236', 'valuenum': 236.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '0', 'valuenum': 0.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '1.6', 'valuenum': 1.6, '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': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '142', 'valuenum': 142.0, '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': '40.3', 'valuenum': 40.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '36.3', 'valuenum': 36.3, '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': '242', 'valuenum': 242.0, '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': '4.55', 'valuenum': 4.55, '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': '399', 'valuenum': 399.0, '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': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 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'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94.7', 'valuenum': 94.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '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': 91.0, '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': '4.1', 'valuenum': 4.1, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '208', 'valuenum': 208.0, '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': '4.48', 'valuenum': 4.48, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'AVSS, NAD\nAOx3, moderate short-term memory loss/confusion at times\n___ strength in all extremities\nnegative pronator drift', 'diagnoses': [{'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '45341', 'desc': 'Acute venous embolism and thrombosis of deep vessels of proximal lower extremity'}, {'icd_code': '75310', 'desc': 'Cystic kidney disease, unspecified'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': '462', 'desc': 'Acute pharyngitis'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': 'V1741', 'desc': 'Family history of sudden cardiac death (SCD)'}, {'icd_code': 'V173'}, {'icd_code': 'V643'}, {'icd_code': 'V1301', 'desc': 'Personal history of urinary calculi'}, {'icd_code': 'V4364'}, {'icd_code': 'V1255', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': '___ 01:06PM BLOOD Creat-0.9\n___ 04:40AM BLOOD WBC-8.5 RBC-4.39* Hgb-14.1 Hct-40.8 \nMCV-93 MCH-32.1* MCHC-34.4 RDW-12.6 Plt ___\n___ 04:40AM BLOOD Plt ___\n___ 04:40AM BLOOD Glucose-112* UreaN-15 Creat-0.9 Na-141 \nK-3.8 Cl-105 HCO3-27 AnGap-13\nThe patient was admitted to the Neurologic Surgery Service for \nmanagement of a brain tumor. The patient was taken to the OR \nand underwent an uncomplicated stereotactic biopsy of the brain \ntumor. The patient tolerated the procedure without complications \nand was transferred to the PACU in stable condition. Please see \noperative report for details. Post operatively pain was \ncontrolled with intravenous medication with a transition to PO \npain meds once tolerating POs. The patient tolerated diet \nadvancement without difficulty and made steady advancement with \ndiet and ambulation.\n\nThe incision was clean, dry, and intact without evidence of \nerythema or drainage. The patient was discharged in stable \ncondition with written instructions concerning precautionary \ninstructions and the appropriate follow-up care (Brain Tumor \nClinic and Neurosurgery Clinic). All questions were answered \nprior to discharge and the patient expressed readiness for \ndischarge.'}}
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{'final_diagnoses': ['brain mass awaiting pathology'], 'procedures': ['stereotactic biopsy of brain tumor'], 'visit_summary': 'The patient was admitted to the Neurologic Surgery Service for \nmanagement of a brain tumor. The patient was taken to the OR \nand underwent an uncomplicated stereotactic biopsy of the brain \ntumor. The patient tolerated the procedure without complications \nand was transferred to the PACU in stable condition. Please see \noperative report for details. Post operatively pain was \ncontrolled with intravenous medication with a transition to PO \npain meds once tolerating POs. The patient tolerated diet \nadvancement without difficulty and made steady advancement with \ndiet and ambulation.\n\nThe incision was clean, dry, and intact without evidence of \nerythema or drainage. The patient was discharged in stable \ncondition with written instructions concerning precautionary \ninstructions and the appropriate follow-up care (Brain Tumor \nClinic and Neurosurgery Clinic). All questions were answered \nprior to discharge and the patient expressed readiness for \ndischarge.', 'medications_prescribed': ['1. Docusate Sodium 100 mg PO BID ', '2. Multivitamins 1 TAB PO DAILY ', '3. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth every four to six (___) \nhours Disp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 62, 'gender': 'F', 'symptoms': 'N/V, DKA', 'medical_history': ['Type I DM', 'Chronic kidney disease s/p living related donor renal transplant \nin ___ ', 'Autonomic neuropathy with orthostatic hypotension causing ___ \nsyncopal episodes per day (wears helmet)', 'Hyperlipidemia'], 'family_history': 'DM, Parkinsons (father), ___ CA (grandmother age ___', 'present_illness': '___ with type I DM, frequent syncope with 4 episodes per day \n(wears helmet) related to dysautonomia, living related donor \nrenal transplant in ___ with transplant surgery, presenting to \n___ today for syncope, found to be in DKA. \nPatient states that he has not been feeling well for ___ days \nand has been vomiting "a lot" and "every 20 minutes". Patient \nvomiting red-tinged emesis (no hx of cirrhosis or varices). \nPatient last vomited ___ hours before initial presentation, \napproximately a cupful each time. No melena/hematochezia. Has \nhad abd pain for a few days last about a week ago before which \nstopped a day or two after he started vomiting. Per patient, in \ntouch with his o/p doctors for ___ of 600 or higher; taking 40U \nlantus, 40U Humalog with meals. Took home anti-rejection meds \nat ___ and ___ held them down, but feels likely mostly at \nhome he has been able to keep down most. Sore throat started \nafter vomiting. Negative head and neck CT scan at OSH. OSH labs: \nglucose 946, K=6.1, creat 3.9, GAP29. Patient was given 1L NS at \nOSH, started on 0.1u/kg bolus and 0.1u/kg insulin gtt at OSH.', 'medications': [{'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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'Q5MIN: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': 'Aspirin', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', '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', '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': 'Heparin', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, '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': '13.6', 'valuenum': 13.6, '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}], 'exams': 'ON ADMISSION: \n=================\nVitals: Wt-, T:97.7, HR: 85, BP: 153/79, RR: 17, 98 (RA) \nGENERAL: Alert, oriented, no acute distress. hand tremors \nbilaterally (at baseline per patient) \nHEENT: Sclera anicteric, MM dry, 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 \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: no rash appreciated, multiple, well-dressed lacerations \nb/l arms which per nurse are not erythematous nor purulent\nNEURO: alert and oriented\n\nON DISCHARGE: \n==============\nGeneral: Alert, oriented, in no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL\nNECK: supple, JVP not elevated, no LAD \nCV: Irregular, but not tachycardic, normal S1 + S2, no murmurs, \nrubs, gallops.\nLungs: CTAB, no wheezes, rales, rhonchi \nAbdomen: Soft, NT, ND, BS+, No HSM, no rebound or guarding \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSkin: Abrasions with dried blood on forearms bilaterally, no \nsurrounding erythema, induration, fluctuance or discharge\nNeuro: CNII-XII intact, strength and sensation intact.', 'diagnoses': [{'icd_code': 'R079', 'desc': 'Chest pain, unspecified'}, {'icd_code': 'J439', 'desc': 'Emphysema, unspecified'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R9439', 'desc': 'Abnormal result of other cardiovascular function study'}, {'icd_code': 'Z6837', 'desc': 'Body mass index [BMI] 37.0-37.9, adult'}], 'summary': 'LABS ON ADMISSION: \n======================\n___ 10:21PM ___ PH-7.36\n___ 10:21PM GLUCOSE-168* NA+-141 K+-4.1 CL--109* TCO2-25\n___ 10:21PM O2 SAT-47\n___ 10:00PM GLUCOSE-183* UREA N-54* CREAT-2.6* SODIUM-142 \nPOTASSIUM-4.3 CHLORIDE-108 TOTAL CO2-20* ANION GAP-18\n___ 07:57PM ___ PH-7.38\n___ 07:57PM GLUCOSE-264* NA+-141 K+-4.0 CL--103 TCO2-25\n___ 07:57PM O2 SAT-63\n___ 07:45PM URINE HOURS-RANDOM\n___ 07:45PM URINE HOURS-RANDOM\n___ 07:45PM URINE UHOLD-HOLD\n___ 07:45PM URINE UHOLD-HOLD\n___ 07:45PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 07:45PM URINE BLOOD-SM NITRITE-NEG PROTEIN-30 \nGLUCOSE-1000 KETONE-40 BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n___ 07:45PM URINE RBC-3* WBC-<1 BACTERIA-FEW YEAST-NONE \nEPI-0\n___ 04:15PM ___ PH-7.34*\n___ 04:15PM GLUCOSE-GREATER TH NA+-137 K+-4.3 CL--95* \nTCO2-19*\n___ 04:15PM O2 SAT-75\n___ 04:00PM GLUCOSE-695* UREA N-69* CREAT-3.4*# \nSODIUM-137 POTASSIUM-4.4 CHLORIDE-89* TOTAL CO2-20* ANION \nGAP-32*\n___ 04:00PM estGFR-Using this\n___ 04:00PM CK-MB-5 cTropnT-0.02*\n___ 04:00PM PHOSPHATE-4.1 MAGNESIUM-2.8*\n___ 04:00PM WBC-12.6*# RBC-4.55* HGB-9.8* HCT-32.5* \nMCV-71* MCH-21.5* MCHC-30.2* RDW-16.6* RDWSD-41.1\n___ 04:00PM NEUTS-89.0* LYMPHS-3.9* MONOS-6.4 EOS-0.0* \nBASOS-0.1 IM ___ AbsNeut-11.25* AbsLymp-0.49* AbsMono-0.81* \nAbsEos-0.00* AbsBaso-0.01\n___ 04:00PM PLT COUNT-339\n\nPERTINENT LABS: \n==================\nCHEM 10: \n___ 10:00PM Gluc 183* UreaN 54* Cr 2.6* Na 142 K 4.3 Cl-108 \nHCO3 20\n___ 01:13AM Gluc 141* UreaN 54* Cr 2.7* Na 142 K 4.3 Cl-107 \nHCO3 24 \n___ 06:09AM Gluc 206* UreaN 45* Cr 2.3* Na-141 K-3.7 Cl-107 \nHCO3-24 \n___ 09:47AM Gluc 130* UreaN-41* Cr 2.1* Na-140 K-3.6 Cl-105 \nHCO3-24 \n___ 03:18PM Gluc 279* UreaN-34* Cr 1.9* Na-136 K-4.2 Cl-103 \nHCO3-23 \n___ 12:45AM Gluc 239* UreaN-30* Cr-1.8* Na-136 K-4.0 Cl-101 \nHCO3-26 \n___ 05:55AM Gluc 203* UreaN-26* Cr-1.6* Na-137 K-3.9 Cl-101 \nHCO3-25 \n___ 06:20AM Gluc 136* UreaN-19 Cr-1.4* Na-138 K-3.7 Cl-102 \nHCO3-26 \n\n___ 05:55AM BLOOD %HbA1c-11.4* eAG-280*\n___ 05:55AM BLOOD T4-4.3*\n___ 05:55AM BLOOD TSH-1.6\n___ 05:55AM BLOOD TSH-1.6\n\nBLOOD GASES: \n___ 04:15PM BLOOD ___ pH-7.34*\n___ 07:57PM BLOOD ___ pH-7.38\n___ 10:21PM BLOOD ___ pH-7.36\n\nMICRO: \n=======\n___ 6:09 am BLOOD CULTURE BCx: Pending \nURINE CULTURE (Final ___: < 10,000 CFU/mL. \n\nIMAGING: \n=========\n___ Renal US \n1. Slightly elevated resistive indices ranging from 0.75 to \n0.84, unchanged from ___. \n2. No hydronephrosis. \n\n___ CXR AP \nThe lungs are clear. The hila and pulmonary vasculature are \nnormal. No pleural abnormalities or pneumothorax. The \ncardiomediastinal silhouette is normal. No fractures. \nIMPRESSION: No pneumonia or pulmonary edema.\nSUMMARY\n============================\n\n___ yo M with history significant for DM type 1, ESRD ___ ___ s/p \npreemptive living related kidney transplant from his sister in \n___, and daily episodes of syncope due to dysautonomia who \npresents from OSH with DKA. BG was 900 with gap of 29 on first \npresentation. Resolved with insulin gtt, IV fluids. Cause of DKA \nwas likely inadequate insulin administration given HgbA1c 11.4%. \nInfection work-up was unremarkable, LFTs, lipase, and troponins \nwere normal. ___ endocrinologists were consulted who \nrecommended an adjusted regimen including finger sticks before \nevery meal as well as bedtime, and sliding scale Humalog to \ncorrect these sugars at each of the finger sticks. His blood \nsugars were been better controlled on this regimen. During the \nhospitalization, patient had ___ which was treated with fluids \nand Cr was back to baseline at discharge. patient had an episode \nof syncope, due to his dysautonomia. The autonomic neurologists \nwere consulted and recommended increasing the dose of midodrine \nto be taken during the day at specific times of 8am, 12 pm, 4pm \nin addion to his home dose of fludracortisone. They also \nrecommended lifestyle modifications, and the patient was \neducated on these. On ___, patient had a tilt table test. The \nresults were pending at the time of discharge, but patient was \nadamant about going home despite education about the risks of \nfalling from dysautonomia and going back into DKA without \nadequate blood glucose control.'}}
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{'final_diagnoses': ['Diabetic ketoacidosis', 'Autonomic Dysfunction (Dysautonomia)', 'Hematemesis', 'Anemia', 'Cardiac arrhythmia', 'Acute on Chronic kidney disease', 'Urinary retention'], 'procedures': ['None'], 'visit_summary': 'SUMMARY\n============================\n\n___ yo M with history significant for DM type 1, ESRD ___ ___ s/p \npreemptive living related kidney transplant from his sister in \n___, and daily episodes of syncope due to dysautonomia who \npresents from OSH with DKA. BG was 900 with gap of 29 on first \npresentation. Resolved with insulin gtt, IV fluids. Cause of DKA \nwas likely inadequate insulin administration given HgbA1c 11.4%. \nInfection work-up was unremarkable, LFTs, lipase, and troponins \nwere normal. ___ endocrinologists were consulted who \nrecommended an adjusted regimen including finger sticks before \nevery meal as well as bedtime, and sliding scale Humalog to \ncorrect these sugars at each of the finger sticks. His blood \nsugars were been better controlled on this regimen. During the \nhospitalization, patient had ___ which was treated with fluids \nand Cr was back to baseline at discharge. patient had an episode \nof syncope, due to his dysautonomia. The autonomic neurologists \nwere consulted and recommended increasing the dose of midodrine \nto be taken during the day at specific times of 8am, 12 pm, 4pm \nin addion to his home dose of fludracortisone. They also \nrecommended lifestyle modifications, and the patient was \neducated on these. On ___, patient had a tilt table test. The \nresults were pending at the time of discharge, but patient was \nadamant about going home despite education about the risks of \nfalling from dysautonomia and going back into DKA without \nadequate blood glucose control.', 'medications_prescribed': ['Ferrous Sulfate 325 mg PO DAILY', 'Pantoprazole 40 mg PO Q12H', 'Glargine 16 Units Breakfast\nHumalog 3 Units Breakfast\nHumalog 3 Units Lunch\nHumalog 3 Units Dinner\nInsulin SC Sliding Scale using HUM Insulin', 'Midodrine 10 mg PO TID', 'CycloSPORINE (Neoral) MODIFIED 125 mg PO Q12H', 'Fludrocortisone Acetate 0.1 mg PO BID', 'Mycophenolate Mofetil 500 mg PO TID', 'Sulfameth/Trimethoprim SS 1 TAB PO DAILY', 'Vitamin D 1000 UNIT PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 55, 'gender': 'F', 'symptoms': 'back pain with RLE radiculopathy and weakness', 'medical_history': ['Herniated disc at L4-L5, L5-S1', 'HLD', 'HTN', 'anxiety'], 'family_history': 'nc', 'present_illness': '___ with a background history of sciatica and known herniated\ndisc at L4-L5 and L5-S1, HTN, HLD and anxiety, presenting to ED\nfor admission for back surgery, as patient reports he was\ninformed to do by Dr. ___. He has had chronic lower Right \nback\npain for over one year, but acutely worsened since fall 2 weeks\nago. Located primarily on right side of lower lumbar/sacral\nspine, and radiates down right lower extremity to top of right\nfoot. Associated with weakness, paresthesias and inability to\nambulate more than a few yards. No relief with pain medication.\nNo saddle anesthesia, bladder or bowel incontinence. \n\nRecently seen in ED on ___, with acute on chronic lower \nback\npain, radiating to RLE, following a fall on ice one week prior.\nMRI at the time showed multilevel, multifactorial degenerative\nchanges throughout the lumbar spine and L5-S1 disc degenerative\nchanges consistent with diffuse disc bulge. Seen by ortho spine\nwho felt no acute surgical intervention needed at the time, but\nrecommended close outpatient follow-up for likely surgical\nmanagement.', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'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': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', '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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'ZIPRASidone Hydrochloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'BuPROPion XL (Once Daily)', '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': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LamoTRIgine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': 'Pravastatin', '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': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BREAKFAST', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Baclofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'rOPINIRole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'ClonazePAM', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LaMICtal XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Methylphenidate SR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', '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': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'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': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, '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': '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': '8.2', 'valuenum': 8.2, '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': '0.6', '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 = >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': 91.0, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '278', 'valuenum': 278.0, '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': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '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': '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': '60', 'valuenum': 60.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': 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': '___', 'valuenum': 38.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '99.7AX.'}, {'value': 'VEN.', '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': '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': '8.7', 'valuenum': 8.7, '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': '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': 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': '3', 'valuenum': 3.0, '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': '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': '2.9', 'valuenum': 2.9, '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': '142', 'valuenum': 142.0, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, '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': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '234', 'valuenum': 234.0, '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': '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': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.8', 'valuenum': 49.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '268', 'valuenum': 268.0, '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': '3.28', 'valuenum': 3.28, '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': '49.1', 'valuenum': 49.1, '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': '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': '9.0', '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '4', 'valuenum': 4.0, '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': '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': '14', 'valuenum': 14.0, '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': 'General: NAD. AAO x3. Lying awake in bed. \nSkin: warm, dry, no rash\nCV: RRR, s1 and S2 nl\nPulm: normal effort, lungs are clear\nAbd: soft, NT/ND, + BS\nWound: C/D/I. No swelling, redness, or warmth\nExtremities: calves are soft, no edema\nNeurologic: PERRL. Face symmetrical. Speech clear and fluent.\nTongue ML. EOMs intact. Negative pronator drift. Normal tone and\nbulk universally. \n\nMotor Strength:\n Delt Bi Tri BR WF/WE HI\nRight 5 5 5 5 5 5 \nLeft 5 5 5 5 5 5\n \n\n IP Quad Ham TA Gas ___\nRight 5 5 5 4+ 5 4- \nLeft 5 5 5 5 5 5\n\nSensation: intact to light touch', 'diagnoses': [{'icd_code': 'A419', 'desc': 'Sepsis, unspecified organism'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'J9602', 'desc': 'Acute respiratory failure with hypercapnia'}, {'icd_code': 'J45901', 'desc': 'Unspecified asthma with (acute) exacerbation'}, {'icd_code': 'E6601', 'desc': 'Morbid (severe) obesity due to excess calories'}, {'icd_code': 'E1142', 'desc': 'Type 2 diabetes mellitus with diabetic polyneuropathy'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'S2232XD', 'desc': 'Fracture of one rib, left side, subsequent encounter for fracture with routine healing'}, {'icd_code': 'W19XXXD', 'desc': 'Unspecified fall, subsequent encounter'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'G2581', 'desc': 'Restless legs syndrome'}, {'icd_code': 'Z4889', 'desc': 'Encounter for other specified surgical aftercare'}, {'icd_code': 'M62838', 'desc': 'Other muscle spasm'}, {'icd_code': 'F319', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}], 'summary': "___: WBC: 5.9\n___: HGB: 14.2\n___: HCT: 39.7*\n'Chem 7' sheet entries (Most Recent):\n___: Glucose: 98 (If fasting, 70-100 normal, >125\nprovisional diabetes)\n___: BUN: 18\n___: Creat: 0.8\n___: Na: 144 (New reference range as of ___: K: 4.4\n___: Cl: 104\n___: CO2: 25\n___: Anion Gap: 15 (New reference range as of ___: eGFR: 101/122\nPatient was admitted to Orthopedic Spine Service on ___ for \nfurther management given his foot drop and herniated disc. On \n___ he underwent the above stated procedure. Please review \ndictated operative report for details. Patient was extubated \nwithout incident and was transferred to PACU then floor in \nstable condition. \n\n \n\nDuring the patient's course ___ were used for \npostoperative DVT prophylaxis. Intravenous antibiotics were \ncontinued for 24hrs postop per standard protocol. Initial postop \npain was controlled with oral and IV pain medication. Diet was \nadvanced as tolerated. Hospital course was otherwise \nunremarkable.\n\n \n\nNow, Day of Discharge, patient is afebrile, VSS, and neuro \nintact with improvement of radiculopathy and strength. Patient \ntolerated a good oral diet and pain was controlled on oral pain \nmedications. Patient ambulated independently. Patient's wound is \nclean, dry and intact. Patient noted improvement in radicular \npain. Patient is set for discharge to home in stable condition."}}
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{'final_diagnoses': ['lumbar herniated disc', 'right foot drop'], 'procedures': ['___ L4-L5, L5-S1 LAMINECTOMY DISCECTOMY'], 'visit_summary': "Patient was admitted to Orthopedic Spine Service on ___ for \nfurther management given his foot drop and herniated disc. On \n___ he underwent the above stated procedure. Please review \ndictated operative report for details. Patient was extubated \nwithout incident and was transferred to PACU then floor in \nstable condition. \n\n \n\nDuring the patient's course ___ were used for \npostoperative DVT prophylaxis. Intravenous antibiotics were \ncontinued for 24hrs postop per standard protocol. Initial postop \npain was controlled with oral and IV pain medication. Diet was \nadvanced as tolerated. Hospital course was otherwise \nunremarkable.\n\n \n\nNow, Day of Discharge, patient is afebrile, VSS, and neuro \nintact with improvement of radiculopathy and strength. Patient \ntolerated a good oral diet and pain was controlled on oral pain \nmedications. Patient ambulated independently. Patient's wound is \nclean, dry and intact. Patient noted improvement in radicular \npain. Patient is set for discharge to home in stable condition.", 'medications_prescribed': ['1. Cyclobenzaprine 5 mg PO TID:PRN spasm \nRX *cyclobenzaprine 5 mg 1 tablet(s) by mouth three times a day \nDisp #*60 Tablet Refills:*0', '2. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg ___ tablet(s) by mouth Q4-6h Disp #*40 Tablet \nRefills:*0', '3. Atorvastatin 20 mg PO QPM', '4. Citalopram 20 mg PO DAILY', '5. Gabapentin 300 mg PO TID', '6. Lisinopril 40 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'M', 'symptoms': 'fevers + cough', 'medical_history': ['NHL in remission per the notes (diagnosed in ___ diffuse large \n\nB cell lyphoma high grade. treated with R CHOP and EPOCH and XRT ', 'left bronchial stent due to hilar LAD in ___ ', 'HTN ', 'hypothyroidism ', 'hyperlipidemia ', 'osteoporosis based on compression fractures on xray. ', 'pseudomonas PNA ___ ', 'PPD negative ___'], 'family_history': 'Mother with hypertension, died of stroke. \nFather had unknown cancer, possibly in abdomen. ', 'present_illness': '___ year old female with a prior history of diffuse large B-cell \nlymphoma in the mediastinum s/p R-CHOP and R-EPOCH chemotherapy \nand radiation [completed ___ who has been in complete \nremission since then, now presenting with recurrent fevers \nlikely from a partially treated / undertreated pansensitive \nPseudomonas aeroginosa pneumonia/bronchitis for which she was \nadmitted to ___ from ___. She completed her antibiotic \nregimen on ___. She then started to have daily fevers to 101, \nusually in the afternoon or early evening with associated body \naches and fatigue. Her son reports the cough has improved since \ndischarge. She reports new pain along her right lower rib, esp \nwith coughing or deep inspiration. She denies abd pain, nausea, \nvomiting, diarrhea, or constipation. She has decreased volume of \nurine and the urine appears concentrated. She is thirsty. She \ndenies dysuria. No joint swelling, leg swelling, or rash. She \ndenies headache or sore throat. \n. \nIn the ED, initial VS:99.5, 133/90, 124, 16, 94% RA. CT chest \nshowed a loculated pleural effusion. She was treated with with \nvanc/ceftaz and given 1 L NS. , \n. \n\nROS: Denies headache, vision changes, rhinorrhea, congestion, \nsore throat, abdominal pain, nausea, vomiting, diarrhea, \nconstipation, BRBPR, melena, hematochezia, dysuria, hematuria. ', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY: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': 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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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 Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', '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': 'Q6H: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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'LeVETiracetam', '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': 'Doxycycline Hyclate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': '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': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, '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': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '113', 'valuenum': 113.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.43', 'valuenum': 3.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, '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': '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': '7.5', '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': '0.7', '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': 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': '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': 'HOLD.'}, {'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': '___', 'valuenum': 12.0, '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': 25.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', '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': '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '35.5', 'valuenum': 35.5, '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': '135', 'valuenum': 135.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, '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': '28', 'valuenum': 28.0, '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': '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': 95.0, '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': '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': '34.7', 'valuenum': 34.7, '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': '29.4', 'valuenum': 29.4, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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 - afebrile, normotensive \nGENERAL: elderly woman, NAD\nHEENT: MMM\nCARDIAC: S1+, S2+, RRR, No M/R/G\nLUNG: Decrease breath sounds posteriorly. \nABDOMEN: soft/nt/nd\nEXT: no c/c/e', 'diagnoses': [{'icd_code': '0543', 'desc': 'Herpetic meningoencephalitis'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}], 'summary': "___ 04:23PM OTHER BODY FLUID CD45-D KAPPA-D CD19-D \nLAMBDA-D\n___ 02:38PM OTHER BODY FLUID PH-7.35\n___ 11:07AM PLEURAL TOT PROT-4.0 GLUCOSE-55 LD(LDH)-1194\n___ 11:07AM PLEURAL WBC-3050* RBC-2350* POLYS-53* \nLYMPHS-28* ___ MACROPHAG-19*\n___ 08:22AM GLUCOSE-82 UREA N-7 CREAT-0.6 SODIUM-132* \nPOTASSIUM-3.5 CHLORIDE-99 TOTAL CO2-27 ANION GAP-10\n___ 08:22AM LD(LDH)-157\n___ 08:22AM TOT PROT-5.8* CALCIUM-8.0* PHOSPHATE-3.1 \nMAGNESIUM-1.8\n___ 08:22AM TSH-7.3*\n___ 08:22AM WBC-3.5* RBC-3.20* HGB-9.3* HCT-28.7* MCV-90 \nMCH-29.1 MCHC-32.5 RDW-14.3\n___ 08:22AM PLT COUNT-210\n___ 09:25PM GLUCOSE-89 UREA N-11 CREAT-0.6 SODIUM-130* \nPOTASSIUM-3.7 CHLORIDE-96 TOTAL CO2-24 ANION GAP-14\n___ 09:25PM WBC-4.3 RBC-3.43* HGB-10.5* HCT-29.9* MCV-87 \nMCH-30.6 MCHC-35.1* RDW-14.4\n___ 09:25PM NEUTS-79.8* LYMPHS-14.5* MONOS-5.3 EOS-0.4 \nBASOS-0.1\n___ 01:00PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 01:00PM URINE RBC-2 WBC-3 BACTERIA-NONE YEAST-NONE \nEPI-4\n\nHaptoglobin - 411\nVitamin B12 346\nFolate 8.5\n\nTSH - 7.3\nFree T4 0.97\n\nANCA - negative\nHistoplasma Ag - pending\n\nPleural fluid \n PLEURAL ANALYSIS WBC RBC Polys Lymphs Monos Macro \nOther \n___ 10:55AM 900* 3900* 2* 82* 0 5* \n11*\n___ 11:07AM 3050* 2350* 53* 28* 0 19* \nother - ATYPICAL IMMUNOBLASTS SEE SEPARATE FLOW REPORT \n\n PLEURAL CHEMISTRY TotProt Glucose LD(LDH) \n___ 10:55AM 2.9 102 134 \n___ 11:07AM 4.0 55 1194 \n\n OTHER BODY FLUID pH \n___ 11:09AM 7.331 \n___ 02:38PM 7.351 \n\n___ Blood Culture x 2 - no growth \n___ PLEURAL FLUID GRAM STAIN-FINAL; FLUID \nCULTURE-PRELIMINARY; ANAEROBIC CULTURE-PRELIMINARY; FUNGAL \nCULTURE-PRELIMINARY; ACID FAST SMEAR-PRELIMINARY; ACID FAST \nCULTURE-PRELIMINARY \n___ SPUTUM Immunoflourescent test for Pneumocystis \njirovecii (carinii)- negative\n___ Blood Culture -no growth\n___ Blood Culture -no growth \n___ SPUTUM GRAM STAIN/ RESPIRATORY CULTURE-contaminated\n___ Legionella Urinary Antigen - negative\n___ URINE CULTURE - no growth\n___ Blood Culture x 2 PENDING \n___ Blood Culture x 2 PENDING \n___ BRONCHOALVEOLAR LAVAGE GRAM STAIN-FINAL; RESPIRATORY \nCULTURE-FINAL {PSEUDOMONAS AERUGINOSA}; POTASSIUM HYDROXIDE \nPREPARATION-FINAL; FUNGAL CULTURE-PRELIMINARY {YEAST}; ACID FAST \nSMEAR-FINAL; ACID FAST CULTURE-NGTD\n___ Influenza A/B by DFA DIRECT INFLUENZA A ANTIGEN TEST- \nnegative\n___ SWAB GRAM STAIN-FINAL; WOUND CULTURE-FINAL; ANAEROBIC \nCULTURE-FINAL; FUNGAL CULTURE-PRELIMINARY; ACID FAST \nSMEAR-FINAL; ACID FAST CULTURE-NGTD\n___ Blood Culture x 2 - No growth\n___ Blood Culture x 2 - No growth \n___ STOOL FECAL CULTURE- negative; CAMPYLOBACTER \nCULTURE-negative; CLOSTRIDIUM DIFFICILE TOXIN A & B TEST- \npositive for CLOSTRIDIUM DIFFICILE\n___ URINE CULTURE-negative\n___ Immunology (CMV) CMV Viral Load- non detectable\n___ Blood Culture x 2 - No growth\n___ SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL \n{PSEUDOMONAS AERUGINOSA}; FUNGAL CULTURE-PRELIMINARY INPATIENT \n___ SEROLOGY/BLOOD MONOSPOT- negative\n___ BLOOD CULTURE ( MYCO/F LYTIC BOTTLE) BLOOD/FUNGAL \nCULTURE- NGTD; BLOOD/AFB CULTURE- NGTD\n___ URINE CULTURE - No growth\n___ SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE- \nPositive for PSEUDOMONAS AERUGINOSA\n___ URINE CULTURE - No growth\n___ Blood Culture x 4 - No growth\n___ SPUTUM GRAM STAIN-FINAL; RESPIRATORY CULTURE-FINAL \nINPATIENT \n___ PLEURAL FLUID GRAM STAIN-FINAL; FLUID CULTURE-FINAL; \nANAEROBIC CULTURE-FINAL; FUNGAL CULTURE-PRELIMINARY; ACID FAST \nSMEAR-FINAL; ACID FAST CULTURE- NGTD\n___ URINE Legionella Urinary Antigen - negative\n___ Blood Culture x 2 - No growth\n___ URINE CULTURE-FINAL {STAPHYLOCOCCUS, COAGULASE \nNEGATIVE} \n\nCytology/Pathology:\n \n___ Tissue: Immunophenotyping, Pleural - pending\n\n___ Cytology PLEURAL FLUID - ATYPICAL.\n \n Polymorphic population of lymphocytes, some with atypical\n nuclear membranes. \n \n___ Cytology BRONCHIAL WASHINGS \nBronchial lavage (left lower lobe): NEGATIVE FOR MALIGNANT \nCELLS. \nPulmonary macrophages, squamous metaplastic appearing cells and \nlymphocytes. No fungal elements or viral cytopathic effect seen. \n\n \n___ Cytology T11\nFNA and Touch prep of core, T11: NON-DIAGNOSTIC. \nRare bone marrow elements and abundant blood. \n\n___ Pathology Tissue: T 11 (1 JAR) - pending\n\n___ Pathology Tissue: immunophenotyping - BM \nNon-diagnostic study. A limited cell marker analysis was \nattempted, but was non-diagnostic in this case due to \ninsufficient numbers of lymphoid cells for analysis. \nCorrelation with clinical findings and morphology (see \n___ is recommended. \n \n___ Cytology PLEURAL FLUID \nPleural Fluid: NEGATIVE FOR MALIGNANT CELLS. \nScattered mesothelial cells in a background of abundant \nneutrophils and lymphocytes. \n\n___ Pathology Tissue: immunophenotyping - pleural \nNon-diagnostic study. Cell marker analysis was attempted, but \nwas non-diagnostic in this case due to scant numbers of B-cells. \n Correlation with clinical findings and morphology (see \n___ is recommended. Flow cytometry immunophenotyping may \nnot detect all lymphomas due to topography, sampling or \nartifacts of sample preparation. \n\nImaging: \n___ SHOULDER ___ VIEWS - IMPRESSION: \n1. No fracture. \n2. Prominence of the right hilum, recommend correlation with \nradiographs \nperformed same day from ___, for full characterization. \n3. Suggestion of inferior subluxation of the humeral head on the \nglenoid. \n4. Calcific densities projecting along the humeral head that \ncould either \nrepresent loose bodies, or calcific tendinitis of the \nsupraspinatus and \nsubscapularis. \n5. Degenerative changes most prominent at the acromioclavicular \njoint. \n \n___ CHEST (PORTABLE AP) -\nHeterogeneous opacification in the right mid lung zone, new \nsince ___, could be due to fissural deposition of \nincreasing small right pleural \neffusion, or alternatively early pneumonia. Heart size is top \nnormal. \nPost-radiation appearance of the left hilus is unchanged. Left \nsubclavian \nline tip projects over the low SVC. ___ paged to \nreport these \nfindings. \n \n___ CT CHEST W/O CONTRAST - IMPRESSION: \n1. Resolution of right lower lobe consolidation with no evidence \nof pneumonia. Bilateral lower lobe bronchial wall thickening and \nand mucus impaction, worsened when compared to prior studies. \n2. Slight increase of small pleural effusions. \n3. Chronic narrowing of the origin of the left upper lobe \nbronchus to less \nthan 3mm, unchaged since ___. \n4. Small stable pericardial effusion. \n \n___ MR ___ &W/O CONTR - IMPRESSION: \n1. Diffuse marrow edema within the T11 vertebral body is \nconcerning for \nmalignant involvement. No epidural or paravertebral soft tissue \ncomponent at this site. \n2. Stable compression deformities involving the T6 through T8 \nvertebrae when compared to ___ CT. Marrow edema \ninvolving the T3 through T8 vertebral bodies appears linear and \nwhile indeterminate, is more suggestive of osteoporotic \ncompression, rather than marrow replacement. \n\n___ CT ABDOMEN/PELVIS W/CONTRAST \n1. No evidence of lymphoma recurrence or progression with \nmultiple calcified lymph nodes consistent with treated lymphoma.\n2. Sub-5-mm hepatic hypoattenuation could reflect cyst or \nhemangioma, but too small to characterize.\n3. Small right pleural effusion and bibasilar atelectasis.\n4. Relative sclerotic appearance of T11 vertebral body could \nreflect radiation-associated changes and correlation with bone \nscan on a on-emergent basis is recommended.\n \n___ UNILAT UP EXT VEINS US - LEFT UPPER EXTREMITY \nULTRASOUND: Duplex imaging of the left internal jugular, \nsubclavian, axillary, basilic, cephalic and brachial veins was \nperformed. There was normal compressibility, augmentation, \nwaveforms, and flow. Flow was slow throughout the left venous \nsystem (approximately 6 cm/second in the left subclavian vein, \ncompared with 20 cm/second in the right), but otherwise \nunremarkable. The right subclavian vein demonstrated normal \nwaveforms and flow. There is no evidence of DVT. \nIMPRESSION: Slow flow throughout the left upper extremity \nwithout evidence of DVT. \n \n___ CTA CHEST W&W/O C&RECO- IMPRESSION: \n1. No evidence of pulmonary embolism or aortic dissection. \n2. Small right pleural effusion is now loculated. Superinfection \ncannot \nexcluded. There is no thick enhancing rim to suggest empyema. \nThere is \nassociated atelectasis and moderate volume loss in the right \nlower lobe. \n3. No focal consolidation to suggest pneumonia. Paramediastinal \nfibrosis is longstanding and consistent with radiation exposure. \n\n4. Extensive collateralization within the chest and mediastinum \nwith \nnonvisualization of the subclavian and brachiocephalic veins \nbilaterally, including surrounding the left-sided \nPort-A-Catheter. These \nfindings suggest central venous occlusion. The SVC is patent. \n___ year old female with a prior history of diffuse large B-cell \nlymphoma in the mediastinum s/p R-CHOP and R-EPOCH chemotherapy \nand radiation [completed ___ who has been in complete \nremission since then, who presented with recurrent fevers which \ncontinued even on appropriate therapy for a Pseudomonas PNA and \nC.diff. \n\n# Fever of unknown origin: The patient presented with ongoing \nfevers. During her hospital course infection was a major \nconcern in the differential. Her fevers were initially thought \nto be due to a recurrent pseudomonal pneumonia, however she was \ntreated appropriately with ceftazadime throughout her hospital \ncourse and continued to experience fevers. She was found to be \nC.diff positive and was initially treated with po flaygl, \nhowever this was changed to po vancomycin due to fever despite \ntid Flagyl treatment of her C.diff colitis. A PPD was placed \nand was negative and a quantaferon-gold test was sent, the \nresults were pending at time of discharge. Cultures from the \nT11 biopsy, bone marrow, and pleural fluid were all no growth. \nShe did continued to grow pseudomonas from her sputum, making it \nlikely that this was a contaminant. \n\nShe underwent a throacentesis on admission which showed so many \nwhite blood cells due to her pneumonia so that cytology could \nnot be accurately performed to evaluate for abnormal cells. An \nMRI of her T11 vertebrae showed abnormal bone marrow edema \nconcerning for malignancy so a CT-guided biopsy of T11 was \npreformed. Pathology showed only connective tissue and cultures \nhave been no growth to date. Due to her history of a bronchial \nstent in her left lobe she underwent a bronchoscopy to evaluate \nfor evidence of infection of the stent which was within normal \nlimits. A BAL was done which grew pseudomonas. Given \npersistent pleural effusion and cough she underwent a second \nthoracentesis which showed improvement of the white count of the \npleural fluid and 11% other cells which were described as \nimmature immunoblasts. Cytology showed atypical cells. Due to \nconcern for malignancy as a source of her fevers a bone marrow \nbiopsy was preformed which did not reveal any evidence of \nmalignancy.\n\nBesides infectious disease and heme/onc consults, rheumatology \nwas also consulted as rheumatologic disease remained in the \ndifferential for FUO, however they did not feel that further \nrheum workup was indicated given lack of history to point \ntowards a specific disease.\n\n# Respiratory distress: Throughout her hospitalization she had \nmultiple episodes of respiratory worsening, then improvement. \nHer respiratory distress was initially thought to be due to her \npseudomonal PNA. She began improving, but after the \nbronchoscopy she worsened and her CXR showed a new infiltrate in \nher RUL. She was treated for a possible MRSA HCAP for a 7 day \ncourse with vancomycin. She was placed on standing nebs and \nguafenesin. She was encouraged to use incentive spirometry and \nget OOB with her family and ___. Due to continued shortness of \nbreath with exertion a TTE was preformed which showed no acute \nchange but mildly decreased systolic function.\n\n# Psudomonas pneumonia: She was thought to have recurrent \npseudomonas pneumonia from incomplete treatment after her \nprevious admission for pnueumonia. There was some concern for \nempyema given persistence of a right pleural effusion and a \nthoracentesis was done which had elevated counts of red and \nwhite blood cells but no organisms, and the culture was \nnegative. There was also concern for lymphoma recurrence, but \ncytology of the pleural cells was negative for atypical cells \nand a CT of the chest and abdomen did not reveal any new areas \nof adenopathy. She was followed by both the heme-onc and \ninfectious disease consult services and was ultimately completed \na three week course of ceftazadime. She will need five more \ndays of PO vancomycin. \n\n# Right pleuritic chest pain: This was thought to be secondary \nto pleurisy from her right pleural effusion, and it improved \ngradually over the course of her hospital stay. A chest CTA was \nperformed to rule out pulmonary embolism and was negative. She \nwas managed with tylenol and oxycodone prn.\n\n# Left subclavian vein stenosis: She was found to have \nsignificant collateral venous circulation in chest incidentally \non a chest CT to rule out PE, and this was consistent with \nchronic obstruction of the left subclavian vein. It was unclear \nwhether the obstruction was due to subclavian stenosis from the \nleft chest port catheter or a chronic thrombosis, and left upper \nextremity ultrasound was performed which was negative for clot. \nAn MRV of the extremity was considered for further evaluation of \nthe nature of the stenosis, as a chronic clot could not be ruled \nout with the ultrasound study, but after discussion with \nradiology, it was determined that no noninvasive test would be \nable to differentiate between chronic sclerosis and clot. \nBecause the collateral circulation suggested a chronic process \nand because there was no concern for PE, it was concluded that \nthe stenosis was likely secondary to the existence of a port \ncatheter in the vein.\n\n# NHL: She has a history of diffuse large B-cell lymphoma in the \nmediastinum s/p R-CHOP and R-EPOCH chemotherapy and radiation \n[completed ___ and also has a right bronchial stentin place. \nShe has been in complete remission. The heme-onc service was \nconsulted to evaluate whether her fevers could be related to a \ncancer recurrence, but there was no evidence of this, as \ndescribed above.\n\n# ___ sclerosis: Sclerosis of T11 spine found incidentally \non abdominal CT and likely represents radiation changes. An MRI \nwas performed to further evaluate it and showed some abnormal \nbone marrow edema at T11. A biopsy was completed. Cultures \nhave been no growth to date, cytology was negative, and \npathology preliminarily has shown only connective tissue.\n\n# Tachycardia: She was in a sinus tachycardia throughout the \nhospital stay with a heart rate between 90-110, and it was \ngenerally not fluid responsive. It was thought to be secondary \nto her underlying infectious process and physical \ndeconditioning.\n\n# Anemia: She has chronic anemia and had declined outpatient \ncolonoscopy. She was given 1 unit of PRBC during her \nhospitalization when her Hct dropped to the low 20's for \nsymptomatic benefit. Her Hct remained in the mid to high 20's \nthrough most of her hospitalization. She was guaiac negative. \nBone marrow biopsy did not show recurrent lymphoma. Colonoscopy \nwill be arranged as outpatient.\n\n# Asthma: She was continued on advair and albuterol prn.\n \n# Hypothyroidism: She was continued levothyroxine. Her TSH was \nmildly elevated but FT4 was within normal limits. She should \nhave a repeat TSH performed in the beginning of ___. \n\n# HTN: She was initially continued on dilitiazem, however her \nblood pressure was on the low side so this was stopped and she \nremained normotensive.\n\n# Patient will need a colonoscopy as an outpatient. \n\n# Code: Full code"}}
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{'final_diagnoses': ['Pseuodomonal pneumonia', 'Clostridium difficle infection', 'Left subclavian vein stenosis', 'Exudative pleural effusion', 'Hypertension', 'Dyslipidemia', 'Hypothyroidism', 'History of lymphoma'], 'procedures': ['Thoracentesis x 2', 'Bronchoscopy', 'Bone marrow biopsy'], 'visit_summary': "___ year old female with a prior history of diffuse large B-cell \nlymphoma in the mediastinum s/p R-CHOP and R-EPOCH chemotherapy \nand radiation [completed ___ who has been in complete \nremission since then, who presented with recurrent fevers which \ncontinued even on appropriate therapy for a Pseudomonas PNA and \nC.diff. \n\n# Fever of unknown origin: The patient presented with ongoing \nfevers. During her hospital course infection was a major \nconcern in the differential. Her fevers were initially thought \nto be due to a recurrent pseudomonal pneumonia, however she was \ntreated appropriately with ceftazadime throughout her hospital \ncourse and continued to experience fevers. She was found to be \nC.diff positive and was initially treated with po flaygl, \nhowever this was changed to po vancomycin due to fever despite \ntid Flagyl treatment of her C.diff colitis. A PPD was placed \nand was negative and a quantaferon-gold test was sent, the \nresults were pending at time of discharge. Cultures from the \nT11 biopsy, bone marrow, and pleural fluid were all no growth. \nShe did continued to grow pseudomonas from her sputum, making it \nlikely that this was a contaminant. \n\nShe underwent a throacentesis on admission which showed so many \nwhite blood cells due to her pneumonia so that cytology could \nnot be accurately performed to evaluate for abnormal cells. An \nMRI of her T11 vertebrae showed abnormal bone marrow edema \nconcerning for malignancy so a CT-guided biopsy of T11 was \npreformed. Pathology showed only connective tissue and cultures \nhave been no growth to date. Due to her history of a bronchial \nstent in her left lobe she underwent a bronchoscopy to evaluate \nfor evidence of infection of the stent which was within normal \nlimits. A BAL was done which grew pseudomonas. Given \npersistent pleural effusion and cough she underwent a second \nthoracentesis which showed improvement of the white count of the \npleural fluid and 11% other cells which were described as \nimmature immunoblasts. Cytology showed atypical cells. Due to \nconcern for malignancy as a source of her fevers a bone marrow \nbiopsy was preformed which did not reveal any evidence of \nmalignancy.\n\nBesides infectious disease and heme/onc consults, rheumatology \nwas also consulted as rheumatologic disease remained in the \ndifferential for FUO, however they did not feel that further \nrheum workup was indicated given lack of history to point \ntowards a specific disease.\n\n# Respiratory distress: Throughout her hospitalization she had \nmultiple episodes of respiratory worsening, then improvement. \nHer respiratory distress was initially thought to be due to her \npseudomonal PNA. She began improving, but after the \nbronchoscopy she worsened and her CXR showed a new infiltrate in \nher RUL. She was treated for a possible MRSA HCAP for a 7 day \ncourse with vancomycin. She was placed on standing nebs and \nguafenesin. She was encouraged to use incentive spirometry and \nget OOB with her family and ___. Due to continued shortness of \nbreath with exertion a TTE was preformed which showed no acute \nchange but mildly decreased systolic function.\n\n# Psudomonas pneumonia: She was thought to have recurrent \npseudomonas pneumonia from incomplete treatment after her \nprevious admission for pnueumonia. There was some concern for \nempyema given persistence of a right pleural effusion and a \nthoracentesis was done which had elevated counts of red and \nwhite blood cells but no organisms, and the culture was \nnegative. There was also concern for lymphoma recurrence, but \ncytology of the pleural cells was negative for atypical cells \nand a CT of the chest and abdomen did not reveal any new areas \nof adenopathy. She was followed by both the heme-onc and \ninfectious disease consult services and was ultimately completed \na three week course of ceftazadime. She will need five more \ndays of PO vancomycin. \n\n# Right pleuritic chest pain: This was thought to be secondary \nto pleurisy from her right pleural effusion, and it improved \ngradually over the course of her hospital stay. A chest CTA was \nperformed to rule out pulmonary embolism and was negative. She \nwas managed with tylenol and oxycodone prn.\n\n# Left subclavian vein stenosis: She was found to have \nsignificant collateral venous circulation in chest incidentally \non a chest CT to rule out PE, and this was consistent with \nchronic obstruction of the left subclavian vein. It was unclear \nwhether the obstruction was due to subclavian stenosis from the \nleft chest port catheter or a chronic thrombosis, and left upper \nextremity ultrasound was performed which was negative for clot. \nAn MRV of the extremity was considered for further evaluation of \nthe nature of the stenosis, as a chronic clot could not be ruled \nout with the ultrasound study, but after discussion with \nradiology, it was determined that no noninvasive test would be \nable to differentiate between chronic sclerosis and clot. \nBecause the collateral circulation suggested a chronic process \nand because there was no concern for PE, it was concluded that \nthe stenosis was likely secondary to the existence of a port \ncatheter in the vein.\n\n# NHL: She has a history of diffuse large B-cell lymphoma in the \nmediastinum s/p R-CHOP and R-EPOCH chemotherapy and radiation \n[completed ___ and also has a right bronchial stentin place. \nShe has been in complete remission. The heme-onc service was \nconsulted to evaluate whether her fevers could be related to a \ncancer recurrence, but there was no evidence of this, as \ndescribed above.\n\n# ___ sclerosis: Sclerosis of T11 spine found incidentally \non abdominal CT and likely represents radiation changes. An MRI \nwas performed to further evaluate it and showed some abnormal \nbone marrow edema at T11. A biopsy was completed. Cultures \nhave been no growth to date, cytology was negative, and \npathology preliminarily has shown only connective tissue.\n\n# Tachycardia: She was in a sinus tachycardia throughout the \nhospital stay with a heart rate between 90-110, and it was \ngenerally not fluid responsive. It was thought to be secondary \nto her underlying infectious process and physical \ndeconditioning.\n\n# Anemia: She has chronic anemia and had declined outpatient \ncolonoscopy. She was given 1 unit of PRBC during her \nhospitalization when her Hct dropped to the low 20's for \nsymptomatic benefit. Her Hct remained in the mid to high 20's \nthrough most of her hospitalization. She was guaiac negative. \nBone marrow biopsy did not show recurrent lymphoma. Colonoscopy \nwill be arranged as outpatient.\n\n# Asthma: She was continued on advair and albuterol prn.\n \n# Hypothyroidism: She was continued levothyroxine. Her TSH was \nmildly elevated but FT4 was within normal limits. She should \nhave a repeat TSH performed in the beginning of ___. \n\n# HTN: She was initially continued on dilitiazem, however her \nblood pressure was on the low side so this was stopped and she \nremained normotensive.\n\n# Patient will need a colonoscopy as an outpatient. \n\n# Code: Full code", 'medications_prescribed': ['Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed. ', 'Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily). ', 'Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day). ', 'Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', 'Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) \nTablet, Chewable PO BID (2 times a day). ', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily). ', 'Benzonatate 100 mg Capsule Sig: One (1) Capsule PO TID (3 \ntimes a day) as needed.\nDisp:*30 Capsule(s)* Refills:*2*', 'Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed.\nDisp:*20 Tablet(s)* Refills:*0*', 'Albuterol 90 mcg/Actuation Aerosol Sig: ___ puffs Inhalation \nfour times a day as needed for shortness of breath or wheezing. ', 'Loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day. ', 'Vancomycin 125 mg Capsule Sig: One (1) Capsule PO Q6H (every \n6 hours) for 5 days. ', 'Heparin Flush (10 units/ml) 2 mL IV PRN line flush ', 'Heparin Flush (10 units/ml) 5 mL IV PRN line flush \nIndwelling Port (e.g. Portacath), heparin dependent: Flush with \n10 mL Normal Saline followed by Heparin as above daily and PRN \nper lumen. ', 'Heparin Flush (100 units/ml) 5 mL IV PRN DE-ACCESSING port \nIndwelling Port (e.g. Portacath), heparin dependent: When \nde-accessing port, instill Heparin as above per lumen. ', 'Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', 'Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation every ___ hours as needed \nfor shortness of breath or wheezing. ', 'Codeine Sulfate 30 mg Tablet Sig: One (1) Tablet PO Q4H \n(every 4 hours) as needed for cough, pain. ', 'Guaifenesin 100 mg/5 mL Syrup Sig: Fifteen (15) ML PO Q6H \n(every 6 hours). ', 'Celebrex ___ mg Capsule Sig: One (1) Capsule PO twice a day. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 82, 'gender': 'M', 'symptoms': 'Headache, ptosis', 'medical_history': ['COPD', 'CAD', 'Asthma', 'Migraine', 'DVT/PE', 'shoulder surgery'], 'family_history': 'No known neurological disorders', 'present_illness': 'Mr. ___ is a ___ year old male with history of COPD, CAD, \nPE\nand DVT who presents with a headache. He says that he developed\nan acute onset headache about two weeks ago. He says that he \ndoes\nnot remember exactly what he was doing when it started. He says\nthat he had some cough and congestion, and he was blowing his\nnose a lot. He denies any trauma or neck manipulation. He says\nthat the headache was left sided, characterized by pressure. He\nsays that it sometimes radiates to his teeth. He says that he \nhas\nbeen nauseated but not had vomiting. He denies photophobia and\nphonophobia. He was seen by his PCP who prescribed amoxicillin\nout of concern for sinusitis. However, the headache continued\nunabated. About one week ago, his wife also noted that his left\neyelid was droopy. He denies a positional component to the\nheadache. He has had migraine headaches in the past but not had\nthem for several years. He says that this headache does not feel\nlike a migraine. Given the lack of improvement in the headache\nwith antibiotics, he went to an OSH today, where a CT scan\ndemonstrated findings concerning for a subarachnoid hemorrhage.\nHe received vitamin K to reverse his Coumadin.\n\nMr. ___ underwent cardiac catheterization in ___, and he\nhad two stents placed in ___. He was also found to have small\npulmonary emboli. He was initially on Plavix, but he then\ndeveloped swelling of the foot and was found to have a DVT. He\nwas switched to Coumadin, and he has been on Coumadin ever \nsince.\nHe does not think that he has ever been worked up for\nhypercoaguability.\n\nHe states that he has occasional dizziness, but denies loss of\nvision, blurred vision, diplopia, dysarthria, dysphagia, \ntinnitus\nor hearing difficulty. Denies difficulties producing or\ncomprehending speech. Denies focal weakness, numbness,\nparasthesiae. General review of systems is notable for the viral\nsymptoms that he had reported that have since resolved.', 'medications': [{'medication': 'Senna', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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}, {'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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': '1X', '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 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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE: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': '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q5MIN: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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', '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': '26', 'valuenum': 26.0, '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': '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': 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': '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, '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': '32.1', 'valuenum': 32.1, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.09', 'valuenum': 4.09, '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': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '32.8', 'valuenum': 32.8, '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': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM:\nGeneral: Awake, cooperative, NAD. \nHEENT: NC/AT, no scleral icterus noted, MMM\nNeck: Supple\nPulmonary: No increased WOB\nCardiac: RRR\nAbdomen: soft, non-distended\nSkin: no rashes or lesions noted. \n \nNeurologic: \n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive, able to name days of the week\nbackward without difficulty. Language is fluent with intact\nrepetition and comprehension. Normal prosody. He made two\nparaphasic errors during the conversation. He was able to name\nboth high frequency objects, had some difficulty with 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 neglect. \n \n-Cranial Nerves: \nII: Pupils equal and reactive to light, VFF to confrontation. \nIII, IV, VI: EOMI without nystagmus. Normal saccades. Ptosis of \nthe left eye.\nV: Facial sensation intact to light touch. \nVII: No facial droop, closes eyes tightly and unable to overcome \n\nVIII: Hearing intact to finger-rub bilaterally. \nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally. \nXII: Tongue protrudes in midline with normal strength \n \n-Motor: Normal bulk, tone throughout. No pronator drift \nbilaterally. \n Delt Bic Tri WrE IO IP Quad Ham TA Gastroc \nL 5 ___ ___ 5 5 5 \nR 5 ___ ___ 5 5 5 \n \n-Sensory: No deficits to light touch\n \n -DTRs: \n Bi Tri ___ Pat Ach \nL 2 2 2 1 1 \nR 2 2 2 1 1 \nPlantar response was flexor bilaterally. \n \n-Coordination: No intention tremor. No dysmetria on FNF or HKS \nbilaterally. \n \n-Gait: Normal based gait', 'diagnoses': [{'icd_code': '82120', 'desc': 'Closed fracture of lower end of femur, unspecified part'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': 'V4364'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': 'E8490', 'desc': 'Home accidents'}], 'summary': 'ADMISSION LABS:\n\n___ 11:02PM ___\n___ 09:45PM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS \ncocaine-NEG amphetmn-NEG oxycodn-NEG mthdone-NEG\n___ 09:45PM URINE COLOR-Yellow APPEAR-Clear SP \n___\n___ 09:45PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 09:45PM URINE RBC-3* WBC-0 BACTERIA-NONE YEAST-NONE \nEPI-0\n___ 09:45PM URINE MUCOUS-RARE\n___ 04:45PM GLUCOSE-101* UREA N-16 CREAT-0.8 SODIUM-137 \nPOTASSIUM-3.9 CHLORIDE-101 TOTAL CO2-24 ANION GAP-16\n___ 04:45PM cTropnT-<0.01\n___ 04:45PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 04:45PM WBC-11.2* RBC-5.13 HGB-14.8 HCT-44.9 MCV-88 \nMCH-28.8 MCHC-33.0 RDW-13.3 RDWSD-42.9\n___ 04:45PM NEUTS-70.7 LYMPHS-15.7* MONOS-8.8 EOS-3.5 \nBASOS-0.8 IM ___ AbsNeut-7.91* AbsLymp-1.76 AbsMono-0.99* \nAbsEos-0.39 AbsBaso-0.09*\n___ 04:45PM PLT COUNT-220\n___ 04:45PM ___ PTT-38.7* ___\n\n********\n\nIMAGING:\n\nCT head ___ (OSH, ___ opinion here):\nIMPRESSION: \n1. Small caliber of the visualized distal cervical left internal \ncarotid \nartery with severe narrowing at the skullbase and of the \nhorizontal petrous segment, and slight narrowing of the \nremaining petrous, cavernous, and supraclinoid segments. These \nfindings are suspicious for dissection. \n2. Increased number of small blood vessels in the region of the \npreviously \ndemonstrated left parietal subarachnoid hemorrhage. This may \nrepresent \nreactive hyperemia, but a developmental venous anomaly, or a \nsubtle \narteriovenous malformation or fistula, cannot be excluded on the \nbasis of this exam. \n3. No evidence for an intracranial aneurysm, allowing for \nabsence of 3D volume rendered images on this exam from BID \n___. \n4. No evidence for dural venous sinus thrombosis. \n5. Fluid, secretions, and mucosal thickening in the paranasal \nsinuses could be related to prolonged supine positioning or \nactive sinus disease. Please correlate with symptoms. \nRECOMMENDATION(S): \n1. Neck MRA with fat-suppressed axial T1 weighted images is \nrecommended to \nassess for cervical left internal carotid artery dissection. Of \nnote, this has already been performed at the time of final \ninterpretation. \n2. Conventional cerebral angiogram should be considered to \nexclude a subtle arteriovenous malformation or fistula in the \nregion of the left parietal subarachnoid hemorrhage. \n \nMRI/MRA brain ___:\nIMPRESSION: \n1. Small focus of left parietal subarachnoid hemorrhage is again \ndemonstrated. No evidence for amyloid angiopathy is seen. No \nclear evidence for a cavernous malformation is demonstrated. \nPlease refer to the preceding head CTA report for further \nobservation and recommendations. \n2. Dissection of the distal cervical left internal carotid \nartery at the \nskullbase and of the horizontal portion of the petrous segment \nwith acute to subacute thrombus. Other portions of the left \ninternal carotid artery are small in caliber compared to the \nright, which may reflect diminished flow secondary to the \ndissection, but chronic dissection of the more proximal cervical \ninternal carotid artery cannot be excluded. \n3. Otherwise, neck MRA is technically limited due to poor timing \nand motion artifact. \n4. The motion limited MRA of the brain demonstrates no evidence \nfor an \naneurysm larger than 3 mm, concordant with the preceding head \nCTA. \n5. No evidence of major dural venous sinus thrombosis. \n6. Fluid and secretions in the paranasal sinuses may be \nsecondary to prolonged supine positioning in the inpatient \nsetting versus active sinusitis. Please correlate with \nsymptoms. \n\nCXR 2v ___:\nFINDINGS: \nLungs are relatively hyperinflated and there is relative lucency \nprojecting over the right upper lung with changes in the \nunderlying parenchyma raising the possibility of emphysema. \nThere is also left apical scarring. There is no focal \nconsolidation or edema. Moderate-sized hiatal hernia is noted. \nNo acute osseous abnormalities. Right shoulder arthroplasty \nchanges are noted. \nIMPRESSION: \nHiatal hernia and findings suggestive of emphysema. No acute \ncardiopulmonary process. \n\nCT head noncontrast ___:\nIMPRESSION: \n1. Stable small left parietal subarachnoid hemorrhage. No new \nhemorrhage. \n2. Fluid and secretions in the paranasal sinuses may relate to \nprolonged \nsupine positioning in the inpatient setting or active sinus \ndisease. Please correlate with symptoms.\nPatient is a ___ year old male with history of CAD and PE/DVT on \ncoumadin who presented with a headache and ptosis, subsequently \nfound on CT with L ICA dissection and a small convexal left \nparietal SAH. He had no risk factors for dissection with \nexception of possible valsalva/sneezing. He has no physical exam \nfindings to suggest a collagen vascular disorder. His imaging \ndoes not support fibromuscular dysplasia. His family history \ndoes not suggest a collagen vascular disorder. \n\nThe CTA brain ___ opinion report mentioned concern regarding an \n"Increased number of small blood vessels in the region of the \npreviously demonstrated left parietal subarachnoid hemorrhage. \nThis may represent reactive hyperemia, but a developmental \nvenous anomaly, or a subtle arteriovenous malformation or \nfistula, cannot be excluded on the basis of this exam. No \nevidence for an intracranial aneurysm, allowing for absence of \n3D volume rendered images on this exam from ___\n\nMRI brain/MRA brain showed no evidence of an AVM or amyloid \nangiopathy. Neurosurgery (Dr. ___ was consulted for \npossibility of performing angiography to rule out arteriovenous \nmalformation, dural AV fistula, or aneurysm, but he thought that \nthese were highly unlikely to be present and that the risks of \nthe procedure outweighed the benefits. In the final analysis, \nthe small left parietal SAH appeared likely spontaneous, in \nsetting of anticoagulation.\n\nDr. ___ discussed with his cardiologist who had been treating \nMr. ___ with Coumadin for the DVT and PE. The cardiologist \nconfirmed that the DVT and PE occurred more than one year ago. \nGiven the risks and benefits, his cardiologist was in agreement \nwith not resuming the Coumadin. His Coumadin was stopped and he \nwas placed on aspirin 81mg. He was treated with SBP goal <160, \nand he was continued on his home lasix and lisinopril. His \nheadache was controlled with fioricet and compazine and he was \narranged for a follow up MRI in ___s follow up in \nStroke clinic. \n\nTransitional issues:\n[ ] Coumadin was stopped and aspirin 81mg was started for \ncardiovascular prevention in setting of admission with \nsubarachnoid hemorrhage. If felt that his risk of DVT/PE is high \nenough or he experiences recurrence, please consider \nconsultation for placement of IVC filter.\n[ ] Please follow up repeat MRI head brain without contrast/ MRA \nbrain without contrast/MRA neck w/wo contrast to assess for \nresolution of SAH and carotid dissection.'}}
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{'final_diagnoses': ['Left parietal convexal subarachnoid hemorrhage', 'Left internal carotid artery dissection', 'Recent PE/DVT', 'Coronary artery disease'], 'procedures': ['N/A'], 'visit_summary': 'Patient is a ___ year old male with history of CAD and PE/DVT on \ncoumadin who presented with a headache and ptosis, subsequently \nfound on CT with L ICA dissection and a small convexal left \nparietal SAH. He had no risk factors for dissection with \nexception of possible valsalva/sneezing. He has no physical exam \nfindings to suggest a collagen vascular disorder. His imaging \ndoes not support fibromuscular dysplasia. His family history \ndoes not suggest a collagen vascular disorder. \n\nThe CTA brain ___ opinion report mentioned concern regarding an \n"Increased number of small blood vessels in the region of the \npreviously demonstrated left parietal subarachnoid hemorrhage. \nThis may represent reactive hyperemia, but a developmental \nvenous anomaly, or a subtle arteriovenous malformation or \nfistula, cannot be excluded on the basis of this exam. No \nevidence for an intracranial aneurysm, allowing for absence of \n3D volume rendered images on this exam from ___\n\nMRI brain/MRA brain showed no evidence of an AVM or amyloid \nangiopathy. Neurosurgery (Dr. ___ was consulted for \npossibility of performing angiography to rule out arteriovenous \nmalformation, dural AV fistula, or aneurysm, but he thought that \nthese were highly unlikely to be present and that the risks of \nthe procedure outweighed the benefits. In the final analysis, \nthe small left parietal SAH appeared likely spontaneous, in \nsetting of anticoagulation.\n\nDr. ___ discussed with his cardiologist who had been treating \nMr. ___ with Coumadin for the DVT and PE. The cardiologist \nconfirmed that the DVT and PE occurred more than one year ago. \nGiven the risks and benefits, his cardiologist was in agreement \nwith not resuming the Coumadin. His Coumadin was stopped and he \nwas placed on aspirin 81mg. He was treated with SBP goal <160, \nand he was continued on his home lasix and lisinopril. His \nheadache was controlled with fioricet and compazine and he was \narranged for a follow up MRI in ___s follow up in \nStroke clinic. \n\nTransitional issues:\n[ ] Coumadin was stopped and aspirin 81mg was started for \ncardiovascular prevention in setting of admission with \nsubarachnoid hemorrhage. If felt that his risk of DVT/PE is high \nenough or he experiences recurrence, please consider \nconsultation for placement of IVC filter.\n[ ] Please follow up repeat MRI head brain without contrast/ MRA \nbrain without contrast/MRA neck w/wo contrast to assess for \nresolution of SAH and carotid dissection.', 'medications_prescribed': ['Albuterol Inhaler ___ PUFF IH Q4H:PRN as directed', 'BuPROPion (Sustained Release) 150 mg PO QAM', 'Fish Oil (Omega 3) 1000 mg PO DAILY', 'Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', 'Furosemide 20 mg PO DAILY', 'Lisinopril 20 mg PO DAILY', 'Pantoprazole 40 mg PO Q12H', 'Aspirin 81 mg PO DAILY \nRX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*5', 'Multivitamins 1 TAB PO DAILY', 'Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain', 'Acetaminophen-Caff-Butalbital ___ TAB PO Q6H:PRN headaches \nRX *butalbital-acetaminophen-caff 50 mg-325 mg-40 mg 1 tablet(s) \nby mouth every 6 hours as needed Disp #*30 Tablet Refills:*1', 'Prochlorperazine ___ mg PO Q6H:PRN Nausea or headache \nRX *prochlorperazine maleate [Compazine] 5 mg ___ tablet(s) by \nmouth every 6 hours as needed Disp #*30 Tablet Refills:*0', 'Amitriptyline 25 mg PO QHS \nRX *amitriptyline 25 mg 1 tablet(s) by mouth nightly Disp #*30 \nTablet Refills:*3']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'M', 'symptoms': 'Tumor', 'medical_history': ['HTN', 'Seizures', 'metastatic melanoma'], 'family_history': 'NC', 'present_illness': 'This is a ___ year old gentleman with known metastatic melanoma \nwith previous WBRT and cyberknife who had a tonic clonic seizure \non ___\nas witnessed by friends. He has been followed in the ___\nsince. Imaging reveals persistent right temporal metastasis. It \nwas recommended that he be seen in the ___ for \npossible resection and he agreed to proceed', 'medications': [{'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', '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': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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': 'FLUoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '67', 'valuenum': 67.0, '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': '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': 0.0, 'ref_range_upper': 1.5, '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '74', 'valuenum': 74.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '___', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.3, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}], 'exams': 'Pre-op:\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: 4-3mm EOMs Full\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nLanguage: Speech fluent with good comprehension and repetition.\nNaming intact. No dysarthria or paraphasic errors.\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 4mm to 3mm\nbilaterally. Visual fields are full to confrontation.\nIII, IV, VI: Extraocular movements intact bilaterally without\nnystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to voice.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements,\ntremors. Strength full power ___ throughout. No pronator drift\n\nSensation: Intact to light touch\n\nCoordination: normal on finger-nose-finger\n.\n.\nPhysical examination on discharge:\nNon-focal neurological examination A+Ox3. \nHis incision was clean, dry and intact with dissolvable sutures.', 'diagnoses': [{'icd_code': 'F2089', 'desc': 'Other schizophrenia'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'L309', 'desc': 'Dermatitis, unspecified'}, {'icd_code': 'Z915', 'desc': 'Personal history of self-harm'}], 'summary': 'MRI brain ___\nWithin the right temporal lobe is a peripherally enhancing \nlesion \nmeasuring 2.6 x 1.9 cm, increased in size since the previous \nexamination. \nIncreased susceptibility is present within this area as well as \nhigh T1 signal on pre-contrast image to suggest the presence of \nblood products. In the right temporal lobe in the region of \nenhancement, there was no increase in blood flow, or blood \nvolume. There is extensive perilesional edema, which appears \nsomewhat more pronounced than on the prior examination and \ncontinues up into the right corona radiata. There is a stable \nenhancing 4-mm lesion in the right parietal lobe (1101:89). \nPrevious enhancing tumor within the left temporal lobe is \nsignificantly less conspicuous on this current examination. No \nnew enhancing lesions are present. \nSlight FLAIR signal abnormalities are present in the \nperiventricular regions bilaterally which appear somewhat \nsimilar to that on prior studies. The size and configuration of \nventricles appears normal. No abnormal restricted diffusion is \npresent. The vascular flow voids appear normal. The sinuses and \norbits appear normal. \nIMPRESSION: \n1. Interval increase in size of a right temporal lobe lesion \nwith increased blood products and surrounding edema. However, \nsince there is no increased blood flow or blood volume within \nthis lesion suggests that this likely represents the effects of \nradiation necrosis. \n2. Otherwise, stable appearance to metastatic disease with no \nnew metastatic lesions identified. \n\nBrain MRI ___\nRight temporal and frontal lobe lesions are again identified. \nBoth these lesions may not have significantly changed compared \nto the recent study of ___ and when accounting for \ndifferences in slice selection. No definite new enhancing \nlesions are seen. \n\nCT head ___\nExpected postoperative appearance of status post right temporal \nlobe \nresection with only minimal blood at the resection cavity and \npneumocephalus. Stable perilesional edema. \n\nMRI brain ___\nReport awaited.\nMr. ___ was admitted to ___ under the care of Dr. ___ \non ___. He underwent a MRI wand and was taken to the OR for a \nright craniotomy for tumor resection. Afterwards he was \nextubated and taken to the ___. Post-op CT head showed no \nhemorrhage. He remained stable and was trasnfered to the floor \non ___. His diet was advanced. His cathter was removed. He was \ntransitioned OOB. ___ was ordered. MRI brain showed \npost-operative changes. On ___ he was neurologically \nstable, tolerated a po diet and pain was controiled and had \nvioded without issue and hence was deemed fit for discharge. He \nhas brain tumor clinic follow-up.'}}
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{'final_diagnoses': ['Right temporal brain lesion', 'Radiation necrosis'], 'procedures': ['Right Craniotomy for tumor resection ___'], 'visit_summary': 'Mr. ___ was admitted to ___ under the care of Dr. ___ \non ___. He underwent a MRI wand and was taken to the OR for a \nright craniotomy for tumor resection. Afterwards he was \nextubated and taken to the ___. Post-op CT head showed no \nhemorrhage. He remained stable and was trasnfered to the floor \non ___. His diet was advanced. His cathter was removed. He was \ntransitioned OOB. ___ was ordered. MRI brain showed \npost-operative changes. On ___ he was neurologically \nstable, tolerated a po diet and pain was controiled and had \nvioded without issue and hence was deemed fit for discharge. He \nhas brain tumor clinic follow-up.', 'medications_prescribed': ['acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for fever/pain.', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*0*', 'oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain.\nDisp:*60 Tablet(s)* Refills:*0*', 'dexamethasone 2 mg Tablet Sig: See taper instructions Tablet \nPO See instructions for 3 days: Take 2 tablets every 8 hours for \none days then 1 tablet every 8 hours for 1 day then 1 tablet \ntwice daily for 1 day then stop.\nDisp:*QS Tablet(s)* Refills:*0*', 'levetiracetam 500 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day).', 'lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 86, 'gender': 'M', 'symptoms': 'dizziness, palpitations', 'medical_history': ['1. CARDIAC RISK FACTORS: \n- Dyslipidemia\n- Hypertension ', '2. CARDIAC HISTORY: \n- PERCUTANEOUS CORONARY INTERVENTIONS: reported by patient in \n___ after a syncopal episode, but none in the system ', '3. OTHER PAST MEDICAL HISTORY: \n- History of dizziness due to NSVT \n- Gout'], 'family_history': 'Mother died at age ___ of DVT and PE. Father died of heart \ndisease in his ___. Sister has breast cancer.', 'present_illness': 'Mr. ___ is a ___ yo man with a history of HTN, HLD, and \ndizziness believed to be secondary to NSVT, who again presents \nwith dizziness. The patient presented to his PCP ___ ___ for \npalpitation and dizziness and had a 24-hour holter that \nreportedly showed VT, so he was admitted at that time for \nfurther workup. His neuro exam was non-focal and his symptoms \nwere felt unlikely to have a neurological cause. A TTE was \nnormal and a cardiac MR was negative for any infiltrative or \ninflammatory process. The EP service was consulted and \nrecommended starting quinidine, after which he was noted to have \nfrequent PVCs but no further NSVT. A treadmill cardiac stress \ntest post-quinidine initation did not trigger any VT. He was \nsent home on quinidine with ___ of hearts which showed sinus \nrhythm at rates 45 to 87 BPM with APBs, episodes of ectopic \natrial rhythm, isolated VPBs and ventricular couplets. He had no \nfurther dizzy episodes on the quinidine, however he developed a \nrash and was switched to propafenone on ___. Since that \ntime, he has experienced 3 episodes of dizziness associated with \npalpitation, similar to his previous episodes, though less \nintense and only lasting several seconds at a time. The \ndizziness is non-positional and not associated with any specific \nactivities. He denies any chest pain, SOB, cough, fevers, or \nsyncope. \n.\nIn the ED, initial vitals were: 98.2, 83, 141/91, 16, 99%. Labs \nwere significant for K 6.7 (4.7 on repeat) and trop <0.01. EKG \nshowed NSR at 75 bpm, LAD, PVCs, QII, III, aVF, and poor RWP, \nsimilar to prior EKGs. He was admitted to the ___ service for \nfurther workup. \n.\nOn the floor, he is comfortable and denies any current \ndizziness, palpitations, or other complaints.', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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 via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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', 'doses_per_24_hrs': 4.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', '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': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Azithromycin', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'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': '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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '32.9', 'valuenum': 32.9, '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': '103', 'valuenum': 103.0, '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': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '147', 'valuenum': 147.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '31', 'valuenum': 31.0, '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': '1.9', 'valuenum': 1.9, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', '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 = 52 if non African-American (mL/min/1.73 m2). Estimated GFR = 63 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': 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': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, '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': '22', 'valuenum': 22.0, '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': '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': '6.0', 'valuenum': 6.0, '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': '1.016', 'valuenum': 1.016, '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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, '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': '546', 'valuenum': 546.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mEq/L', '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '988', 'valuenum': 988.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVS: 96.2, 147/80, 73, 18, 98% on RA \nGENERAL: WDWN man in NAD. Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple, no LAD, JVP not elevated. \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or \nS4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. \nRespirations unlabored, no accessory muscle use. Scant bibasilar \nrales, L>R. \nABDOMEN: Soft, NTND. NABS. \nEXTREMITIES: No ___ edema. \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+\nNEURO: CNs II-XII intact, sensory function intact, strength ___ \nin upper and lower extremities, no neurologic deficits\n.\nDISCHARGE EXAM:\nVS: 99, 120/70, 60, 18, 98% on RA \nGENERAL: WDWN man in NAD. Oriented x3. Mood, affect appropriate.\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple, no LAD, JVP not elevated. \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or \nS4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. \nRespirations unlabored, no accessory muscle use. A few bibasilar \nrales, L>R. \nABDOMEN: Soft, NTND. NABS. \nEXTREMITIES: No ___ edema. \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+\nNEURO: CNs II-XII intact, sensory function intact, strength ___ \nin upper and lower extremities, no neurologic deficits ', 'diagnoses': [{'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '135', 'desc': 'Sarcoidosis'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}, {'icd_code': 'V1007', 'desc': 'Personal history of malignant neoplasm of liver'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '5178', 'desc': 'Lung involvement in other diseases classified elsewhere'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': "ADMISSION LABS:\n___ 03:20PM BLOOD WBC-6.1 RBC-4.81 Hgb-13.4* Hct-39.0* \nMCV-81* MCH-28.0 MCHC-34.4 RDW-13.5 Plt ___\n___ 03:20PM BLOOD Neuts-51.0 ___ Monos-5.6 Eos-3.9 \nBaso-0.9\n___ 03:20PM BLOOD ___ PTT-25.0 ___\n___ 03:20PM BLOOD Glucose-83 UreaN-21* Creat-1.2 Na-138 \nK-6.7* Cl-105 HCO3-24 AnGap-16\n___ 03:20PM BLOOD Calcium-9.6 Phos-4.4 Mg-2.3\n___ 03:20PM BLOOD cTropnT-<0.01\n___ 12:40PM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:00AM BLOOD TSH-2.7\n___ 07:00AM BLOOD Free T4-1.3\n___ 07:00AM BLOOD ALT-21 AST-25 AlkPhos-58 TotBili-0.7\n.\nDISCHARGE LABS:\n___ 07:25AM BLOOD WBC-5.2 RBC-4.67 Hgb-13.4* Hct-39.0* \nMCV-83 MCH-28.7 MCHC-34.4 RDW-13.5 Plt ___\n___ 07:25AM BLOOD ___ PTT-25.7 ___\n___ 07:25AM BLOOD Glucose-89 UreaN-17 Creat-0.8 Na-141 \nK-4.6 Cl-104 HCO3-28 AnGap-14\n___ 07:25AM BLOOD Calcium-9.4 Phos-3.2 Mg-2.0\n.\nIMAGING:\n___ CXR: As compared to the previous radiograph, there is \nno relevant \nchange. Moderate cardiomegaly. No evidence of pneumonia, no \npulmonary edema. No pulmonary fibrosis. No evidence of pleural \neffusions. \n___ yo man with a history of HTN, HLD, and dizziness secondary to \nNSVT, who again presents with dizziness and palpitations after \nrecently stopping quinidine and starting propafenone.\n. \n# Dizziness/palpitations: The patient states that these symptoms \nare identical to his prior episodes. He was asymptomatic on \nquinidine, and only starting having these symptoms after \nswitching from quinidine to propafenone. He was monitored on \ntelemetry and was noted to have numerous episodes of polymorphic \nNSVT up to 10 beats at a time. Baseline TFTs, LFTs, and CXR were \nperformed which were all wnl. The propafenone was stopped and we \nstarted amiodarone 400 mg BID until ___, and then 400 mg \ndaily thereafter. He had episodes of asymptomatic bradycardia to \nthe ___ while sleeping so the metoprolol tartrate was decreased \nfrom 50 mg BID to 25 mg BID. He was discharged with ___ of \nHearts monitor and will follow up with Dr. ___. \n. \n# Hypertension: BP was well controlled. We continued finasteride \n5mg daily and decreased lopressor as discussed above. \n. \n# Hyperlipidemia: Continued simvastatin 20mg daily.\n.\n**A copy of this discharge summary was faxed to the patient's \nPCP ___ "}}
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{'final_diagnoses': ['Nonsustained ventricular tachycardia'], 'procedures': ['none'], 'visit_summary': "___ yo man with a history of HTN, HLD, and dizziness secondary to \nNSVT, who again presents with dizziness and palpitations after \nrecently stopping quinidine and starting propafenone.\n. \n# Dizziness/palpitations: The patient states that these symptoms \nare identical to his prior episodes. He was asymptomatic on \nquinidine, and only starting having these symptoms after \nswitching from quinidine to propafenone. He was monitored on \ntelemetry and was noted to have numerous episodes of polymorphic \nNSVT up to 10 beats at a time. Baseline TFTs, LFTs, and CXR were \nperformed which were all wnl. The propafenone was stopped and we \nstarted amiodarone 400 mg BID until ___, and then 400 mg \ndaily thereafter. He had episodes of asymptomatic bradycardia to \nthe ___ while sleeping so the metoprolol tartrate was decreased \nfrom 50 mg BID to 25 mg BID. He was discharged with ___ of \nHearts monitor and will follow up with Dr. ___. \n. \n# Hypertension: BP was well controlled. We continued finasteride \n5mg daily and decreased lopressor as discussed above. \n. \n# Hyperlipidemia: Continued simvastatin 20mg daily.\n.\n**A copy of this discharge summary was faxed to the patient's \nPCP ___ ", 'medications_prescribed': ['1. metoprolol tartrate 25 mg Tablet Sig: One (1) Tablet PO BID.\nDisp:*60 Tablet(s)* Refills:*0*', '2. finasteride 5 mg Tablet Sig: One (1) Tablet PO DAILY. ', '3. simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY. ', '4. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY. ', '5. amiodarone 400 mg Tablet Sig: One (1) Tablet PO As directed: \nTake 1 tablet TWICE DAILY until ___ and then decrease to 1 \ntablet ONCE DAILY.\nDisp:*40 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 88, 'gender': 'F', 'symptoms': 'fever, cough', 'medical_history': ['Diabetes Mellitus Type II - insulin-dependent', 'CAD - anterior MI ___', 'Hypertrophic obstructive cardiomyopathy', 'Conduction system disease - h/o first degree AV block, RBBB', 'PVD - s/p bilateral BKAs', 'Neuropathic pain after bilateral BKAs', 'Esophageal stricutures', 'Osteoarthritis', '.'], 'family_history': 'non-contributory', 'present_illness': "Mrs. ___ is a very pleasant ___ yo F w/ a hx of DMII (s/p b/l \nBKA), CHF, HTN presenting after falling out of her wheelchair 2 \ndays ago. She notes that when the newly installed washer and \ndryer go on in the apartment below her, she is shaken out of her \nchair (particularly while pt. sleeping in chair). She denied \nLOC, lightheadedness, dizziness, chest pain, palpiations. She \ndoes report ___ days of dry cough, fever noted this morning. \nPatient's househelpedr who comes 7 days/wk has had cough/URTI. \nShe has also noted decreased appetitie and pain with urination. \nPatient was seen in HCA and was noted to have rales on lung exam \nand shortness of breath. He was also concerned that she has had \nmultiple falls from her wheelchair and may be unsafe at home. \n. \nIn ED tmax 100.8 156/71 68 25 95%RA. Patient was given \nlevofloxacin.", 'medications': [{'medication': 'Hydrochlorothiazide', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE MR1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Q4H: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': 'Docusate Sodium', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', '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', 'route': 'PO', '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': 'Lisinopril', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Hydroxychloroquine Sulfate', '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', 'route': 'IV', 'frequency': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.74', 'valuenum': 1.74, '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': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, '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': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '33.8', 'valuenum': 33.8, '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': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55.1', 'valuenum': 55.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, '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': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.93', 'valuenum': 0.93, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.44', 'valuenum': 3.44, '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': '43.3', 'valuenum': 43.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '35', 'valuenum': 35.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, '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': '14', 'valuenum': 14.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 50.0, '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': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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 (eGFR) is likely between 68 and >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': 79.0, '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': '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': '153', 'valuenum': 153.0, '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': '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': 4.1, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, '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': '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': '___', 'valuenum': 4.7, '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': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, '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': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': None, 'valuenum': None, 'valueuom': '/hpf', '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': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TR*.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LG*.'}, {'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': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.038', 'valuenum': 1.038, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, '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': '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '28', 'valuenum': 28.0, '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}, {'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': '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': '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': 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': '2.1', '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': 4.0, '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': '10', 'valuenum': 10.0, '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': 'VS: T: 99.2 BP: 160/54 HR: 88 RR:22 O2 99%RA \nGEN: Thin elderly female \nLUNGS: Mildly tender to palpation over laterally right lower \nribs. No audible rales. \nCV: JVP 10 cm. III/VI SEM at apex \nABD: Soft, nontender, non-distended, no CVA tenderness \nEXTR: bilateral BKA, no edema or skin breakdown. \nNEUOR: Alert and oriented x 2+(knows month but not day).', 'diagnoses': [{'icd_code': 'I63422', 'desc': 'Cerebral infarction due to embolism of left anterior cerebral artery'}, {'icd_code': 'Z9282', 'desc': 'Status post administration of tPA (rtPA) in a different facility within the last 24 hours prior to admission to current facility'}, {'icd_code': 'R4701', 'desc': 'Aphasia'}, {'icd_code': 'G309', 'desc': "Alzheimer's disease, unspecified"}, {'icd_code': 'F0280', 'desc': 'Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}], 'summary': "___ 06:45AM BLOOD WBC-5.8 RBC-3.24* Hgb-9.7* Hct-29.4* \nMCV-91 MCH-29.9 MCHC-32.9 RDW-14.1 Plt ___\n___ 04:00PM BLOOD WBC-7.1 RBC-3.34* Hgb-9.8* Hct-30.3* \nMCV-91 MCH-29.3 MCHC-32.3 RDW-14.0 Plt ___\n___ 09:30PM BLOOD Glucose-168* UreaN-25* Creat-0.9 Na-137 \nK-3.9 Cl-103 HCO3-24 AnGap-14\n___ 10:57PM URINE Color-Yellow Appear-Hazy Sp ___\n___ 10:57PM URINE Blood-TR Nitrite-POS Protein-500 \nGlucose-NEG Ketone-TR Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-MOD\n___ 10:57PM URINE ___ WBC->50 Bacteri-MOD Yeast-NONE \n___\nA/P: \n___ yo F w/ DMII, ___ and b/l BKAs presenting 2 days after fall \nfrom her wheelchair with fever, rales on lung exam. Admitted for \ninfectious workup and placement. \n. \n# Fever: Given clinical picture of shortness of breath and \nunilateral rales, pneumonia was considered in the ED and patient \ngiven levofloxacin. However there was no evidence of pneumonia \non the CXR and symptoms more consistent with viral URTI (per pt. \nher daily helper also with URTI). U/A was grossly positive and \nso patient switched to a 3 day course of Cipro for \nuncomplicated. \n. \n# Cough: Patient's cough most consistent with viral URTI, \nhowever given recent D/C of lasix, elevated JVP and small \neffusion are consistent with mild diastolic heart failure. \nHowever, patient is stable on room air, appears mildly \ndry/dehydrated and no diuresis was indicated. Patient \nprescribed guaifenisin for cough. Patient also evaluated by \nspeech and swallow who noted she had some difficulty with pills. \nThey offered her an outpatient follow up, which she declined. We \nrecommended soft foods.\n. \n# Mechanical fall: No syncopal symptoms, no change in vision. \nHowever, given multiple falls the patient is at risk for injury. \n Patient evaluated by ___ and OT who recommended rehab, but \ndespite fully understanding the risks the patient refused to go \nto rehab. We had our case managers increase her home services.\n. \n# Hyperkalemia: Sample is moderately hemolyzed. EKG done and not \nconcerning for hyperK related changes. Re checked and 3.9, not \nhemolyzed. \n. \n# Hypertension: Continued outpatient Amlodipine and Losartan. \n. \n# DM - Held metformin as inpatient. FSG well controlled on SSI. \n Increased the patient's Gabapentin from BID to TID due to \nworsening of neuropathic pain.\n. \n# GERD: Continued ranitidine.\n. \n# Code: DNR/DNI, confirmed with patient and with PCP. \n. "}}
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{'final_diagnoses': ['Urinary Tract Infection', 'Upper Respiratory Tract Infection', 'Mechanical Fall from wheelchair', 'Hypertension', 'Diabetes type 2', 'Neuropathic Pain'], 'procedures': ['None'], 'visit_summary': "A/P: \n___ yo F w/ DMII, ___ and b/l BKAs presenting 2 days after fall \nfrom her wheelchair with fever, rales on lung exam. Admitted for \ninfectious workup and placement. \n. \n# Fever: Given clinical picture of shortness of breath and \nunilateral rales, pneumonia was considered in the ED and patient \ngiven levofloxacin. However there was no evidence of pneumonia \non the CXR and symptoms more consistent with viral URTI (per pt. \nher daily helper also with URTI). U/A was grossly positive and \nso patient switched to a 3 day course of Cipro for \nuncomplicated. \n. \n# Cough: Patient's cough most consistent with viral URTI, \nhowever given recent D/C of lasix, elevated JVP and small \neffusion are consistent with mild diastolic heart failure. \nHowever, patient is stable on room air, appears mildly \ndry/dehydrated and no diuresis was indicated. Patient \nprescribed guaifenisin for cough. Patient also evaluated by \nspeech and swallow who noted she had some difficulty with pills. \nThey offered her an outpatient follow up, which she declined. We \nrecommended soft foods.\n. \n# Mechanical fall: No syncopal symptoms, no change in vision. \nHowever, given multiple falls the patient is at risk for injury. \n Patient evaluated by ___ and OT who recommended rehab, but \ndespite fully understanding the risks the patient refused to go \nto rehab. We had our case managers increase her home services.\n. \n# Hyperkalemia: Sample is moderately hemolyzed. EKG done and not \nconcerning for hyperK related changes. Re checked and 3.9, not \nhemolyzed. \n. \n# Hypertension: Continued outpatient Amlodipine and Losartan. \n. \n# DM - Held metformin as inpatient. FSG well controlled on SSI. \n Increased the patient's Gabapentin from BID to TID due to \nworsening of neuropathic pain.\n. \n# GERD: Continued ranitidine.\n. \n# Code: DNR/DNI, confirmed with patient and with PCP. \n. ", 'medications_prescribed': ['1. Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '2. Clotrimazole 1 % Cream Sig: One (1) Appl Topical BID (2 times \na day). ', '3. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '4. Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Loperamide 2 mg Capsule Sig: ___ Capsules PO DAILY (Daily) as \nneeded for diarrhea. ', '6. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '7. Losartan 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '8. Guaifenesin 100 mg/5 mL Syrup Sig: ___ MLs PO Q6H (every 6 \nhours) as needed for cough.\nDisp:*500 ML(s)* Refills:*0*', '9. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H \n(every 24 hours) for 2 days.\nDisp:*2 Tablet(s)* Refills:*0*', '10. Metformin 500 mg Tablet Sig: One (1) Tablet PO once a day. ', '11. Flunisolide 25 mcg (0.025 %) Aerosol, Spray Sig: Two (2) \nsprays each nostril Nasal twice a day as needed for nasal \ncongestion. ', '12. Hydroxyzine HCl 10 mg Tablet Sig: One (1) Tablet PO three \ntimes a day as needed for itching. ', '13. Gabapentin 100 mg Capsule Sig: One (1) Capsule PO TID (3 \ntimes a day).\nDisp:*90 Capsule(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['___ muscular dystrophy', 'Bipolar disorder', 'Chronic opioid use with chronic pain', 'Seizure disorder (last seizure ___ years ago)', 'Osteoporosis', 'recent aspiration PNA', 'PUD secondary to NSAIDwith recent UGIB', 'recent acalculous cholecystitis treated with percutaneous cholecystotomy tube on ___', 'ORIF B femur fx ___ PCT placement ___'], 'family_history': 'Non-contributory', 'present_illness': "This is a complicated ___ year old male with multiple medical \nissues including ___ muscular dystrophy with a recent \nhistory of aspiration pneumonia, Upper GI bleed, and acalculous \ncholecystitis. A percutaneous cholecystostomy tube was placed \nfor temporizing treatment of his cholecystitis. He was scheduled \nfor lap cholecystectomy on ___ by Dr. ___ planned surgery \nrescheduled for this admission given recent history of \naspiration pneumonia, successfully treated with IV antibiotics, \nand severe constipation secondary to non-adherence with the \npatient's bowel regimen.", 'medications': [{'medication': 'Aspirin', '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 via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Rosuvastatin Calcium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '42.1', 'valuenum': 42.1, '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': '26.0', 'valuenum': 26.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '222', 'valuenum': 222.0, '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': '5.48', 'valuenum': 5.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, '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': '273', 'valuenum': 273.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, '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': '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': '4.5', 'valuenum': 4.5, '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': 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': '11', 'valuenum': 11.0, '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': '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, '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': '139', 'valuenum': 139.0, '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}, {'value': '41.4', 'valuenum': 41.4, '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': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '215', 'valuenum': 215.0, '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': '5.38', 'valuenum': 5.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T: 99.0 PO, BP: 98/60, HR: 94, RR: 16, SaO2: 94% RA\nGEN: In NAD. \nHEENT: EOMI, PERRL, sclera anicteric, conjunctivae clear, OP \nmoist and without lesion. \nNECK: Supple, no JVD \nCV: RRR S1, S2. No m/r/g. \nCHEST: CTA(B)\nABD: Well approximated incision OTA with staples c/d/i. \nNormoactive BSx4. Soft/NT/ND. \nEXT: No c/c/e. \nSKIN: Small grade 2 decubitus on sacrum; duoderm applied. Skin \notherwise intact.\nNEURO: A+Ox3. Baseline muscle atrophy.', 'diagnoses': [{'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '7812', 'desc': 'Abnormality of gait'}, {'icd_code': '7804', 'desc': 'Dizziness and giddiness'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '78906', 'desc': 'Abdominal pain, epigastric'}], 'summary': '___ 01:33PM ___ PTT-25.8 ___\n___ 01:33PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 01:33PM URINE BLOOD-TR NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 01:33PM URINE ___ BACTERIA-FEW YEAST-NONE \n___\nThe patient was admitted to the General Surgical Service for \nevaluation and treatment. He underwent laparoscopic converted \nto open cholecystectomy due to biliary leak and intraoperative \ncholangiogram on ___, which went well without complication \n(reader referred to the Operative Note for details). After a \nbrief, uneventful stay in the PACU, the patient arrived on the \nfloor on IV fluids, with a foley catheter and JP drain in place, \nable to take clear liquids, and a Bupivucaine erpidural and IV \nDilaudid for pain control. Acute Pain Service (APS) follwed the \npatient closely for pain control issues, adjusting the pain \nregimen, icluding adding a IV Ketamine infusion with adequate \npain control. The patient was hemodynamically stable.\n\n___: Patient experinced ongoing isssues with pain \ncontrol; Lyrica added on ___. Ultimately, patient was brought \nto PACU and epidural replaced and a Dilaudid PCA added. Ketamine \ninfusion continued. Pain control improved. Hemodynamically \nstable.\n___: Pan-cultured for fever. KUB/upright revealed dilated \ngastric bubble; patient refused miralax, enemas. CXR \nunremarkable. Started presumptively on IV Ancef for minimal \nincision line erythema. Ketamineinfusion discontinued due to \nsedation. Out of bed to chair. Physical Therapy consulted.\n___: Repeat abdominal x-ray unremarkable; no obstruction. \nDilaudid PCA and epidural discontinued; IV Dilaudid PRN with \ngood pain control. Clear diet with good tolerability. \nNon-adherent with bowel regimen. Foley discontinued; voided \nwithout problem.\n___: Fleets enema ordered, but refused. Tolerated regular \ndiet. Duplex U/S for minimal (L) arm swelling unremarkable, \nrevealed no DVT. JP discontinued. No events.\n___: Small grade ___ sacral decubitus noted; duoderm placed. \nRepositioning and out of bed encouraged. Tolerating regular \ndiet. Flatus, but no bowel movement; continued to decline enema \nor Miralax. Voiding without problem. Afebrile with stable vital \nsigns. Pain controlled home home regimen. Ready for discharge to \nassisted living facility.'}}
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{'final_diagnoses': ['Cholelithiasis', 'prior cholecystitis'], 'procedures': ['Laparoscopic converted to open cholecystectomy, intraoperative cholangiogram ___'], 'visit_summary': 'The patient was admitted to the General Surgical Service for \nevaluation and treatment. He underwent laparoscopic converted \nto open cholecystectomy due to biliary leak and intraoperative \ncholangiogram on ___, which went well without complication \n(reader referred to the Operative Note for details). After a \nbrief, uneventful stay in the PACU, the patient arrived on the \nfloor on IV fluids, with a foley catheter and JP drain in place, \nable to take clear liquids, and a Bupivucaine erpidural and IV \nDilaudid for pain control. Acute Pain Service (APS) follwed the \npatient closely for pain control issues, adjusting the pain \nregimen, icluding adding a IV Ketamine infusion with adequate \npain control. The patient was hemodynamically stable.\n\n___: Patient experinced ongoing isssues with pain \ncontrol; Lyrica added on ___. Ultimately, patient was brought \nto PACU and epidural replaced and a Dilaudid PCA added. Ketamine \ninfusion continued. Pain control improved. Hemodynamically \nstable.\n___: Pan-cultured for fever. KUB/upright revealed dilated \ngastric bubble; patient refused miralax, enemas. CXR \nunremarkable. Started presumptively on IV Ancef for minimal \nincision line erythema. Ketamineinfusion discontinued due to \nsedation. Out of bed to chair. Physical Therapy consulted.\n___: Repeat abdominal x-ray unremarkable; no obstruction. \nDilaudid PCA and epidural discontinued; IV Dilaudid PRN with \ngood pain control. Clear diet with good tolerability. \nNon-adherent with bowel regimen. Foley discontinued; voided \nwithout problem.\n___: Fleets enema ordered, but refused. Tolerated regular \ndiet. Duplex U/S for minimal (L) arm swelling unremarkable, \nrevealed no DVT. JP discontinued. No events.\n___: Small grade ___ sacral decubitus noted; duoderm placed. \nRepositioning and out of bed encouraged. Tolerating regular \ndiet. Flatus, but no bowel movement; continued to decline enema \nor Miralax. Voiding without problem. Afebrile with stable vital \nsigns. Pain controlled home home regimen. Ready for discharge to \nassisted living facility.', 'medications_prescribed': ['Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).', 'Lamotrigine 100 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily).', 'Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day).', 'Risperidone 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Quetiapine 100 mg Tablet Sig: One (1) Tablet PO QHS (once a \nday (at bedtime)).', 'Celexa 40 mg Tablet Sig: One (1) Tablet PO once a day.', 'Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical TID \n(3 times a day).', 'Clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO TID (3 times \na day).', 'Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H \n(every 6 hours) as needed for fever or pain.', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours).', 'Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 \ntimes a day).', 'Bisacodyl 5 mg Tablet Sig: ___ Tablets PO once a day as \nneeded for constipation.', 'Morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO Q8H (every 8 hours).', 'Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day.', 'Polyethylene Glycol 3350 100 % Powder Sig: Seventeen (17) gm \nin 8oz water or juice PO DAILY (Daily) as needed for \nconstipation.', 'Seroquel 100 mg Tablet Sig: One (1) Tablet PO at bedtime.', 'Trazodone 50 mg Tablet Sig: 1.5 Tablets PO at bedtime as \nneeded for insomnia.', 'Hydromorphone 4 mg Tablet Sig: One (1) Tablet PO every ___ \nhours as needed for pain.', 'Lyrica 50 mg Capsule Sig: One (1) Capsule PO three times a \nday.', 'Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8) \nhours as needed for nausea.', 'Keflex ___ mg Capsule Sig: One (1) Capsule PO four times a \nday for 7 days.\nDisp:*28 Capsule(s)* Refills:*0*', 'Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Positive blood cultures', 'medical_history': ['DM type 1', 'Gastroparesis', 'ESRD s/p LRRT ___ (baseline Cr 0.8 - 1.0)', 'HTN', 'Hypercholesterolemia', 'CAD s/p NSTEMI ___', 'GERD'], 'family_history': '+ for DM, HTN, and renal dz', 'present_illness': '___ h/o CKD (s/p renal transplant ___, T1DM, HTN, CAD, and \nfoot \nulcer who presented to the ED 2 days ago with chest pain and \nrigors following debridement of foot ulcer by podiatrist. \nPatient was admitted to the medicine floor (SIRS1) and treated \nfor presumed bacteremia with broad spectrum antibiotics \n(Vanc/unasyn overnight), and discharged on Augmentin with blood \nand urine cultures pending and with the understanding that if \ncultures grew bacteria, he would have to return for IV \nantibiotics. \n \nToday, blood cultures returned positive with GPC in pairs and \nclusters and patient was called back to the hospital for \ncontinued IV antibiotic therapy.\n \nOn the floor, patient reports feeling well and has been \nasymptomatic since discharge yesterday. \n \nOn ROS, he denies cough, shortness of breath, N/V/D, \nconstipation or abdominal pain. No recent change in bowel or \nbladder habits. No dysuria. No edema or orthopnea.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q5MIN:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', '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': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q24H', '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': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine SR (MS Contin)', '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': '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': 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': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QTHUR', 'doses_per_24_hrs': 0.0}]}, '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, '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': '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': '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': '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': '___', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '37.4', 'valuenum': 37.4, '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': '31.4', 'valuenum': 31.4, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '271', 'valuenum': 271.0, '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': '4.09', 'valuenum': 4.09, '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': '13', 'valuenum': 13.0, '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': '9.1', 'valuenum': 9.1, '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '35.1', 'valuenum': 35.1, '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': '31.3', 'valuenum': 31.3, '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': '93', 'valuenum': 93.0, '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': 440.0, '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': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION:\nVitals: T 97.6 139/55 62 18 100RA FS216\nGeneral: well-appearing man, wearing street clothes, sitting \ncomfortably with his wife\n___ anicteric, MMM, oropharynx clear \nLungs: CTAB\nCV: RRR, no m/r/g\nAbdomen: soft, non-tender, non-distended \nExt: warm, no edema, left foot with dressing in place \n \nDISCHARGE:\nVitals: 98.6 98.3 120/50 57 98onRA ___ 143\nI/O: 860/BRP\nGeneral: well-appearing man, wearing street clothes, sitting in \nchair.\n___: Sclera anicteric, MMM, oropharynx clear \nLungs: CTAB\nCV: RRR, no m/r/g\nAbdomen: soft, non-tender, non-distended \nExt: warm, no edema, left foot with dressing in place; R leg \nsoft, nontender to palpation; 1+ R DP pulse.', 'diagnoses': [{'icd_code': '73313', 'desc': 'Pathologic fracture of vertebrae'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}], 'summary': 'ADMISSION LABS:\n___ 07:05AM BLOOD WBC-4.1 RBC-3.55* Hgb-11.3* Hct-35.3* \nMCV-100* MCH-31.9 MCHC-32.0 RDW-13.3 Plt ___\n___ 01:15PM BLOOD Neuts-61 Bands-9* Lymphs-16* Monos-3 \nEos-4 Baso-1 Atyps-6* ___ Myelos-0\n___ 01:15PM BLOOD Hypochr-2+ Anisocy-1+ Poiklo-1+ \nMacrocy-1+ Microcy-1+ Polychr-OCCASIONAL Ovalocy-1+ Tear \n___\n___ 07:05AM BLOOD Glucose-430* UreaN-25* Creat-1.0 Na-134 \nK-4.5 Cl-98 HCO3-23 AnGap-18\n___ 07:05AM BLOOD Calcium-8.6 Phos-3.1 Mg-2.0\n___ 07:05AM BLOOD Cyclspr-147\n \nDISCHARGE LABS:\n___ 07:10AM BLOOD WBC-6.2 RBC-3.35* Hgb-10.6* Hct-32.0* \nMCV-96 MCH-31.5 MCHC-33.0 RDW-13.2 Plt ___\n___ 03:35PM BLOOD ESR-16*\n___ 07:10AM BLOOD Glucose-125* UreaN-23* Creat-0.9 Na-136 \nK-5.2* Cl-102 HCO3-26 AnGap-13\n___ 07:10AM BLOOD Calcium-9.2 Phos-3.4 Mg-1.9\n___ 03:08PM BLOOD %HbA1c-8.4* eAG-194*\n___ 03:35PM BLOOD CRP-6.8*\n \nMICROBIOLOGY;\n___ 12:15 pm BLOOD CULTURE\n\n Blood Culture, Routine (Preliminary): \n GRAM POSITIVE COCCUS(COCCI). POSSIBLE ANAEROBE. \n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS.\n \nIMAGING:\n___ 2:53 ___ Chest x-ray\nThe cardiac, mediastinal and hilar contours are unchanged, with \nthe heart size within normal limits. Metallic stent is again \nnoted in the region of the SVC and right brachiocephalic vein, \nunchanged. Lungs are clear. Pulmonary vascularity is normal. \nThere is mild hyperinflation of the lungs with flattening of the \n\ndiaphragms. No pleural effusion or pneumothorax is seen. There \n\nare no acute osseous abnormalities. \n \n___ 2:51 ___ ANKLE (AP, MORTISE & LAT) LEFT\nSite of ulceration is not indicated and not clearly evident on \nthese views. Allowing for this, no findings definitive for \nosteomyelitis are identified. Note is made of an old ununited \nnon-displaced fracture of the distal fibula and some \nnon-aggressive periosteal new bone formation along the distal \ntibial medial metaphysis, which likely represents a chronic \nfinding. Mild soft tissue swelling and dense vascular \ncalcification is present. Clustered phleboliths projecting \nalong the posteromedial ankle could reflect a small soft tissue \nhemangioma. Mild prominence of the distal Achilles tendon at \nthe level of the posterosuperior calcaneus most likely reflects \nmild tendinopathy.\n \n___ 6:46 ___ FOOT AP,LAT & OBL LEFT\nAtherosclerotic vascular calcifications. Rounded calcific \ndensities are seen along the posteromedial aspect of the foot, \nwhich may be vascular in nature. Mild diffuse soft tissue \nswelling. No ulcers identified. No evidence for cortical \ndestruction or erosion. No evidence for focal cortical \nthickening. No evidence for periostitis. No acute fracture or\ndislocation. Bipartite medial sesamoid.\n___ year-old male with Type I DM, ESRD s/p LRRT in ___, CAD, and \nhypertension, readmitted ___ positive blood cultures from \n___ following brief hospitalization for transient rigors and \nchest pain following foot ulcer debridement.\n \n#Bacteremia: Patient was asymptomatic and appeared stable and \nnot septic. No leukocytosis or L shift noted on CBC. Blood \ncultures from ___ grew GPCs slowly in the anerobic bottle, \ntherefore no sensitivities had returned at the time of \ndischarge. Surveillance blood cultures to date have been no \ngrowth. The cultures were re-plated twice with little yield. \nInfectious disease was consulted, who recommended inflammatory \nmarkers including ESR and CRP, and a foot film, which was \nunremarkable. He was treated empirically with IV vancomycin for \nseveral days and transitioned back to augmentin upon discharge, \nwhich will finish a 14 day course from his first day of negative \nblood cultures, through ___. \n \n# DM-1: Patient had very brittle sugars, which he manages well \nbased on personal complex regimen. This DM-1 is complicated by \nPVD, chronic wounds, and ?neuropathy. Given the brittle blood \nsugars his regimen was changed from ___ of Lantus to ___ of \nlantus for a better basal insulin rate while in house. He will \nreturn to his usual insulin dosing on discharge.\n \n# Claudication: Patient came in complaining of cramping \nsensation of R calf which has been a chronic issue and has \nalways been exacerbated with exertion and when lying in bed. He \nis followed by vascular surgery. Pt was concerned that this was \nrelated to "bulging discs" but straight leg raise was negative \nfor radicular pain; pain described as spasmodic versus nerve \npain. He was given tylenol and his home dose of gabapentin. Had \nno pain after the first day of admission.\n \n# GERD: He was continued on home PPI and ranitidine\n \n# Gastroparesis: patient reported being asymptomatic from this \nsince his renal transplantation, but is continued on medications \nper recs of his doctors. ___ he was continued on \nmetoclopramide\n \n# ESRD s/p Transplant: This was stable so he was maintained on \nhis home doses of cyclosporine and mycophenolate.\n \n# PVD and wounds: Wound care was consulted and gave \nrecommendation while inhouse during prior admission. Nurse \ninstructed to consult these notes in wound care. A foot and \nankle x-ray was done to assess for possible deeper infection of \nthe wound, but was negative for osteomyelitis. His daily \ndressing changes as below, as per wound care:\n1. cleanse skin/ulcer with wound cleanser \n2. then pat dry\n3. apply aloe vesta moisturizer to intact dry skin\n4. cover wound with aquacel ag sheet - ___ piece to fit\nfollowed by dry gauze then softsorb( if needed for increased\ndrainage )\n5. secure with stretch gauze then light ACE wrap if needed to\nprevent dressing from falling off\nchange daily\n \n#HTN: Continued home meds\n \nTRANSITION OF CARE\nThe patient was re-admitted because his blood culture grew out \ngram-positive cocci. Therefore, he was treated with vancomycin \nfor 3 days while in the hospital adn transitioned to augmentin \nto complete a 14-day antibiotic therapy. He continued to be \nhemodynamically stable until discharge.'}}
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{'final_diagnoses': ['Transient bacteremia', 'Diabetes mellitus', 'ESRD s/p LRRT'], 'procedures': ['None'], 'visit_summary': '___ year-old male with Type I DM, ESRD s/p LRRT in ___, CAD, and \nhypertension, readmitted ___ positive blood cultures from \n___ following brief hospitalization for transient rigors and \nchest pain following foot ulcer debridement.\n \n#Bacteremia: Patient was asymptomatic and appeared stable and \nnot septic. No leukocytosis or L shift noted on CBC. Blood \ncultures from ___ grew GPCs slowly in the anerobic bottle, \ntherefore no sensitivities had returned at the time of \ndischarge. Surveillance blood cultures to date have been no \ngrowth. The cultures were re-plated twice with little yield. \nInfectious disease was consulted, who recommended inflammatory \nmarkers including ESR and CRP, and a foot film, which was \nunremarkable. He was treated empirically with IV vancomycin for \nseveral days and transitioned back to augmentin upon discharge, \nwhich will finish a 14 day course from his first day of negative \nblood cultures, through ___. \n \n# DM-1: Patient had very brittle sugars, which he manages well \nbased on personal complex regimen. This DM-1 is complicated by \nPVD, chronic wounds, and ?neuropathy. Given the brittle blood \nsugars his regimen was changed from ___ of Lantus to ___ of \nlantus for a better basal insulin rate while in house. He will \nreturn to his usual insulin dosing on discharge.\n \n# Claudication: Patient came in complaining of cramping \nsensation of R calf which has been a chronic issue and has \nalways been exacerbated with exertion and when lying in bed. He \nis followed by vascular surgery. Pt was concerned that this was \nrelated to "bulging discs" but straight leg raise was negative \nfor radicular pain; pain described as spasmodic versus nerve \npain. He was given tylenol and his home dose of gabapentin. Had \nno pain after the first day of admission.\n \n# GERD: He was continued on home PPI and ranitidine\n \n# Gastroparesis: patient reported being asymptomatic from this \nsince his renal transplantation, but is continued on medications \nper recs of his doctors. ___ he was continued on \nmetoclopramide\n \n# ESRD s/p Transplant: This was stable so he was maintained on \nhis home doses of cyclosporine and mycophenolate.\n \n# PVD and wounds: Wound care was consulted and gave \nrecommendation while inhouse during prior admission. Nurse \ninstructed to consult these notes in wound care. A foot and \nankle x-ray was done to assess for possible deeper infection of \nthe wound, but was negative for osteomyelitis. His daily \ndressing changes as below, as per wound care:\n1. cleanse skin/ulcer with wound cleanser \n2. then pat dry\n3. apply aloe vesta moisturizer to intact dry skin\n4. cover wound with aquacel ag sheet - ___ piece to fit\nfollowed by dry gauze then softsorb( if needed for increased\ndrainage )\n5. secure with stretch gauze then light ACE wrap if needed to\nprevent dressing from falling off\nchange daily\n \n#HTN: Continued home meds\n \nTRANSITION OF CARE\nThe patient was re-admitted because his blood culture grew out \ngram-positive cocci. Therefore, he was treated with vancomycin \nfor 3 days while in the hospital adn transitioned to augmentin \nto complete a 14-day antibiotic therapy. He continued to be \nhemodynamically stable until discharge.', 'medications_prescribed': ['Ascorbic Acid ___ mg PO DAILY', 'Aspirin 325 mg PO DAILY', 'Atorvastatin 80 mg PO HS', 'CycloSPORINE (Neoral) MODIFIED 550 mg PO QHS', 'Gabapentin 1200 mg PO TID', 'Lisinopril 30 mg PO DAILY', 'Metoclopramide 10 mg PO QIDACHS', 'Mycophenolate Mofetil 1000 mg PO BID', 'Omeprazole 20 mg PO DAILY', 'Ranitidine 150 mg PO DAILY', 'Vitamin D 400 UNIT PO DAILY', 'Amoxicillin-Clavulanic Acid ___ mg PO Q12H \nRX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet(s) by \nmouth twice a day Disp #*20 Tablet Refills:*0', 'Levemir *NF* (insulin detemir) 18 units Subcutaneous qam', 'Levemir *NF* (insulin detemir) 12 units SUBCUTANEOUS QPM', 'HumaLOG *NF* (insulin lispro) ___ units SUBCUTANEOUS ASDIR']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 64, 'gender': 'M', 'symptoms': 'Dizziness, Blurry Vision', 'medical_history': ['PAST ONCOLOGIC HISTORY (per OMR):\n- Mantle Cell Lymphoma\n- ___: Develops worsening of lower back pain radiating to the\nmid-posterior thigh, which had been present at a lower level for\n___ years. \n- ___: MRI lumbar spine performed for evaluation of lower \nback\npain. This reveals bulky retroperitoneal lymphadenopathy, only\npartially seen, with two areas of abnormal marrow signal\nconcerning for marrow infiltrative processes. \n- ___: CT abdomen/pelvis reveals extensive abdominal\nlymphadenopathy concerning for leukemia/lymphoma, CLL favored,as\nwell as splenomegaly to 17.4 cm with peripheral wedge-shaped\nhypodensities concerning for infarcts, bladder wall thickening,\nand prostatomegaly.\n- ___: LDH 198, HBV serologies negative, HIV antibody\nnegative. \n- ___: Initial Hematology/Oncology evaluation by Dr.\n___. Bone marrow biopsy reveals involvement by Mantle Cell\nLymphoma, with t(11;14) present by ___. \n- ___: PET shows extensive FDG-avid lymphadenopathy in the\nright cervical, mediastinal, abdominal, and pelvic regions,\nsplenomegaly to 18 cm with SUVmax 4.2, and mild FDG avidity of a\nsingle right inguinal lymph node.', 'PAST MEDICAL HISTORY:\n- Alcohol use \n- Tobacco use \n- Low back pain \n- Hypertension \n- Peptic ulcer disease \n- Left knee replacement ___'], 'family_history': 'Father died of a stroke at age ___. Mother is still alive and \ndoes\nhave some heart condition, but he is unaware of the specific\ndiagnosis. Has two sisters and one brother, who are all healthy.', 'present_illness': '___ yo male with a newly diagnosed mantle cell lymphoma who is \nadmitted with blurry vision and unsteadiness. The patient states \nhe has been having intermittent blurry vision and unsteadiness \nfor about three weeks but it has gotten more severe and frequent \nin the last few days. He also notes feeling dizzy and \nlightheaded intermittently. He denies any specific areas of \nweakness. He denies any fevers, shortness of breath, nausea, \ndiarrhea, or rashes. \nHe was seen in clinic where an LP and head CT were done. The \nhead CT was unremarkable. The decision was made to admit him for \nfurther workup of his neurological symptoms.', 'medications': [{'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Cyclobenzaprine', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Morphine Sulfate', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Simvastatin', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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': 'Inactive (Due to a change order)', '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': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DINNER', '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': 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}]}, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '0.73', 'valuenum': 0.73, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '44.0', 'valuenum': 44.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.2', 'valuenum': 33.2, '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': '219', 'valuenum': 219.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, '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': 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': '8.8', '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': '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': 73.0, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '14', 'valuenum': 14.0, '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': '12.7', 'valuenum': 12.7, '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': '33.5', 'valuenum': 33.5, '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': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.83', 'valuenum': 3.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, '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': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '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': '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': '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': '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': '142', 'valuenum': 142.0, '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}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nGeneral: NAD\nVITAL SIGNS: T 98.5 BP 147/83 HR 88 RR 18 O2 97%RA\nHEENT: MMM, no OP lesions\nCV: RR, NL S1S2\nPULM: CTAB\nABD: Soft, nondistended.\nLIMBS: No edema, clubbing, tremors, or asterixis\nSKIN: No rashes or skin breakdown\nNEURO: Alert and oriented, no focal deficits. Cranial nerves\nII-XII are within normal limits excluding visual acuity which \nwas\nnot assessed, no nystagmus.\n\nDISCHARGE PHYSICAL EXAM:\n=========================\nGeneral: NAD\nVITAL SIGNS: T:98.5 P:70 RR:18 POx:95 Ra \n130/84 Lying P:70\n110/63: Sitting P:66\n109/72: Standing P:70\nHEENT: MMM, PERRLA, EOMI, No eyelid lesions, no OP lesions, no\nscleral icterus. \nCV: RR, NL S1S2\nPULM: CTAB, no wheezes rales or rhonchi. Breathing comfortably\nwithout the use of accessory muscles. \nABD: Soft, nondistended, RLQ tenderness to palpation.\nLIMBS: No edema, clubbing, tremors, or asterixis. Left shoulder\nwith reduced range of overhead motion. Tenderness with empty can\ntest\nSKIN: No rashes or skin breakdown\nNEURO: Alert and oriented, no focal deficits. Cranial nerves\nII-XII are within normal limits excluding visual acuity which \nwas\nnot assessed, no nystagmus. Finger to nose in tact. Heel to shin\ndeferred per patient on left side due to knee pain. Rapid\nalternating movements in tact. Finger tapping in tact. No\npronator drift. Strength and sensation intact in upper and lower\nextremities. \n\nEYE EXAM: ___\n=================\nVisual Acuity;\nOD (sc): ___ pinholes to ___\nOS (sc): ___\n\nMental status: Alert and oriented x 3\n\nPupils (mm)\nRelative afferent pupillary defect: [ x ] none [ ] present\n OD: 4->2\n OS: 4->2\n\nExtraocular motility: Full ___\n\nVisual fields by confrontation: Full to counting fingers ___\n\nColor Vision (___ pseudo-isochromatic plates): \n OD: ___\n OS: ___\n\nIntraocular pressure (mm Hg):\nOD: 13\nOS: 12\n\nExternal Exam: [x ] NL\nNo V1 or V2 hypesthesia\nOrbital rim palpation: No point-tenderness, deformities, and\nstep-offs ___\n\nAnterior Segment (Penlight or portable slitlamp)\nLids/Lashes/Lacrimal: \n OD: Normal \n OS: Normal\nConjunctiva: \n OD: White and quiet \n OS: White and quiet\nCornea: \n OD: Clear, no epithelial defects \n OS: Clear, no epithelial defects\nAnterior Chamber: \n OD: Deep and quiet \n OS: Deep and quiet\n___: \n OD: Flat \n OS: Flat\nLens: \n OD: 2+ milky nuclear sclerosis\n OS: trace nuclear sclerosis\n\nFundus (Indirect Ophthalmoscopy using 20D lens): Dilation\napproved by \nPLEASE NOTE, PUPILS WILL REMAIN DILATED FOR AT LEAST ___ HRS\n\nMedia/Vitreous: \nOD: Clear\nOS: Clear \nDiscs: \nOD: pink, sharp margins\nOS: pink, sharp margins\nMaculae: \nOD: flat, normal foveal light reflex\nOS: flat, normal foveal light reflex\nPeriphery\nOD: no heme, breaks or other notable lesions\nOS: no heme, breaks or other notable lesions', 'diagnoses': [{'icd_code': '5579', 'desc': 'Unspecified vascular insufficiency of intestine'}, {'icd_code': '5781', 'desc': 'Blood in stool'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '33819', 'desc': 'Other acute pain'}, {'icd_code': '78904', 'desc': 'Abdominal pain, left lower quadrant'}, {'icd_code': '5641', 'desc': 'Irritable bowel syndrome'}, {'icd_code': '72210', 'desc': 'Displacement of lumbar intervertebral disc without myelopathy'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '71940', 'desc': 'Pain in joint, site unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V1271', 'desc': 'Personal history of peptic ulcer disease'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V1272', 'desc': 'Personal history of colonic polyps'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}, {'icd_code': '71690', 'desc': 'Arthropathy, unspecified, site unspecified'}, {'icd_code': '33394', 'desc': 'Restless legs syndrome (RLS)'}], 'summary': "ADMISSION LABS:\n===============\nWBC-7.3 RBC-4.12* Hgb-13.8 Hct-39.5* MCV-96 MCH-33.5* MCHC-34.9 \nRDW-12.9 RDWSD-45.3 Plt ___\nNeuts-53 Bands-0 ___ Monos-11 Eos-2 Baso-0 ___ Metas-0 \nMyelos-0 AbsNeut-3.87 AbsLymp-2.48 AbsMono-0.80 AbsEos-0.15 \nAbsBaso-0.00*\nHypochr-NORMAL Anisocy-NORMAL Poiklo-NORMAL Macrocy-NORMAL \nMicrocy-NORMAL Polychr-NORMAL\nUreaN-17 Creat-0.8 Na-142 K-4.3 Cl-102 HCO3-28 AnGap-12\nALT-12 AST-15 LD(LDH)-196 AlkPhos-69 TotBili-0.4\nTotProt-7.0 Albumin-4.5 Globuln-2.5 Calcium-9.2 Phos-3.0 Mg-2.3 \nUricAcd-5.3\nVitB12-335 Folate-10\n%HbA1c-5.8 eAG-120\n\nDISCHARGE LABS:\n===============\nWBC-5.9 RBC-4.21* Hgb-13.9 Hct-40.9 MCV-97 MCH-33.0* MCHC-34.0 \nRDW-12.7 RDWSD-45.4 Plt ___\nGlucose-102* UreaN-20 Creat-0.7 Na-144 K-4.3 Cl-102 HCO3-25 \nAnGap-17*\nCalcium-9.1 Phos-3.5 Mg-2.2\n\nIMAGING:\n========\nCT HEAD NON-CONTRAST ___\nIMPRESSION: \n1. No acute intracranial abnormality on noncontrast head CT. \nSpecifically no evidence of large territory infarct or \nintracranial hemorrhage. \n2. Please note, if there are no contraindications, MRI with \nwithout contrast would be more sensitive for intracranial \nlesions. \n\nMRI HEAD With and Without Contrast ___\nIMPRESSION: \n1. No acute intracranial process such as acute hemorrhage or \ninfarct. No \nevidence to suggest CNS lymphoma. \n2. No abnormal intracranial enhancement after contrast \nadministration. \n3. Additional findings as described above.\nMr. ___ is a ___ year-old male with newly diagnosed mantle \ncell lymphoma who is admitted with blurry vision and \nunsteadiness concerning for CNS involvement found to have ___ \nvision and a cataract in his right eye and orthostasis.\n\n# Blurry Vision: Initially the patient's blurry vision was \nconcerning for central nervous system involvement of his mantle \ncell lymphoma. The patient underwent lumbar puncture in the \nclinic on ___, and initial flow cytometry was non-diagnostic. \nOphthalmology was consulted on ___ found cataract on right \neye, and ___ vision on right eye. Neurology was consulted, who \ndid not feel the patient's blurry vision was attributable to a \nneurological pathology. MRI and CT head were unremarkable. The \npatient's vision improved with refraction. Please schedule an \nappointment with optometry as an outpatient for refraction. \nThen, optometry can refer back to ophthalmology for cataract \nevaluation once the cataract progresses and becomes visually \nsignificant with correction. The patient was also provided with \nartificial tears for symptomatic dry eye. Upon discharge, the \npatient was able to read and watch television. He was not \nexperiencing any double vision. \n\n# Unsteadiness: The etiology of the patient's weakness was \nmultifactorial. There was initial concern for CNS involvement of \nlymphoma, and therefore a lumbar puncture was performed (final \ncytology results pending, although flow non-diagnostic and \nimaging including MRI unremarkable). The patient endorsed \nworsening dizziness upon standing, which would resolve, which \nwas consistent with orthostasis. This was supported by \northostatic vital signs on ___, which showed a 20-point drop in \nsystolic blood pressure from sitting to standing. ___ \nmetoprolol could also contribute to symptoms of orthostasis \ngiven blunted HR response. The patient's blood pressure regimen \nshould be re-evaluated in the outpatient setting. Neurology was \nconsulted, and recommended outpatient tilt table test if the \npatient still felt dizzy in the absence of orthostasis. CT head, \nand MRI head were unremarkable. B12, folate and HgbA1c were all \nwithin normal limits. The patient was recommended to use \ncompression stockings, avoid rising from sitting to standing too \nquickly, and to drink at least 1L of water daily. The patient \nwas evaluated by physical therapy, who felt the patient was safe \nto ambulate without assistance, and recommended discharge to \n___. \n\n# Mantle Cell Lymphoma: New diagnosis, not started on treatment \nyet. The patient was seen by his outpatient oncologist while \nadmitted, and will plan to see Dr. ___ in clinic on \n___. Upon discharge, the cytology results are still \npending."}}
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{'final_diagnoses': ['Mantle Cell Lymphoma', 'Cataracts', 'Orthostasis', 'Hypertension', 'Tobacco Use', 'Peptic Ulcer Disease'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ year-old male with newly diagnosed mantle \ncell lymphoma who is admitted with blurry vision and \nunsteadiness concerning for CNS involvement found to have ___ \nvision and a cataract in his right eye and orthostasis.\n\n# Blurry Vision: Initially the patient's blurry vision was \nconcerning for central nervous system involvement of his mantle \ncell lymphoma. The patient underwent lumbar puncture in the \nclinic on ___, and initial flow cytometry was non-diagnostic. \nOphthalmology was consulted on ___ found cataract on right \neye, and ___ vision on right eye. Neurology was consulted, who \ndid not feel the patient's blurry vision was attributable to a \nneurological pathology. MRI and CT head were unremarkable. The \npatient's vision improved with refraction. Please schedule an \nappointment with optometry as an outpatient for refraction. \nThen, optometry can refer back to ophthalmology for cataract \nevaluation once the cataract progresses and becomes visually \nsignificant with correction. The patient was also provided with \nartificial tears for symptomatic dry eye. Upon discharge, the \npatient was able to read and watch television. He was not \nexperiencing any double vision. \n\n# Unsteadiness: The etiology of the patient's weakness was \nmultifactorial. There was initial concern for CNS involvement of \nlymphoma, and therefore a lumbar puncture was performed (final \ncytology results pending, although flow non-diagnostic and \nimaging including MRI unremarkable). The patient endorsed \nworsening dizziness upon standing, which would resolve, which \nwas consistent with orthostasis. This was supported by \northostatic vital signs on ___, which showed a 20-point drop in \nsystolic blood pressure from sitting to standing. ___ \nmetoprolol could also contribute to symptoms of orthostasis \ngiven blunted HR response. The patient's blood pressure regimen \nshould be re-evaluated in the outpatient setting. Neurology was \nconsulted, and recommended outpatient tilt table test if the \npatient still felt dizzy in the absence of orthostasis. CT head, \nand MRI head were unremarkable. B12, folate and HgbA1c were all \nwithin normal limits. The patient was recommended to use \ncompression stockings, avoid rising from sitting to standing too \nquickly, and to drink at least 1L of water daily. The patient \nwas evaluated by physical therapy, who felt the patient was safe \nto ambulate without assistance, and recommended discharge to \n___. \n\n# Mantle Cell Lymphoma: New diagnosis, not started on treatment \nyet. The patient was seen by his outpatient oncologist while \nadmitted, and will plan to see Dr. ___ in clinic on \n___. Upon discharge, the cytology results are still \npending.", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild', 'Gabapentin 900 mg PO TID', 'Hydrochlorothiazide 25 mg PO DAILY', 'Metoprolol Succinate XL 100 mg PO DAILY', 'Nicotine Patch 21 mg TD DAILY', 'Omeprazole 40 mg PO DAILY', 'TraMADol 100 mg PO Q12H:PRN Pain - Moderate']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 66, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['CARDIAC RISK FACTORS', '- Diabetes', '- Hypertension', '- Dyslipidemia', 'CARDIAC HISTORY', '- No known cardiac history', 'OTHER PAST MEDICAL HISTORY', '- CKD'], 'family_history': 'Father had open heart surgery\nSister had MI\nBrother had CHF', 'present_illness': '___ is a ___ PMH HTN, HLD, CKD, DM who presented to ___ on ___ with chest pain. He \nreports that the chest pain started on ___ when he was \nunloading groceries from the car. He then sat down and ate a \nmeal and was still having chest pressure but thought it was just \nindigestion. He then vomited a couple times with worsening CP so \ndecided to present to the hospital. \n\nAt ___ he was found to have a Trop-I of 0.938, ST elevations in \nV4, and pulmonary edema by CXR, so he went for cardiac cath. The \ncath showed multivessel disease and the patient was difficult to \noxygenate so the decision was made to transfer him to ___ for \nfurther management. He was also given ASA 324mg, Ticagrelor \n180mg PO, and was started on a hep gtt and a nitro gtt. For his \nhypoxemia he was requiring BiPAP but was weaned to NC prior to \narrival at ___. \n \nVitals on transfer: \nT98.4 BP140s/50s-70s HR70s-80s 95%5LNC\n \nOn arrival to the CCU: The patient was in stable condition. He \nwas on 5LNC. He endorsed mild chest pressure that was improved \nsince presenting to ___. He denied any nausea, SOB, abdominal \npain.', 'medications': [{'medication': 'Levothyroxine Sodium', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', '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': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', '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': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Pneumococcal Vac Polyvalent', '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': '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': 'Lisinopril', '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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Rosuvastatin Calcium', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyanocobalamin', '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: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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.0', 'valuenum': 34.0, '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': '8.8', 'valuenum': 8.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.2', 'valuenum': 51.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, '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': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '148', 'valuenum': 148.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '56', 'valuenum': 56.0, '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': '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': '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': '100', 'valuenum': 100.0, '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': 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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1959', 'valuenum': 1959.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.53', 'valuenum': 3.53, '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}, {'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': '21', 'valuenum': 21.0, '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': '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': '___', 'valuenum': 81.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '3.6', 'valuenum': 3.6, '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': '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': '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': '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': 94.0, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, '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': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 95.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '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': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/lpf', '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': 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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.025', 'valuenum': 1.025, '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': 'OCC.'}, {'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': 'POS', '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': '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', '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': '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': 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': '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': '2.9', 'valuenum': 2.9, '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, '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': '33.7', 'valuenum': 33.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.08', 'valuenum': 3.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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}], 'exams': 'ADMISSION PHYSICAL EXAM\n========================\nVS: T98.4 BP140s/50s-70s HR70s-80s 95%4LNC \n___: Well developed, well nourished in NAD. Oriented x3. \nMood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. \nConjunctiva were pink. No pallor or cyanosis of the oral mucosa. \nNECK: Supple \nCARDIAC: Difficult to hear heart sounds with balloon pump going \nLUNGS: No chest wall deformities or tenderness. Respiration is \nunlabored with no accessory muscle use. Diffuse bilateral \ncrackles\nABDOMEN: Soft, non-tender, mildly distended. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or \nperipheral edema. \nSKIN: No significant skin lesions or rashes. \nPULSES: Dorsalis pedis pulsus 1+ bilaterally. TP DP pulses \ndopplerable bilaterally \n\nDISCHARGE PHYSICAL EXAM\n========================\nVS: 97.3 ___ 18 98% on RA\n___: Well developed, well-nourished in NAD. Oriented x3. \nMood, affect appropriate. \nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. \nConjunctiva were pink. No pallor or cyanosis of the oral mucosa. \n\nNECK: Supple \nCARDIAC: RRR, no murmurs rubs or gallops \nLUNGS: CTAB\nABDOMEN: Soft, non-tender, mildly distended. \nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or \nperipheral edema.', 'diagnoses': [{'icd_code': '2910', 'desc': 'Alcohol withdrawal delirium'}, {'icd_code': '30300', 'desc': 'Acute alcoholic intoxication in alcoholism, unspecified'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}, {'icd_code': '2281', 'desc': 'Lymphangioma, any site'}, {'icd_code': '27650', 'desc': 'Volume depletion, unspecified'}, {'icd_code': '7812', 'desc': 'Abnormality of gait'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '2443', 'desc': 'Other iatrogenic hypothyroidism'}, {'icd_code': 'E9420', 'desc': 'Cardiac rhythm regulators causing adverse effects in therapeutic use'}, {'icd_code': '72989', 'desc': 'Other musculoskeletal symptoms referable to limbs'}, {'icd_code': '78194', 'desc': 'Facial weakness'}, {'icd_code': '9089', 'desc': 'Late effect of unspecified injury'}, {'icd_code': 'E9990', 'desc': 'Late effect of injury due to war operations'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': 'V4502', 'desc': 'Automatic implantable cardiac defibrillator in situ'}], 'summary': "===========================\nADMISSION LABS\n===========================\n\n___ 05:56AM BLOOD WBC-12.0* RBC-4.28 Hgb-11.9 Hct-35.9 \nMCV-84 MCH-27.8 MCHC-33.1 RDW-13.6 RDWSD-41.8 Plt ___\n___ 05:56AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-1+ \nMacrocy-NORMAL Microcy-NORMAL Polychr-1+ Ovalocy-1+\n___ 05:56AM BLOOD ___ PTT-43.1* ___\n___ 05:56AM BLOOD Glucose-303* UreaN-37* Creat-2.2* Na-140 \nK-3.7 Cl-101 HCO3-22 AnGap-21*\n___ 05:56AM BLOOD ALT-32 AST-55* AlkPhos-55 TotBili-0.2 \nDirBili-<0.2 IndBili-0.2\n___ 05:56AM BLOOD CK-MB-20* cTropnT-0.95*\n___ 05:56AM BLOOD Calcium-8.9 Phos-2.5* Mg-1.9\n___ 05:56AM BLOOD Hapto-113\n___ 06:01AM BLOOD Type-ART pO2-69* pCO2-34* pH-7.47* \ncalTCO2-25 Base XS-1 Intubat-NOT INTUBA\n___ 06:01AM BLOOD Lactate-2.8*\n\n============\nMICRO\n============\nnone\n\n============\nSTUDIES\n============\n___ TTE:\nThe left atrium is mildly dilated. There is mild symmetric left \nventricular hypertrophy with normal cavity size. There is \nmoderate to severe regional left ventricular systolic \ndysfunction with severe hypokinesis of the distal ___ of the \nseptum and anterior walls, distal half of the inferior wall, and \napex . The remaining segments contract normally (LVEF = ___ \n%). A left ventricular mass/thrombus cannot be excluded, though \nknown is seen. Right ventricular chamber size and free wall \nmotion are normal. The aortic root is mildly dilated at the \nsinus level. The ascending aorta is mildly dilated. The aortic \nvalve leaflets (?#) appear structurally normal with good leaflet \nexcursion. There is no aortic valve stenosis. No aortic \nregurgitation is seen. The mitral valve appears structurally \nnormal with trivial mitral regurgitation. The pulmonary artery \nsystolic pressure could not be determined. There is no \npericardial effusion. IMPRESSION: Suboptimal image quality. Mild \nsymmetric left ventricular hypertrophy with regional systolic \ndysfunction most c/w multivessel CAD. Mildly dilated ascending \naorta. CLINICAL IMPLICATIONS: \n The left ventricular ejection fraction is <40%, a threshold for \nwhich the patient may benefit from a beta blocker and an ACE \ninhibitor or ___. \n\n___ CATH\nCoronary Anatomy\n* Left Anterior Descending\nThere is a 90% stenosis in the Mid LAD. The lesion has a TIMI \nflow of 3 and has severe calcification\nnoted. This lesion is further described as diffusely diseased. \nAn intervention was performed on the Mid\nLAD with a final stenosis of 0%. There were no lesion \ncomplications.\nThere is a 100% stenosis in the Distal LAD. The lesion has a \nTIMI flow of 1 and has no noted\ncalcification. An intervention was performed on the Distal LAD \nwith a final stenosis of 0%. There were no\nlesion complications.\nSee recent diagnostic angiography for complete results \n(___)\nInterventional Details\nEBU-4.0 provided good support. Heparin given and a therapeutic \nACT confirmed. Crossed with ease to the distal LAD through the \ncomplete occlusion using a Samurai wire. We then performed \nserial PTCA of the distal LAD with a 1.5mm OTW balloon at ___ \natm restoring distal flow. However, despite repeated IC \nvasodilators throughout the case the distal LAD remained a \n<1.5mm vessel. Predilatation of the diffuse mid LAD lesions were \nperformed with difficulty using 2.0mm and 2.5mm NC balloons \nresulting in incomplete balloon expansion, even at high pressure \nwith short balloons. Therefore we decided to perform rotational \natherectomy. The workhorse wire was exhanged for a Rota Floppy \nwire, and four passes with a 1.5mm burr (160 rpm for ___ sec) \nperformed. The Rota wire was exchanged again for a Prowater wire \nand the mid LAD predilated with a 2.5mm NC balloon at 12 atm \nobtaining full lesion expansion. A 2.5x38mm Promus Premier \ndrug-eluting stent was deployed at 10 atm and post-dilated with \na 2.5mm NC balloon in the mid and proximal segments to high \npressure ___ atm). The vessel immediately beyond the distal \nstent edge appeared to have significant residual disease despite \nIC nitroglycerin, and therefore a 2.25x16mm Promus Premier \ndrug-eluting stent was deployed distally in overlapping fashion \nat 10 atm and the overlap zone post-dilated with the SDS balloon \nat 20 atm. Final angiography demonstrated 10% residual, no \ndissection, and normal flow.\nImpressions:\nSuccessful rotational atherectomy and PCI of the LAD with \ndrug-eluting stents\n\n============\nDISCHARGE LABS\n============\n___ 07:20AM BLOOD WBC-11.1* RBC-4.19* Hgb-11.5* Hct-35.5* \nMCV-85 MCH-27.4 MCHC-32.4 RDW-13.2 RDWSD-40.5 Plt ___\n___ 07:20AM BLOOD ___ PTT-41.2* ___\n___ 07:20AM BLOOD Calcium-9.1 Phos-3.4 Mg-2.\n___ PMH CKD, DM, HTN, HLD who presented to ___ \n___ with chest pain and on cath was found to have \nmultivessel disease so a balloon pump was placed and the patient \nwas transferred to ___ for further management. He underwent \nhigh risk PCI with 2 DES placed in the proximal LAD. His course \nsubsequently improved and the balloon pump was discontinued. \n\n# NSTEMI: The patient's elevated troponin, and multivessel \ndisease without complete occlusion seen on cath are consistent \nwith NSTEMI. S/P High risk PCI with 2 DES placed in the proximal \nLAD. He was discharged on Ticagrelor 90mg BID and also warfarin \nfor apical akinesis seen on post-MI echocardiogram. He should \ncontinue this for 1 month until he can have a repeat TTE. He was \nalso discharged with a lifevest. Finally he was discharged with \nAtorvastatin 80mg daily and Metoprolol succinate 200 mg daily. \n\n#ACUTE HEART FAILURE WITH PULMONARY EDEMA: Likely pulmonary \nedema secondary to acute heart failure caused by ischemia. S/P \n40mg IV Lasix. Now improved and off Lasix. Discharged on \nvalsartan to 160 BID (max dose), eplerenone 50 mg/day, \nMetoprolol succinate 200 mg daily and was fitted and discharged \nwith a lifevest. \n\n# Apical dyskinesis: Evident on TTE, ___ NSTEMI. Was discharged \non Warfarin 3mg PO daily and will have repeat TTE in one month. \nIf improved at that time, warfarin can be stopped and aspirin \nrestarted. \n\n#HTN: Discharged on the following regimen which can be titrated \nas an outpatient for goal SBP < 140. \n- Metoprolol succinate 200 mg daily\n- Valsartan 160 BID\n- Eplerenone 50 mg/day\n- Amlodipine 10mg daily\n- Held HCTZ\n\n#DM: Was given HISS while in house and discharged on home \nregimen. \n\n#CKD: uncertain baseline. ___ at ___ had Cr 2.2. Was stable \nduring admission and Cr on discharge 1.9."}}
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{'final_diagnoses': ['Non-ST Elevation Myocardial Infarction', 'Acute Heart failure with reduced ejection fraction', 'Hypertension', 'Diabetes', 'Chronic Kidney Disease'], 'procedures': ['CATHETERIZATIOn'], 'visit_summary': "___ PMH CKD, DM, HTN, HLD who presented to ___ \n___ with chest pain and on cath was found to have \nmultivessel disease so a balloon pump was placed and the patient \nwas transferred to ___ for further management. He underwent \nhigh risk PCI with 2 DES placed in the proximal LAD. His course \nsubsequently improved and the balloon pump was discontinued. \n\n# NSTEMI: The patient's elevated troponin, and multivessel \ndisease without complete occlusion seen on cath are consistent \nwith NSTEMI. S/P High risk PCI with 2 DES placed in the proximal \nLAD. He was discharged on Ticagrelor 90mg BID and also warfarin \nfor apical akinesis seen on post-MI echocardiogram. He should \ncontinue this for 1 month until he can have a repeat TTE. He was \nalso discharged with a lifevest. Finally he was discharged with \nAtorvastatin 80mg daily and Metoprolol succinate 200 mg daily. \n\n#ACUTE HEART FAILURE WITH PULMONARY EDEMA: Likely pulmonary \nedema secondary to acute heart failure caused by ischemia. S/P \n40mg IV Lasix. Now improved and off Lasix. Discharged on \nvalsartan to 160 BID (max dose), eplerenone 50 mg/day, \nMetoprolol succinate 200 mg daily and was fitted and discharged \nwith a lifevest. \n\n# Apical dyskinesis: Evident on TTE, ___ NSTEMI. Was discharged \non Warfarin 3mg PO daily and will have repeat TTE in one month. \nIf improved at that time, warfarin can be stopped and aspirin \nrestarted. \n\n#HTN: Discharged on the following regimen which can be titrated \nas an outpatient for goal SBP < 140. \n- Metoprolol succinate 200 mg daily\n- Valsartan 160 BID\n- Eplerenone 50 mg/day\n- Amlodipine 10mg daily\n- Held HCTZ\n\n#DM: Was given HISS while in house and discharged on home \nregimen. \n\n#CKD: uncertain baseline. ___ at ___ had Cr 2.2. Was stable \nduring admission and Cr on discharge 1.9.", 'medications_prescribed': ['amLODIPine 10 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Eplerenone 50 mg PO DAILY', 'TiCAGRELOR 90 mg PO BID', 'Warfarin 3 mg PO DAILY16', 'Metoprolol Succinate XL 200 mg PO DAILY', 'Valsartan 160 mg PO BID', 'Allopurinol ___ mg PO DAILY', 'Fenofibrate 200 mg PO DAILY', 'Levemir FlexTouch (insulin detemir) 20 Units subcutaneous \nQHS', 'Tradjenta (linagliptin) 5 mg oral DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 69, 'gender': 'M', 'symptoms': 'fall, hip fracture', 'medical_history': ["Alzheimer's dementia", 'anxiety', 'depression', 'HTN', 'anemia, + occult blood ___', 'ductal CA of breast s/p lumpectomy', 'cataracts', 'CKD', 'GERD', 'iscehmic heart disease', 'Aortic stenosis with reported ___ 1.3 in ___', 'h/o falls', 'h/o UTIs'], 'family_history': 'non-contributory', 'present_illness': "___ yo ___ speaking F with hx of dementia, aortic stenosis \nwith ___ 1.3 in ___, HTN, presents after a fall at ___ \nwith a right femoral neck fracture. \nA&O X ___ in ___ at baseline per ___ notes though \nfamily states that OX3 at baseline. \n\nPatient has a tendancy to wander in the unit, usually redirected \neasily. At 815pm, found sitting on floor, resing on both hands, \nmoaning and frimacing with pain at right hip via interpreter. \nMorphine 4mg given at 845pm. She was found to have shortened and \nexternally rotated RLE. VS on transfer 98.5, 199/89, 66, 24, 95% \nRA. \nIn the ED, initial VS: 98.6, 61, 149/65, 20, 98/4L. \nLabs notable for a UA with 43 WBC, moderate bacteria, \nelectrolytes within normal with CBC with WBC 7.7, N 74.8, Hct \n35, platelets 231. Coags were normal. \nShe was given morphine 2.5mg IV X 2, Cipro 400mg IV X 1 for a \n+UA at midnight. \nVS on transfer noted as 98, 69, 15, 160/72, 95% on RA however \nnursing notes reveal desat to the high ___ prior to transfer and \npatient's family state that she was placed on oxygen \napproximately 1 hour prior to transfer. \n. \nOn the floor, the patient arrived with her son and \ndaughter-in-law. She appeared anxious/scared with grimmacing, \nshallow breathing but then smiling when she was smiled at. Her \nson spoke to her in ___ but reported that she could not hear \nbecause she was not wearing her hearing aids. At first he said \nthat she was not confused but then he was not sure. She made \ngood eye contact and was able to follow commands during the \nexam. She denies CP, dyspnea or current hip pain.", 'medications': [{'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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Brimonidine Tartrate 0.15% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', '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': '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 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}, {'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': 'Spironolactone', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Tizanidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'HS', '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': 'Metoprolol Tartrate', '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% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'ONCE', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enalapril Maleate', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'Aspirin', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION EXAM\nVS - 98.5, 167/79, 73, 28, 94/4l \nGENERAL - anxious appearing elderly woman in NARD \nHEENT - NC/AT, EOMI, sclerae anicteric, dry MM, OP clear \nNECK - supple \nLUNGS - from anterior CTA bilat, good air movement, resp \nunlabored, no accessory muscle use \nHEART - RRR, no ___ SEM loudest at right sternal margin and left \nmid axillary line, nl S1-S2 \nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - no edema. Grimmaces with removal of right sock. \nCan move all toes/feet. 2+ ___ b/l. Right leg externally \nrotated and shortened. \nNEURO - awake, EOEMI, muscle strength ___ upper extremities. \nCould not assess lower exremities. \n\nDISCHARGE EXAM\nVS - Tm 99.6, BP (111-120)/(50-55), HR 60-65, RR 18, POx 95%RA\nGENERAL - elderly woman in NAD \nHEENT - NC/AT, EOMI, sclerae anicteric, dry MM, OP clear \nNECK - supple \nLUNGS - CTA b/l, good air movement, resp unlabored \nHEART - RRR, ___ SEM loudest at RSB/left axilla, rad to carotids\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding \nEXTREMITIES - no edema. Can move all toes/feet. 2+ ___ b/l. \nRight hip with bandage on lateral side, c/d/i. \nNEURO - awake, EOEMI, muscle strength ___ upper extremities. \nwill not answer questions to test A&O, assume zero.\nGU - foley in place draining yellow clear urine', 'diagnoses': [{'icd_code': '55010', 'desc': 'Inguinal hernia, with obstruction, without mention of gangrene, unilateral or unspecified (not specified as recurrent)'}, {'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': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': 'ADMISSION LABS\n___ 09:45PM BLOOD WBC-7.7 RBC-3.66* Hgb-11.3* Hct-35.0* \nMCV-96# MCH-30.9 MCHC-32.4 RDW-12.8 Plt ___\n___ 09:45PM BLOOD Neuts-74.8* Lymphs-15.7* Monos-5.7 \nEos-3.5 Baso-0.3\n___ 09:45PM BLOOD ___ PTT-27.0 ___\n___ 09:45PM BLOOD Glucose-115* UreaN-26* Creat-1.0 Na-139 \nK-3.9 Cl-106 HCO3-25 AnGap-12\n___ 09:45PM BLOOD Calcium-10.6* Phos-2.1* Mg-1.8\n\nPERTINENT LABS\n___ 09:45PM BLOOD CK(CPK)-55\n___ 05:40AM BLOOD CK(CPK)-54\n___ 09:45PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 05:40AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 05:40AM BLOOD PTH-76*\n___ 10:00AM BLOOD freeCa-1.30\n___ 10:00AM BLOOD Glucose-112* Lactate-0.9 Na-137 K-3.6 \nCl-107\n\nDISCHARGE LABS\n___ 01:00PM BLOOD WBC-9.3 RBC-2.70* Hgb-8.8* Hct-25.6* \nMCV-95 MCH-32.5* MCHC-34.3 RDW-12.8 Plt ___\n___ 03:50PM BLOOD Creat-1.6*\n \nMICRO DATA:\n___ 10:50PM URINE Color-Yellow Appear-Cloudy Sp ___\n___ 10:50PM URINE Blood-TR Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-5.5 Leuks-MOD\n___ 10:50PM URINE RBC-1 WBC-43* Bacteri-MOD Yeast-NONE \nEpi-<1\n___ 10:50 pm URINE\n **FINAL REPORT ___\n URINE CULTURE (Final ___: \n ESCHERICHIA COLI. >100,000 ORGANISMS/ML..\n SENSITIVITIES: MIC expressed in \nMCG/ML\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--------- =>4 R\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n___ BLOOD CULTURE Blood Culture x2 - NEGATIVE\n\nEKG ___ 9:29:16 ___\nSinus rhythm. Findings are within normal limits. Compared to the \nprevious \ntracing of ___ there is no significant diagnostic change. \n\nCT C-SPINE W/O CONTRAST ___ 10:13 ___\n1. No acute cervical fracture or malalignment. \n2. 1.8 x 2.77 cm cyst centrally hypodense right supraclavicular \nlesion \nadjacent to the thyroid gland may represent a exophytic portion \nof a goiter or enlarged node. Consider nonemergent ultrasound \nfor further evaluation. \n\nCT HEAD W/O CONTRAST ___\nNo acute intracranial process. \n \nHIP X-RAY ___\nFindings suspicious for right femoral neck fracture.\n\nCXR ___\nIncreased interstitial markings throughout the lungs \nbilaterally, \npotentially due to chronic underlying lung disease or mild \ninterstitial edema. More focal opacity at the left lung base, \npotentially atelectasis, infection not excluded. PA and lateral \nviews may offer additional detail. \n\nTTE ___\nThe left atrium and right atrium are normal in cavity size. \nThere is mild symmetric left ventricular hypertrophy with normal \ncavity size and regional/global systolic function (LVEF>55%). \nRight ventricular chamber size and free wall motion are normal. \nThe aortic valve leaflets (3) are mildly thickened but aortic \nstenosis is not present. There is severe aortic valve stenosis \n(valve area 0.8-1.0cm2). Trace aortic regurgitation is seen. The \nmitral valve leaflets are mildly thickened. There is no mitral \nvalve prolapse. Mild (1+) mitral regurgitation is seen. There is \nmoderate pulmonary artery systolic hypertension. There is no \npericardial effusion. \nIMPRESSION: Severe calcific aortic stenosis. Mild symmetric left \nventricular hypertrophy with normal global and regional \nbiventricular systolic function. Mild mitral regurgitation. \nModerate pulmonary hypertension\n\nHIP X-RAY ___\nThere is a new right hip hemiarthroplasty. There is no evidence \nof acute \ncomplication, dislocation, or fractures. There is gas in the \nsubcutaneous tissues in the thigh and skin staples.\nMs. ___ is a ___ ___ speaking lady with dementia, severe \naortic stenosis, and HTN who presented after a fall at ___ \n___ with a right femoral neck fracture. She underwent repair \nby Orthopedics on ___ the surgery was uneventful. Her stay \nhas been remarkable for ___ and urinary retention. She is \ndischarged to ___ with a foley and plans to try a \nvoiding trial in a week.'}}
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{'final_diagnoses': ['right femoral neck fracture', 'severe aortic stenosis', 'urinary tract infection', 'acute kidney injury', 'urinary retention', 'dementia', 'depression/anxiety', 'hypertension'], 'procedures': ['right hip hemiarthroplasty on ___'], 'visit_summary': 'Ms. ___ is a ___ ___ speaking lady with dementia, severe \naortic stenosis, and HTN who presented after a fall at ___ \n___ with a right femoral neck fracture. She underwent repair \nby Orthopedics on ___ the surgery was uneventful. Her stay \nhas been remarkable for ___ and urinary retention. She is \ndischarged to ___ with a foley and plans to try a \nvoiding trial in a week.', 'medications_prescribed': ['Acetaminophen 650 mg PO TID', 'anastrozole *NF* 1 mg Oral daily', 'Divalproex (DELayed Release) 125 mg PO BID', 'Ferrous Sulfate 325 mg PO DAILY', 'Isosorbide Mononitrate (Extended Release) 30 mg PO DAILY hold for SBP<110', 'Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS', 'Lorazepam 0.25 mg PO HS:PRN agitation/insomnia hold for sedation or rr < 10.', 'Metoprolol Tartrate 50 mg PO DAILY', 'Omeprazole 40 mg PO DAILY', 'traZODONE 25 mg PO HS', 'Heparin 5000 UNIT SC TID for 4 weeks after surgery (ends ___. ', 'OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain hold for sedation or rr < 10.', 'calcium carbonate-vitamin D3 *NF* 500 mg(1,250mg) -400 unit Oral BID', 'Sulfameth/Trimethoprim DS 1 TAB PO DAILY (___nds ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 19, 'gender': 'F', 'symptoms': 'recurrent abdominal hernia', 'medical_history': ['lumbar radiculopathy', 'hearing loss', 'osteoarthritis', 'PCOS', 'carpal tunnel syndrome', 'morbid obesity', 'anxiety/depression', 'laparoscopic cholecystectomy ___', 'hernia repair with mesh ___'], 'family_history': 'HTN, heart disease, breast cancer, diabetes', 'present_illness': 'Ms. ___ is a ___ year old woman with PMH of obesity, \nosteoarthritis, and recurrent incisional hernia requiring \nmultiple repairs complicated by persistent draining sinus, who \npresented for scheduled ventral hernia repair with mesh \nreplacement, now admitted to the ___ for post-procedure \nhypoxemia. \n.\nShe was initially seen in surgery clinic in ___ for \nconsideration of mesh repair. At that time, she was felt to have \nan infected suture and wound culture was obtained which \nultimately grew MSSA. It is unclear what dose/duration of \nantibiotics she was given for MSSA infection. Per patient she \nwas recently admitted to ___ for MSSA infection \nand was treated with IV antibiotics that were then transitioned \nto PO antibiotics for a total 1.5 week course.\n.\nToday, patient was admitted for planned abdominal wall \nreconstruction. She underwent ventral hernia repair with removal \nof infected mesh and mesh replacement on the day of admission \nwithout reported complications. Procedure was notable for 15cm \ndefect with grossly contaminated mesh; intra-procedure wound \nswab was sent for culture and tissue was sent for pathology. \nPost-procedurally, she was noted to have significant pain \nmedication requirement in the setting of opiod tolerance (takes \noxycodone 60mg at home for osteoarthritis), requiring morphine \nPCA, Precedex drip. She also developed oxygen requirement of 6L \nNC in the setting of sedation. \n.\nOn arrival to the ___, patient reports diffuse abdominal pain, \notherwise no new complaints.', 'medications': [{'medication': 'PredniSONE', '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': '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': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '36.4', 'valuenum': 36.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', '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': '254', 'valuenum': 254.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.26', 'valuenum': 4.26, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.3', 'valuenum': 69.3, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nGENERAL: sleepy but arousable to voice, oriented, no acute \ndistress\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: CTAB, no wheezes, crackles, rhonchi.\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, obese, diffusely tender to palpation, large \nhorizontal incision in lower abdomen with wound vac in place. \nEXT: WWP, no lower extremity edema\nNEURO: face symmetric, moving all extremities', 'diagnoses': [{'icd_code': 'G510', 'desc': "Bell's palsy"}, {'icd_code': 'J0180', 'desc': 'Other acute sinusitis'}], 'summary': '___ 02:20PM GLUCOSE-157* UREA N-21* CREAT-1.2* SODIUM-141 \nPOTASSIUM-4.7 CHLORIDE-105 TOTAL CO2-26 ANION GAP-10\n___ 02:20PM CALCIUM-9.1 PHOSPHATE-4.8* MAGNESIUM-2.0\n___ 02:20PM WBC-18.6* RBC-3.53* HGB-10.6* HCT-32.8* \nMCV-93 MCH-30.0 MCHC-32.3 RDW-13.0 RDWSD-44.2\n___ 02:20PM PLT COUNT-271\n.\nDISCHARGE LABS:\n==============\n___ 06:53AM BLOOD WBC-6.2 RBC-2.99* Hgb-8.8* Hct-28.6* \nMCV-96 MCH-29.4 MCHC-30.8* RDW-14.0 RDWSD-48.0* Plt ___\n___ 06:53AM BLOOD Glucose-106* UreaN-5* Creat-0.8 Na-141 \nK-4.6 Cl-104 HCO3-26 AnGap-11\n___ 06:53AM BLOOD Calcium-9.0 Phos-3.0 Mg-2.0\n.\nTROPONINS:\n=========\n___ 10:50AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 07:30PM BLOOD cTropnT-<0.01\n___ 06:33AM BLOOD cTropnT-<0.01\n.\nMICROBIOLOGY:\n___ 8:59 am SWAB RIGHT ABDOMINAL WALL ABSCESS. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n WOUND CULTURE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH.\n___ year old woman with PMH of obesity, osteoarthritis, and \nrecurrent incisional hernia requiring multiple repairs \ncomplicated by persistent draining sinus, who presented for \nscheduled ventral hernia repair with mesh replacement, now \nadmitted to the FICU for post-procedure hypoxemia.\n.\nACUTE ISSUES:\n=============\n# Acute Hypoxemic Respiratory Failure: \nPost-procedure she was noted to have oxygen requirement up to 6L \nNC, most likely in the setting of sedation with precedex drip \nand morphine PCA, with possible contribution from \natelectasis/splinting. CXR demonstrated LLL atelectasis, no \nevidence of PNA. She was encouraged to utilize incentive \nspirometry and adequate pain control was achieved with dilaudid \nPCA. She was transferred out of ICU on 3L NC.\n.\n# Ventral hernia with persistent draining sinus: S/p ventral \nhernia repair with mesh replacement on ___\n.\n# Pain control: Pain control was achieved initially with IV \ndilaudid PCA, standing toradol, and Tylenol. Patient was \neventually transitioned to oxycodone 10mg po every ___ hours for \nbreakthrough pain (takes Oxycodone 30 mg po BID for \nosteoarthritis pain).\n.\n# c/f infected mesh. \nS/p abdominal wall reconstruction on ___. During procedure she \nwas noted to have grossly infected mesh. Prior wound culture \nfrom ___ grew MSSA. Wound culture from OR and blood cultures \nwere obtained, and both were negative for growth. She received \nIV cefazolin during her hospitalization and was discharged on 3 \nadditional weeks of cefadroxil. \n.\n# ___:\nBaseline Cr is unknown, however her Cr is 1.2 on admission which \nis elevated from 1.0 on ___. Differential includes \nintravascular depletion given insensible losses intraoperatively \nversus recent NSAID use. She received IV fluid resuscitation. \nPatient creatinine on discharge was 0.8.\n.\n# Acute Blood Loss Anemia: \nHgb 10.6 on admission, down from 12.6 on ___ in the setting of \nrecent procedure. She was hemodynamically stable. Hematocrit was \ntrended. \n.\n# Palpitations/sinus tachycardia\nOn POD#4 patient complained of nausea and wanting to throw up. \nShe was made NPO. She then complained of \'heart palpitations\' \nand had a heart rate of 113 and a pain level of ___. EKG \nshowed some questionable changes from baseline so troponin x 3 \nwere obtained and were all negative. Patient was given Ativan \nIV for this episode and reported feeling "much better" as a \nresult.\n.\nCHRONIC ISSUES:\n===============\n# Osteoarthritis:\nReceived dilaudid PCA for pain relief in acute post-op setting \nand transitioned back to her Oxycodone 30 mg Q12 with Oxycodone \n10mg for breakthrough pain.\n.\n# Anxiety/depression:\n- continued home bupropion\n- home vilazodone not on formulary so patient took her own \nvilazodone.\n- had some breakthrough anxiety/depression on POD#4 when she \nexperienced nausea and didn\'t feel well. She was given IV \nAtivan PRN with good effect.\n.\nPatient discharged home on POD#6 after having a bowel movement, \ntolerating a regular diet and having good pain control. Her \nPrevena incisional VAC was in place and her JP drains were \ndraining large amounts of serous fluid.'}}
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{'final_diagnoses': ['Infected mesh', 'recurrent midline abdominal hernia', 'intertrigo and hanging abdominal pannus'], 'procedures': ['Herniorrhaphy Ventral with Bilateral Component Separation', 'Removal Infected Mesh/Replacement Mesh', 'Massive Panniculectomy'], 'visit_summary': '___ year old woman with PMH of obesity, osteoarthritis, and \nrecurrent incisional hernia requiring multiple repairs \ncomplicated by persistent draining sinus, who presented for \nscheduled ventral hernia repair with mesh replacement, now \nadmitted to the FICU for post-procedure hypoxemia.\n.\nACUTE ISSUES:\n=============\n# Acute Hypoxemic Respiratory Failure: \nPost-procedure she was noted to have oxygen requirement up to 6L \nNC, most likely in the setting of sedation with precedex drip \nand morphine PCA, with possible contribution from \natelectasis/splinting. CXR demonstrated LLL atelectasis, no \nevidence of PNA. She was encouraged to utilize incentive \nspirometry and adequate pain control was achieved with dilaudid \nPCA. She was transferred out of ICU on 3L NC.\n.\n# Ventral hernia with persistent draining sinus: S/p ventral \nhernia repair with mesh replacement on ___\n.\n# Pain control: Pain control was achieved initially with IV \ndilaudid PCA, standing toradol, and Tylenol. Patient was \neventually transitioned to oxycodone 10mg po every ___ hours for \nbreakthrough pain (takes Oxycodone 30 mg po BID for \nosteoarthritis pain).\n.\n# c/f infected mesh. \nS/p abdominal wall reconstruction on ___. During procedure she \nwas noted to have grossly infected mesh. Prior wound culture \nfrom ___ grew MSSA. Wound culture from OR and blood cultures \nwere obtained, and both were negative for growth. She received \nIV cefazolin during her hospitalization and was discharged on 3 \nadditional weeks of cefadroxil. \n.\n# ___:\nBaseline Cr is unknown, however her Cr is 1.2 on admission which \nis elevated from 1.0 on ___. Differential includes \nintravascular depletion given insensible losses intraoperatively \nversus recent NSAID use. She received IV fluid resuscitation. \nPatient creatinine on discharge was 0.8.\n.\n# Acute Blood Loss Anemia: \nHgb 10.6 on admission, down from 12.6 on ___ in the setting of \nrecent procedure. She was hemodynamically stable. Hematocrit was \ntrended. \n.\n# Palpitations/sinus tachycardia\nOn POD#4 patient complained of nausea and wanting to throw up. \nShe was made NPO. She then complained of \'heart palpitations\' \nand had a heart rate of 113 and a pain level of ___. EKG \nshowed some questionable changes from baseline so troponin x 3 \nwere obtained and were all negative. Patient was given Ativan \nIV for this episode and reported feeling "much better" as a \nresult.\n.\nCHRONIC ISSUES:\n===============\n# Osteoarthritis:\nReceived dilaudid PCA for pain relief in acute post-op setting \nand transitioned back to her Oxycodone 30 mg Q12 with Oxycodone \n10mg for breakthrough pain.\n.\n# Anxiety/depression:\n- continued home bupropion\n- home vilazodone not on formulary so patient took her own \nvilazodone.\n- had some breakthrough anxiety/depression on POD#4 when she \nexperienced nausea and didn\'t feel well. She was given IV \nAtivan PRN with good effect.\n.\nPatient discharged home on POD#6 after having a bowel movement, \ntolerating a regular diet and having good pain control. Her \nPrevena incisional VAC was in place and her JP drains were \ndraining large amounts of serous fluid.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild/Fever', 'cefaDROXil 500 mg oral BID', 'LORazepam 1 mg PO QHS:PRN sleep/anxiety', 'OxyCODONE (Immediate Release) 30 mg PO Q12H', 'OxyCODONE (Immediate Release) 10 mg PO Q4H:PRN Pain - \nModerate', 'BuPROPion XL (Once Daily) 150 mg PO BID', 'Vitamin D 800 UNIT PO DAILY', 'vilazodone 40 mg oral DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'MS flare', 'medical_history': ['HTN', 'Secondary progressive MS with relapses under Dr ___', 'Frequent UTIs', 'Hyperparathyroidism but no clear parathyroid adenoma under Dr\n___', 'Possible seizure disorder: black out episodes lasting several \nhours, EEG with intermittent bitemporal slowing. States that she\nhas not had an episode in years. Previously treated with \nphenytoin and sodium valproate, no current treatment.', 'Drop attacks with negative autonomic testing in ___ and\n___', 'Cervical spondylosis on MRI C spine', 'h/o pulmonary nodules being followed by serial scanning', 'h/o Right common carotid artery occlusion', 'Osteopenia', 'PUD', 'h/o positive PPD', 'OA', 'h/o nephrolithiasis', 'Allergic Rhinits', 'h/o sepsis from a skin infection associated with her port, \nport\nnow removed', 's/p Multiple foot surgeries bilaterally', 's/p Choleystectomy'], 'family_history': 'Mother - died ___ CAD\n\nFather - died ? cause\nPaternal grandmother stroke\n___ - twin sister well without MS "but crazy and thinks she \ndoes", ___hildren - 3 well\n\nNo FH of MS.\n\n___ is no history of seizures, developmental disability, \nlearning disorders, migraine headaches, strokes less than 50, \nneuromuscular disorders, dementia or movement disorders.', 'present_illness': '___ with a PMH of secondarily progressive MS with relapses and \nlast relapse in ___ admitted with difficulty ambulating and \nprogressive blurred vision with dizziness and dysequilibrium s/p \n5 days IV ACTH, chronic pain, recurrent UTIs, HTN, primary \nhyperparathyroidism, possible seizure disorder and OA presents \nwith myriad symptoms with concern for possible MS flare.\n\nThe patient notes 1 month of worsening mobility and having to \nuse her walker for the past 2 week (although was doing so at her \nlast Dr ___ in ___, intermittent slurred \nspeech, increasing urinary incontinence and 2 weeks or \nincreasing numbness and tingling in her feet, worsening pain in \nher back and neck, flashing lights and progressive blurred \nvision without orbital myalgia. She had 1 non-injurious fall 1 \nweek ago. She was seen by her PCP and referred for possible ACTH \ntreatment of her MS flare.\n \nThe patient was previously admitted to neurology from \n___ after worsening mobility, "drop attacks" \nprogressive blurred vision, dizziness with dysequilibrium but no \nvertigo and slurred speech and was treated with 5 days of IV \nACTH and also treated for a UTI with improvement in her \nsymptoms. She was last seen by Dr ___ on ___ when she \nhad a decline in function and was using her walker.\n\nThe patient currently notes 1 month of worsening of several \nsymptoms and others over the past 2 weeks. She feels her most \nsignificant symptoms are worsening urination are her mobility. \n\nShe feels her urination has worsened over the past 1 month with \nincreasing urinary incontinence (has this frequently at baseline \nat night). She can hold her urine at times and use the toilet \nbut this has become much less frequent and is currently using \ndiapers. She notes increased frequency of micturition as well. \n\nShe also notes 1 month of intermittent slurred speech. Her \nspeech is not currently slurred. \n\nShe also notes 1 month of worse mobility such that she had \npreviously been ambulating with a cane and a trolley for \nshopping but now has had to use a walker over the past 2 weeks \nand is "scared now". She wonders if her legs are weaker. She \nnotes 1 fall 1 week or so ago when she slipped upstairs and did \nnot injure herself or hit her head. She has had no further \nfalls. \n\nShe also notes 2 weeks of worsening numbness and tingling in her \nfeet.\n\nShe also notes increasing of her pain worst in the lower back \nand neck and initially wondered whether she may have had a UTI \nas she had had similar back pain when she had one. She also \nnotes pain in her feet and shoulders and has difficulty \ndescribing her pain other than it is severe and ___ although \ndoe snot look this uncomfortable. In regards to treatment of her \npain she generally "says a little prayer" and takes Tylenol with \ncodeine Q4-Q6H and ibuprofen.\n\nShe also notes 2 weeks of worsening blurred vision although can \nread reasonably well and this has been progressive in addition \nto episodes of flashing lights in her vision which she describes \nlike "electrical dots".\n\nOn neuro ROS, the pt denies headache, loss of vision, diplopia, \ndysphagia, lightheadedness, vertigo, tinnitus or hearing \ndifficulty. Denies difficulties producing or comprehending \nspeech. No bowel incontinence or retention. \n\nOn general review of systems, the pt denies recent fever or \nchills. No night sweats or recent weight loss or gain. Denies \ncough, shortness of breath. Denies chest pain or tightness, \npalpitation. Denies nausea, vomiting, diarrhea, constipation. \nNo recent change in bowel habits. No dysuria. Denies \narthralgias or myalgias. Denies rash.', 'medications': [{'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', 'route': 'SC', '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': 'Zolpidem Tartrate', '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: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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', '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': 'Aspirin', '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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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}]}, 'clinical_findings': {'labs': [], 'exams': 'Vitals: T:97.8 P:64 R:16 BP:145/78 SaO2:96% RA\nGeneral: Awake, cooperative, complans of back and upper neck \npain. \nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in \noropharynx \nNeck: Supple, no carotid/vertebral bruits appreciated. No nuchal \nrigidity. Decreased neck rotation right>left and intact \nflexion/extension. \nSpine: C/O tenderness in midline cervical area and in sacral \narea. \nPulmonary: Lungs CTA bilaterally without R/R/W \nCardiac: RRR, nl. S1S2, no M/R/G noted \nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or \norganomegaly noted. \nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses \nbilaterally. Calves SNT bilaterally. \nSkin: no rashes or lesions noted.\n\nNeurological examination: \n\n- Mental Status: \nTangential and rambling as previously documented and complaining \nof pain.\nORIENTATION - Alert, oriented x person, place and month and year \nbut not date\nThe pt. had reasonably good knowledge of current events. \nSPEECH\nAble to relate history without difficulty. \nLanguage is fluent with intact repetition and comprehension. \nNormal prosody. There were no paraphasic errors.\nSpeech was not dysarthric. \nNAMING Pt. was able to name both high and low frequency objects.\nREADING - Able to read without difficulty\nATTENTION - Attentive, able to name ___ backward with 1 error. \nREGISTRATION and RECALL\nPt. was able to register 3 objects and recall ___ at 5 minutes \n___ with category prompting.\nCOMPREHENSION\nAble to follow both midline and appendicular commands \nThere was no evidence of apraxia or neglect \n\n- Cranial Nerves: \nI: Olfaction not tested. \nII: PERRL 4 to 3mm and sluggish. RAPD noted on Dr ___ \nreview but I was not able to appreciate it. Also patient is \nconstantly blinking. VFF to confrontation. Funduscopic exam \nreveals no papilledema, exudates, or hemorrhages and no pale \ndiscs. \nIII, IV, VI: EOMI without nystagmus. Slightly jerky pursuits and \nsaccades. \nV: Facial sensation reduced on the right and variable to all \nmodalities icluding vibration without clear midline splitting. \nGood power in muscles of mastication. \nVII: No facial weakness, 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 with normal velocity movements.\n \n- Motor: Normal bulk, tone throughout in UE and marked \nspasticity in LEs. No pronator drift bilaterally. No \nadventitious movements, such as tremor, noted. No asterixis \nnoted.\n SAb SAdd ElF ElE WrE FFl FE IO HipF HipE KnF KnE AnkD ___\nL 5 5 ___ 5 4+ 4+ ___ ___ ___\nR 5 5 ___ 5 4+ 4+ ___ ___ ___\n \n* Patient with significant tremor on lifting both legs and also \nhas give way weakness bilaterally worse on the right although \nwhen IPs are tested with holding distal leg appears better than \nabove hence range.\n\n- Sensory: \nHighly variable.\nDecreased sensation in left arm and both legs to knee but right \nworse than left and variable.\nDecreased temperature to knees.\nDecreasd pinprick to the mid shins.\nVibration intact in UEs but able to feel but reduced at ankles \nbilaterally but not the knees.\nDecreased prprioception at the great toes and presnet with \nerrors in the ankles.\nNo extinction to DSS.\n \n- DTRs: \n BJ SJ TJ KJ AJ \nL ___ 3 - \nR ___ 3 -\nUnabel to assess ankles as joints very stiff.\nThere was no evidence of clonus.\n___ negative.\nPlantar response was extensor bilaterally.\n \n- Coordination: Blateral mild intention tremor, out of \nproportion slow finger tapping bilaterally with decreased RAMs. \nReasonably accurate on FNF and unable to do HKS bilaterally bt \nsevere tremor on lifting both legs.\n \n- Gait: Unable to assess. Patient would sit without evidenc of \nany truncal ataxia but feet slip forward when trying to stand.\n\nPhysical Exam on Discharge\n\nT 98.7 BP 130-190/62-92 HR ___ RR 18 O2 98 RA\n\nII: PERRL 4 to 3mm and sluggish. \nIII, IV, VI: EOMI without nystagmus. Slightly jerky pursuits and \nsaccades. \nV: Facial sensation intact. \nVII: No facial weakness, 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 with normal velocity movements.\n \n- Motor: Normal bulk, tone throughout in UE and marked \nspasticity in LEs. No pronator drift bilaterally. No \nadventitious movements, such as tremor, noted. No asterixis \nnoted.\n SAb SAdd ElF ElE WrE FFl FE IO HipF HipE KnF KnE AnkD ___\nL 5 5 ___ ___- 4+ ___ 5 5 5-\nR 5 5 ___ ___- 4+ 5- 5 5 5 5 5-\n \n \n- DTRs: \n BJ SJ TJ KJ AJ \nL ___ 2+ - \nR ___ 2+ -\n\nPlantar response was mute bilaterally.\n \n- Coordination: Blateral mild intention tremor. Reasonably \naccurate on FNF and unable to do HKS bilaterally bt severe \ntremor on lifting both legs.\n \n- Gait: Unable to assess. Patient would sit without evidenc of \nany truncal ataxia but feet slip forward when trying to stand.', 'diagnoses': [{'icd_code': 'I972', 'desc': 'Postmastectomy lymphedema syndrome'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}], 'summary': '___ 07:04PM BLOOD WBC-6.3 RBC-3.90* Hgb-12.5 Hct-37.1 \nMCV-95 MCH-32.1* MCHC-33.7 RDW-13.9 Plt ___\n___ 07:04PM BLOOD Neuts-32* Bands-0 Lymphs-57* Monos-5 \nEos-4 Baso-2 ___ Myelos-0\n___ 07:04PM BLOOD Glucose-92 UreaN-16 Creat-0.8 Na-139 \nK-4.5 Cl-103 HCO3-28\n___ 07:04PM BLOOD ALT-36 AST-34 CK(CPK)-244* AlkPhos-120* \nTotBili-0.2\n___ 07:04PM BLOOD CK-MB-4\n___ 07:04PM BLOOD cTropnT-<0.01\n___ 07:04PM BLOOD Albumin-4.8 Calcium-10.9* Phos-3.0 Mg-2.2\n___ 12:29AM BLOOD %HbA1c-6.1* eAG-128*\n___ 07:04PM BLOOD TSH-1.7\n___ 07:04PM BLOOD ASA-NEG Acetmnp-NEG Bnzodzp-NEG \nBarbitr-NEG Tricycl-NEG\n___ 11:48PM URINE bnzodzp-NEG barbitr-NEG opiates-POS \ncocaine-NEG amphetm-NEG mthdone-NEG\n\n___ 02:33PM URINE RBC-0 WBC-6* Bacteri-FEW Yeast-NONE Epi-8\n___ 02:33PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-SM \n\n___ Urine Culture URINE CULTURE (Final ___: \n MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT \nWITH SKIN\n AND/OR GENITAL CONTAMINATION. \n\n___ Repeat Urine Culture: P\n___ with a PMH of secondarily progressive MS with relapses; \nlast relapse in ___ presents with myriad symptoms with \nconcern for possible MS flare: 1 month of worsening mobility and \nhaving to use her walker for the past 2 week, intermittent \nslurred speech, increasing urinary incontinence and 2 weeks or \nincreasing numbness and tingling in her feet, worsening pain in \nher back and neck, flashing lights and progressive blurred \nvision without orbital myalgia. Admission labs were unremarkable \nwithout evidence of a UTI in the ED. She has had some low grade \nfevers to 99.7 on ___, and a repeat U/A had 6WBC with trace \nLEs, so given her history of frequent UTIs and current low back \npain, she was empirically treated with Cipro. Because of prior \nMS flares responding poorly to steroids (psychosis), she was \ngiven 5 doses of Cosyntropin. A PICC line was placed on ___ \nto facilitate this. Her cortisol levels were monitored during \nthis time. She was evaluated frequently by ___ and OT, and \nimproved over her course of cosyntropin. ___ and OT deemed her \nsafe to be at home without help on ___, and she was then \ndischarged in improved condition with plans to follow up with \nDr. ___ in about a month.'}}
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{'final_diagnoses': ['MS ___', 'urinary tract infection'], 'procedures': ['___ line placement ___'], 'visit_summary': '___ with a PMH of secondarily progressive MS with relapses; \nlast relapse in ___ presents with myriad symptoms with \nconcern for possible MS flare: 1 month of worsening mobility and \nhaving to use her walker for the past 2 week, intermittent \nslurred speech, increasing urinary incontinence and 2 weeks or \nincreasing numbness and tingling in her feet, worsening pain in \nher back and neck, flashing lights and progressive blurred \nvision without orbital myalgia. Admission labs were unremarkable \nwithout evidence of a UTI in the ED. She has had some low grade \nfevers to 99.7 on ___, and a repeat U/A had 6WBC with trace \nLEs, so given her history of frequent UTIs and current low back \npain, she was empirically treated with Cipro. Because of prior \nMS flares responding poorly to steroids (psychosis), she was \ngiven 5 doses of Cosyntropin. A PICC line was placed on ___ \nto facilitate this. Her cortisol levels were monitored during \nthis time. She was evaluated frequently by ___ and OT, and \nimproved over her course of cosyntropin. ___ and OT deemed her \nsafe to be at home without help on ___, and she was then \ndischarged in improved condition with plans to follow up with \nDr. ___ in about a month.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain fever', 'Ascorbic Acid ___ mg PO BID', 'Aspirin 81 mg PO BID', 'Baclofen 10 mg PO TID', 'Baclofen 5 mg PO HS', 'Calcium Carbonate 500 mg PO DAILY', 'Codeine Sulfate ___ mg PO Q6H:PRN pain', 'Lisinopril 5 mg PO DAILY', 'Metoprolol Tartrate 37.5 mg PO BID', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Omeprazole 40 mg PO DAILY', 'Simvastatin 40 mg PO DAILY', 'Vitamin D 1000 UNIT PO DAILY', 'Vitamin E 400 UNIT PO DAILY', 'Oxybutynin 5 mg PO TID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 58, 'gender': 'M', 'symptoms': 'Ischemic Pain', 'medical_history': ['CARDIAC RISK FACTORS: \n- Diabetes has been documented in medical records; however, patient denies h/o diabetes, takes no oral hypoglycemics, and has normal or slightly elevated glucose from recent admission\n- Dyslipidemia - controlled on statin\n- Hypertension - controlled on ___, clonidine, labetolol, furosemide', 'CARDIAC HISTORY: \n-PERCUTANEOUS CORONARY INTERVENTIONS: CATH for NSTEMI ___, stent placed in renal artery', 'OTHER PAST MEDICAL HISTORY: (per medical records; patient and daughter do not mention majority of these conditions or cannot recall details)\n- CAD (___ in ___, 50% RCA on cath, no interventions) \n- HTN \n- Hyperlipidemia \n- Renal artery stenosis s/p L stent in ___ \n- peripheral vascular disease\n- Carotid artery stenosis \n- osteoarthritis \n- PUD\n- LLE angioplasty of popliteal artery; angioplasty and stenting of superficial femoral artery; angioplasty of profunda femoral artery; primary stenting of external iliac artery.\n- Admission from ___', 'Ultrasound-guided puncture of left common femoral artery.', 'Contralateral second-order catheterization of right external iliac artery.', 'Abdominal aortogram.', 'Serial arteriogram of right lower extremity.'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death; otherwise non-contributory.', 'present_illness': '___ yo lady with history of numbness and\nleg feeling heavy this morning. No pain. Could not walk at all\nthis morning. Daughter said her foot was cold so she was brought\nto the ED.', 'medications': [{'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'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': 'Influenza Virus Vaccine', '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': '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 Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'MR X1', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'PB', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H: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}]}, 'clinical_findings': {'labs': [{'value': '68', 'valuenum': 68.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2470.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 79.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '450', 'valuenum': 450.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '475', 'valuenum': 475.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, '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': '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, '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': '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': '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': '135', 'valuenum': 135.0, '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': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '313', 'valuenum': 313.0, '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': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '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 = 62 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': '142', 'valuenum': 142.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, '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': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '9.8', 'valuenum': 9.8, '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': '34.0', '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': '312', 'valuenum': 312.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Neuro/Psych: Oriented x3, Affect Normal. \nNeck: No right carotid bruit, No left carotid bruit. \nHeart: Regular rate and rhythm. \nLungs: Normal respiratory effort, abnormal: Occasional wheeze. \nGastrointestinal: Non distended, No masses. \nRectal: Not Examined. \nExtremities: No popiteal aneurysm, No RLE edema, No LLE Edema, \nNo\nvaricosities, No skin changes, abnormal: L femoral bruit. \n\nPulse Exam (P=Palpation, D=Dopplerable, N=None)\nRUE Radial: P. \nLUE Radial: P. \nRLE Femoral: P. DP: D. ___: D. Other: palp\nLLE Femoral: P. DP: D. ___: D.', 'diagnoses': [{'icd_code': '78951', 'desc': 'Malignant ascites'}, {'icd_code': '1985', 'desc': 'Secondary malignant neoplasm of bone and bone marrow'}, {'icd_code': '1970', 'desc': 'Secondary malignant neoplasm of lung'}, {'icd_code': '1969', 'desc': 'Secondary and unspecified malignant neoplasm of lymph nodes, site unspecified'}, {'icd_code': '1977', 'desc': 'Malignant neoplasm of liver, secondary'}, {'icd_code': '1976', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'V1052', 'desc': 'Personal history of malignant neoplasm of kidney'}, {'icd_code': 'V1082', 'desc': 'Personal history of malignant melanoma of skin'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': '___ 05:25AM BLOOD \n\nWBC-14.3* RBC-3.85* Hgb-8.2* Hct-26.9* MCV-70* MCH-21.3* \nMCHC-30.5* RDW-21.7* Plt ___\n\n___ 05:25AM BLOOD \n\n___ PTT-67.0* ___\n\n___ 03:10AM BLOOD \n\nGlucose-146* UreaN-18 Creat-1.5* Na-139 K-3.7 Cl-102 HCO3-29 \nAnGap-12\n\n___:38PM BLOOD \n\nCalcium-9.2 Phos-3.9 Mg-2.1\n\nCHEST, PA AND LATERAL: \n\nMild pulmonary edema is unchanged. Severe cardiomegaly and \naortic tortuosity persist. There are no pleural effusions. \n \nIMPRESSION: Unchanged severe cardiomegaly and mild vascular \ncongestion. \n\nGENERAL URINE INFORMATION \n\nYellow Clear 1.021 \n\nBlood Nitrite Protein Glucose Ketone Bilirub Urobiln pH Leuks \nNEG NEG TR NEG NEG NEG NEG 6.5 TR \n\nRBC WBC Bacteri Yeast Epi \n___ FEW NONE ___\nwas admitted on ___ with down graft. Agreed to \nhave an elective surgery. Pre-operatively, she was consented. A \nCXR, EKG, UA, CBC, Electrolytes, T/S - were obtained, all \nother preparations were made.\n \nIt was decided that she would undergo:\n\nOPERATIONS:\n1. Ultrasound-guided puncture of the left common femoral\n artery.\n2. Contralateral third-order catheterization of the right\n popliteal artery.\n3. Abdominal aortogram.\n4. Serial arteriogram of the right lower extremity.\n5. AngioJet thrombectomy of the right common femoral artery\n to above-knee popliteal artery bypass graft.\n6. Balloon angioplasty of the right common femoral artery\n at the proximal anastomosis and the right popliteal\n artery across the distal anastomosis.\n7. Stenting across the proximal anastomosis and distal\n anastomosis.\n8. Perclose closure of the left common femoral arteriotomy.\n\nPrepped, and brought down to the endo suite room for surgery. \nIntra-operatively, was closely monitored and remained \nhemodynamically stable. Tolerated the procedure well without any \ndifficulty or complications.\n \nPost-operatively, transferred to the PACU for further \nstabilization and monitoring. \n \nWas then transferred to the VICU for further recovery. While in \nthe VICU, received monitored care. When stable was delined. \nDiet was advanced. \n \nWhen stabilized from the acute setting of post operative care, \nwas then transferred to floor status.\n \nOn the floor, remained hemodynamically stable with pain \ncontrolled. Continues to make steady progress without any \nincidents. Discharged home in stable condition.\n \nReceived preoperative hydration. On DC the creatinine is stable.\n\nPt was on IV heparin, coumadin started. On DC lovenox / coumadin \nbridge. PCP is following INR.'}}
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{'final_diagnoses': ['Right lower extremity ischemia with rest pain.'], 'procedures': ['Ultrasound-guided puncture of the left common femoral artery.', 'Contralateral third-order catheterization of the right popliteal artery.', 'Abdominal aortogram.', 'Serial arteriogram of the right lower extremity.', 'AngioJet thrombectomy of the right common femoral artery to above-knee popliteal artery bypass graft.', 'Balloon angioplasty of the right common femoral artery at the proximal anastomosis and the right popliteal artery across the distal anastomosis.', 'Stenting across the proximal anastomosis and distal anastomosis.', 'Perclose closure of the left common femoral arteriotomy.'], 'visit_summary': 'was admitted on ___ with down graft. Agreed to \nhave an elective surgery. Pre-operatively, she was consented. A \nCXR, EKG, UA, CBC, Electrolytes, T/S - were obtained, all \nother preparations were made.\n \nIt was decided that she would undergo:\n\nOPERATIONS:\n1. Ultrasound-guided puncture of the left common femoral\n artery.\n2. Contralateral third-order catheterization of the right\n popliteal artery.\n3. Abdominal aortogram.\n4. Serial arteriogram of the right lower extremity.\n5. AngioJet thrombectomy of the right common femoral artery\n to above-knee popliteal artery bypass graft.\n6. Balloon angioplasty of the right common femoral artery\n at the proximal anastomosis and the right popliteal\n artery across the distal anastomosis.\n7. Stenting across the proximal anastomosis and distal\n anastomosis.\n8. Perclose closure of the left common femoral arteriotomy.\n\nPrepped, and brought down to the endo suite room for surgery. \nIntra-operatively, was closely monitored and remained \nhemodynamically stable. Tolerated the procedure well without any \ndifficulty or complications.\n \nPost-operatively, transferred to the PACU for further \nstabilization and monitoring. \n \nWas then transferred to the VICU for further recovery. While in \nthe VICU, received monitored care. When stable was delined. \nDiet was advanced. \n \nWhen stabilized from the acute setting of post operative care, \nwas then transferred to floor status.\n \nOn the floor, remained hemodynamically stable with pain \ncontrolled. Continues to make steady progress without any \nincidents. Discharged home in stable condition.\n \nReceived preoperative hydration. On DC the creatinine is stable.\n\nPt was on IV heparin, coumadin started. On DC lovenox / coumadin \nbridge. PCP is following INR.', 'medications_prescribed': ['Amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Labetalol 200 mg Tablet Sig: 1.5 Tablets PO BID (2 times a day).', 'Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*', 'Warfarin 5 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 ___: stip lovenox when INR is 2 or greater.\nDisp:*30 Tablet(s)* Refills:*1*', 'Coumadin 1 mg Tablet Sig: One (1) Tablet PO once a day: this is an adjunct to your 5 mg. do not take unless PCP tell you to.\nDisp:*120 Tablet(s)* Refills:*2*', 'Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Enoxaparin 80 mg/0.8 mL Syringe Sig: One (1) Subcutaneous QD (): stop when INR is greater then 2.\nDisp:*6 80 mg/0.8 mL Syringe* Refills:*1*', 'Clonidine 0.1 mg Tablet Sig: One (1) Tablet PO BID (2 times a day).', 'Hydralazine 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a day).', 'Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.', 'Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once a day.', 'Atacand 16 mg Tablet Sig: One (1) Tablet PO twice a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 47, 'gender': 'M', 'symptoms': 'Seizure.', 'medical_history': ['Oncological History (from note by Drs. ___: This \nis a ___ man who was diagnosed with metastatic renal \ncell carcinoma to the brain and lungs in ___. He received \nCyberKnife therapy following resection of a right parietal lobe \nmetastasis. He was enrolled in DC tumor fusion vaccine protocol \nand on ___ he underwent radical left nephrectomy, \ncholecystectomy, and omentectomy for metastatic renal cell \ncarcinoma. Pathology revealed an 18 cm x 15 cm x 6 cm tumor, \nclear cell type, with tumor growth invading into therenal vein. \nA CT scan on ___, showed progression of bilateral pulmonary \nnodules and evidence of tumor recurrence in the left nephrectomy \nbed. He received his first dose of the dendritic cell vaccine \non ___. His second injection was on ___ and his third \ninjection on ___. His follow up CT scan on ___ \nshowed partial regression of multiple lung metastases. He had \nserial CT torsos which continued to note the stable appearance \nof target and non-target lesions including pulmonary nodules and \nmasses in the left nephrectomy bed. On ___, MRI of the ___ \nsuggested that the operative cavity in the right parietal lobe \nwas unchanged in size though slightly increased in intensity \nalong the superior medial aspect. He underwent a thallium scan \non ___ which was again notable for linear increased \nthallium uptake along the superior medial aspect of the \nresection bed. He underwent a stereotactic brain biopsy by Dr. \n___ on ___ which was notable only for reactive brain and \ngliotic brain white matter with no tissue diagnostic for \nmetastatic carcinoma. He then had an MRI of his ___ on \n___, which was notable for decreased nodular enhancement \nalong the right parietal surgical cavity and slight interval \nenlargement of the left frontal mass with increased extent of \nassociated white matter edema. He then underwent a single \nfraction of CyberKnife radiosurgery to his brain on ___. He \nthen developed seizures and was hospitalized throughout much of \n___ and ___. He has been difficult to wean off of \ndexamethasone and began study NTI ___ using Xerecept for \npatients who are unable to wean off of dexamethasone. He has \nbeen followed closely and his CT scans have been notable for \nstable pulmonary nodules. He has been\nable to be weaned down to dexamethasone 0.5 mg every other day. \nThe goal is to discuss systemic treatment options once he has \nbeen able to be weaned off of dexamethasone.', '1. Hypertension', '2. Left inguinal hernia, s/p surgery', '3. RCC metastatic to brain, lung and liver', '4. s/p Radical left nephrectomy ___. s/p Open cholecystectomy ___. s/p Omentectomy ___. s/p right craniectomy ___'], 'family_history': 'Non-contributory.', 'present_illness': '___ is a ___ right-handed man with metastatic \nrenal cell carcinoma to the brain, lung s/p resection of brain \nmetastasis from right parietal lobe in ___, with new \nbrain metastasis diagnosed in ___ presenting with \nseizures. He has been difficult to wean off of dexamethasone and \nfor last 32 weeks or so, has been in study NTI ___ using \nXerecept and then NTI 0501 for patients who are unable to wean \noff of dexamethasone. Most recently his dexamethasone has been \nweaned to 0.5 mg every other day in mid ___. \n\nYesterday, he was sitting at home when he began to notice his \nhands and arms moving in a "disoriented way". He told his sister \nthat this was the predecessor to seizure. He then presented to \n___ after a seizure at home and apparently seized \nagain at ___ ED. He was given 2 mg lorazepam and \nthen transferred to ___ ED for continuity of care. In the ED, \nDr. ___ was called and agreed to admit to ___. Neurology was \nnot able to see him in the ED.\n\nCurrently, he reports feeling a little nauseated but otherwise \nfeeling well. \n\nROS: No recent fevers, chills, chest pain, dyspnea, abdominal \npain, nausea, vomiting, or diarrhea.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', 'frequency': 'PRN', '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': 'Calcium Acetate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CARVedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Verapamil', '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 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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', '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': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', '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': 'Ferrous GLUCONATE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Verapamil', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Dwell (1000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.67', 'valuenum': 1.67, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 23.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58.5', 'valuenum': 58.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, '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': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.65', 'valuenum': 2.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.38', 'valuenum': 0.38, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.60', 'valuenum': 0.6, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, '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': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, '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 11.0, . estimated GFR (eGFR) is likely between 5 and 6 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': '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': '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': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '151', 'valuenum': 151.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 78.0, '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': '28', 'valuenum': 28.0, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, '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': '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '158', 'valuenum': 158.0, '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': '2.71', 'valuenum': 2.71, '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': '45.7', 'valuenum': 45.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '65', 'valuenum': 65.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '359', 'valuenum': 359.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/mg', 'ref_range_lower': 0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '436', 'valuenum': 436.0, 'valueuom': 'mg/dL', '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': None, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TR*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': 'MOD*.'}, {'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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.012', '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': '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': '21', 'valuenum': 21.0, '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}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '163', 'valuenum': 163.0, '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': '2.99', 'valuenum': 2.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '9', 'valuenum': 9.0, '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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'POS*.'}, {'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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.296', 'valuenum': 0.296, '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': '1.98', 'valuenum': 1.98, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.041', 'valuenum': 0.041, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '___'}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, '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': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 79.0, '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, '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': '___', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '18', 'valuenum': 18.0, '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': '7.6', 'valuenum': 7.6, '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': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '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': '7.3', 'valuenum': 7.3, '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, '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': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '136', 'valuenum': 136.0, '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': '2.84', 'valuenum': 2.84, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.42', 'valuenum': 2.42, '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': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.0', 'valuenum': 54.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '123', 'valuenum': 123.0, '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': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.34', 'valuenum': 0.34, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.65', 'valuenum': 0.65, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.10', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '45.6', 'valuenum': 45.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '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': '7.4', 'valuenum': 7.4, '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': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '7.8', 'valuenum': 7.8, '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': '6.8', 'valuenum': 6.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, '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': '10', 'valuenum': 10.0, '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': '67', 'valuenum': 67.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '211', 'valuenum': 211.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '5.4', 'valuenum': 5.4, '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, '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', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, '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 5.1, . estimated GFR (eGFR) is likely between 12 and 15 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': 75.0, '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': '0', 'valuenum': 0.0, '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, '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}], 'exams': 'VITAL SIGNS: Tm 99.3 F lowered to 98.4 F, BP 120/66, RR 16, \nPulse 85, and oxygen saturation 100% in room air.\nGENERAL: alert, disinhibited, oriented to place with some word \nmix-ups\nSKIN: Petechial-like rash on left arm, shins bilaterally. \nCircle of erythema over RLQ.\nHEENT: CN ___ intact, OP clear, neck supple and symmetric\nCARDIOVASCULAR: Reg, distant S1, S2, no m/r/g\nPULMONARY: Clear\nABDOMEN: Soft, NT/ND\nEXTREMITIES: warm, trace, non-pitting edema bilaterally\n\nNEUROLGOCIAL EXAMINATION: His Karnofsky Performance Score is 70. \nHe is awake, alert, and oriented times 3. His language is fluent \nwith good comprehension. Cranial Nerve Examination: His pupils \nare equal and reactive to light, 4 mm to 2 mm bilaterally. \nExtraocular movements are full. Visual fields are full to\nconfrontation. His face is symmetric. Facial sensation is intact \nbilaterally. His hearing is intact bilaterally. His tongue is \nmidline. Palate goes up in the midline. Sternocleidomastoids and \nupper trapezius are strong. Motor Examination: He does not have \na drift. His muscle strengths are ___ at all muscle groups. His \nmuscle tone is normal. His reflexes are 2- throughout. His ankle \njerks are 2-. His toes are down going. Sensory examination is \nintact to touch and proprioception. Coordination examination \ndoes not reveal dysmetria. His gait is normal. Tandem gait is \nintact. He does not have a Romberg.', 'diagnoses': [{'icd_code': 'I120', 'desc': 'Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease'}, {'icd_code': 'N186', 'desc': 'End stage renal disease'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'N3021', 'desc': 'Other chronic cystitis with hematuria'}, {'icd_code': 'B952', 'desc': 'Enterococcus as the cause of diseases classified elsewhere'}, {'icd_code': 'B965', 'desc': 'Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere'}, {'icd_code': 'E8770', 'desc': 'Fluid overload, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E1140', 'desc': 'Type 2 diabetes mellitus with diabetic neuropathy, unspecified'}, {'icd_code': 'E559', 'desc': 'Vitamin D deficiency, unspecified'}], 'summary': "136 104 21 AGap=9 \n------------( 153 \n5.4 28 1.3 <--1.3 (___) <-- 1.1 (___\n\nCa: 8.5 Mg: 1.9 P: 4.6\nALT: 51 AP: Tbili: 0.2 Alb: 4.6 \nAST: 26 \n\nWBC: 9.2 (N:89.0 L:8.2 M:2.1 E:0.3 Bas:0.4)\nhgb/hct: 13.5/38.1\nplt: 197\n\nRADIOLOGY:\n___: MRI ___: Stable right parietal enhancing lesion. No new \nlesions identified. Unchanged chronic microhemorrhage or \ncalcification in the left \nparasagittal frontal lobe. \n\n___ CT Torso: Stable left lung nodules and right paratracheal \nlymph node. These three target lesions were entered into the \noncology table. \nStable left hilar adenopathy which was new on the prior study. \nNew low-attenuation lesion in the right lobe of the thyroid. \nLikely this represents a thyroid nodule. However if clinically \nindicated further \nevaluation with a dedicated thyroid ultrasound would be useful. \nIncidental note is made of a small fat-containing umbilical \nhernia best seen on sagittal image 300B #44. \n\nMR ___ (PER ___. ___ - No interval change in known metastatic \ndisease. Final Read was pending at the time of discharge.\nThis is a ___ right-handed man with metastatic RCC to \nlung, brain s/p resection of brain metastasis complicated by \nrecurrent seizures, difficulty to wean off decadron now on study \nNTI ___ and then 0501, using Xerecept for patients who are \nunable to wean off of dexamethasone presenting with seizures.\n\n1. Seizure: The patient had been difficult to wean off steroids \nbut was able to be weaned on study med. In ED at ___, \nreceived 2mg ativan and in ED at ___, was given 500mg dilantin \nand 4mg decadron. While in house that patient was kept on \nseizure precautions as well as telemetry. His Keppra and \nDilantin were continued and his decadron, which he was \npreviously taking 0.5mg PO Daily, was increased to 4mg PO Daily. \nA MR ___ showed no interval change in the patients know \nmetastatic disease. \nThe patient was discharged on Dexamthesaone 4mg PO Daily. \n\n2. Metastatic RCC: The patient's current goal for therapy is to \nwean off decadron prior to any future potential therapies for \nmetastatic disease. The patient underwent a MRI that showed no \ninterval change in the patients know metastatic disease. \n\n3. HTN: The patient was continued on atenolol\n\n4. Anxiety: The patient was continued on lorazepam prn."}}
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{'final_diagnoses': ['Seizure', 'Metastatic Renal Cell Carcinoma', 'Hypertension', 'Anxiety'], 'procedures': ['None.'], 'visit_summary': "This is a ___ right-handed man with metastatic RCC to \nlung, brain s/p resection of brain metastasis complicated by \nrecurrent seizures, difficulty to wean off decadron now on study \nNTI ___ and then 0501, using Xerecept for patients who are \nunable to wean off of dexamethasone presenting with seizures.\n\n1. Seizure: The patient had been difficult to wean off steroids \nbut was able to be weaned on study med. In ED at ___, \nreceived 2mg ativan and in ED at ___, was given 500mg dilantin \nand 4mg decadron. While in house that patient was kept on \nseizure precautions as well as telemetry. His Keppra and \nDilantin were continued and his decadron, which he was \npreviously taking 0.5mg PO Daily, was increased to 4mg PO Daily. \nA MR ___ showed no interval change in the patients know \nmetastatic disease. \nThe patient was discharged on Dexamthesaone 4mg PO Daily. \n\n2. Metastatic RCC: The patient's current goal for therapy is to \nwean off decadron prior to any future potential therapies for \nmetastatic disease. The patient underwent a MRI that showed no \ninterval change in the patients know metastatic disease. \n\n3. HTN: The patient was continued on atenolol\n\n4. Anxiety: The patient was continued on lorazepam prn.", 'medications_prescribed': ['1. Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. Dexamethasone 4 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*0*', '3. Levetiracetam 250 mg Tablet Sig: Seven (7) Tablet PO BID (2 \ntimes a day).', '4. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) as needed for nausea.', '5. Phenytoin Sodium Extended 100 mg Capsule Sig: Two (2) Capsule \nPO BID (2 times a day).', '6. Buspirone 5 mg Tablet Sig: Three (3) Tablet PO TID (3 times a \nday).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 58, 'gender': 'M', 'symptoms': 'anxiety, poor concentration, inattention, forgetfullness, and \ntunnel vision', 'medical_history': ['Neurologic - Schwannoma', 'Chronic hemicrania', 'Chronic headaches with improvement on \nindomethacin', 'Endocrine - Low testosterone', 'Musculoskeletal - s/p ACL tear and replacement', 'Psychiatric - Anxiety'], 'family_history': 'Primary progressive aphasia (mother). Otherwise no known \nneurologic diseases.', 'present_illness': 'The patient is a ___ year old man presenting with anxiety, poor \nconcentration, inattention, forgetfullness, and tunnel vision \nthis morning. His story makes more sense when told \nchronologically: he has a longstanding history of headaches and \nanxiety. The headaches have been present throughout life and \nhave had variable characterizations, but they are often \nunilateral, dull or pulsatile, and associated with photophobia. \nIn the past 18 months to ___ years, his life seems to have \n"fallen apart" with a whole slew of new symptoms. In ___, he \nwas having left leg "sciatica" with radiating leg pain. During \nthe past ___ years, he has had intermittent episodes of days to \nweeks of ear "aches," usually on the right side, one at least \nonce with weeks of hearing loss (that resolved spontaneously but \nfelt like fluid in his ears). During this time, he has been \nchronically fatigued, often sleeping 12 hours without \ninterruption but still feeling very tired (without significant \nsleep latency or snoring, awakening with gasping, or other \nsymptoms of sleep apnea). He feels like he\'s become a \nhypochrondriac because he was otherwise healthy before this. For \nhis headaches, he saw a Neurologist who thought he might have \nchronic hemicrania and started indomethacin which was very \neffective for the headache. However, he started taking this \nmedication frequently, as much as every day during ___. \n\nOn ___, he awoke that morning with mid, substernal \nchest pain and his left arm "locked" against his chest (flexed \nand adducted). He went to ___ and had an \ninvestigation for chest pain which was essentially negative \nuntil they performed a CT Chest which revealed a tumor. In \n___, this was resected (over a 7.5 hour long surgery \nperformed by a Thoracic surgeron and Neurosurgeon who was \nworried the tumor involved the spine, or perhasp the nerve \nroots), and it was found to be a relatively large Schwannoma. He \nwas on pain medications for about three weeks after that and \nthen stopped those medications. Since then, however, he feels \nthat he has been more anxious and panicky. He feels that his \ncognition has worsened considerably: he works as a ___ \n___, performing ___ and writing reports, and he feels \nthat he is not as sharp or quick as he used to be. He has been \nforgetting names and has been having difficulty concentrating. \nIt takes him much longer to complete tasks. His Zoloft was \nincreased by his primary doctor ___ few weeks ago, but this did \nnot improve his symptoms. He started having some episodes where \nhe felt quite faint in the shower and also dizzy (without \nvertigo) with "sudden, intense lightheadedness" upon leaving the \nshower. Two weeks ago, he had another sudden onset episode with \nleft face, neck, shoulder, and arm numbness lasting several \nhours (until the next morning). He underwent an investigation at \n___ for stroke, but this was unrevealing. It \napparently involved and MRI of the Head and possibly neck \n(likely MRA). He also started tripping a lot when walking up \nstairs though he usually has good balance. Finally, today, he \nwoke up and put on the wrong clothes (not fit for work). He \nmissed his exit when driving to work. When he arrived, he felt \nhe had a hard time keeping track of conversations ("almost as if \neveryone was speaking a foreign language"), even though he \nunderstood the words that were being spoken. He became anxious \nand had tunneling of his vision. This\nprompted a visit to this ED.\n\nOf note, during this entire time since ___, he has had a \nheadache every single day. It is unilateral, dull, and lasts for \nat least hours. There is photophobia, but no nausea, sonophobia, \nor osmophobia. He has occasional episodes lasting minutes of \n"flashing stars" assocaited with these headaches. He has been\ntaking Advil 400 mg daily to address these headaches (since \n___. The headache otherwise does not have other concerning \nfeatures such as night awakenings, postural changes, fever, \nfocal neurologic signs (besides the aura), depression of \nconsciousness, or sudden severe onset.\n\nHe is not aware of any birth marks. He has not had tinnitus. He \nhas not had any apparent vision loss or diplopia. He has never \nhad seizures in the past. He has several graduate degrees.\n\nOn review of systems, the patient endorses: headache, confusion, \ndifficulty understanding speech, tunnel vision, anxiety, poor \nconcentration, prior hearing loss, fatigue.\nOn review of systems, the patient denies the following:\n- Neurologic: difficulty producing speech, vision loss, \ndiplopia,\nvertigo, dysarthria, dysphagia, focal limb weakness, sensory\nloss, gait imbalance.\n- Constitutional: fever, rigors, night sweats, unintentional\nweight loss.\n- Cardiovascular: chest pain, palpitations, lightheadedness.\n- Gastrointestinal: nausea, emesis, diarrhea, constipation.\n- Genitourinary: dysuria, urinary urgency, urinary incontinence.\n- Ear, Nose, Throat: tinnitus, rhinorrhea, odynophagia.\n- Hematologic: bleeding, easy bruising.\n- Musculoskeletal: arthralgia, myalgia.\n- Psychiatric: depression.\n- Respiratory: dyspnea, cough, hematemesis.\n- Skin: rash, new skin lesions.', 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'sevelamer CARBONATE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Aluminum Hydroxide Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate Replacement (Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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', 'route': 'TP', 'frequency': 'TID: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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aranesp', 'proc_type': 'Non-Formulary', 'status': 'Discontinued', 'route': 'SC', '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': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'NOON', 'doses_per_24_hrs': 1.0}, {'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': 'sevelamer CARBONATE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcitriol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'NOON', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'sevelamer CARBONATE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nephrocaps', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, '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': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.90', 'valuenum': 0.9, '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': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '8.6', 'valuenum': 8.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.8', 'valuenum': 82.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '262', 'valuenum': 262.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.91', 'valuenum': 1.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.17', 'valuenum': 10.17, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '52.5', 'valuenum': 52.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, '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': '___', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, '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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.0, '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': '8', 'valuenum': 8.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, '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 4.8, . Estimated GFR = 12 if non African-American (mL/min/1.73 m2) . Estimated GFR = 15 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': 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': '136', 'valuenum': 136.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.47, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '120', 'valuenum': 120.0, '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': '20.2', 'valuenum': 20.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, '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': '32.7', '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': '238', 'valuenum': 238.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.16', 'valuenum': 2.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.0', 'valuenum': 52.0, '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': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': '20', 'valuenum': 20.0, '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': '8.5', 'valuenum': 8.5, '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': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '16', 'valuenum': 16.0, '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, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.49, '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': '118', 'valuenum': 118.0, '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': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, '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': '33.8', 'valuenum': 33.8, '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': '223', 'valuenum': 223.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.32', 'valuenum': 2.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, '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': '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': '___', 'valuenum': 0.53, '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': '21.1', 'valuenum': 21.1, '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': '31.2', 'valuenum': 31.2, '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': '91', 'valuenum': 91.0, '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': 400.0, 'flag': None, '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': '2.31', 'valuenum': 2.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '53.6', 'valuenum': 53.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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': '9', 'valuenum': 9.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '5.6', 'valuenum': 5.6, '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': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.55, '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': '110', 'valuenum': 110.0, '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': '21.3', 'valuenum': 21.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': 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Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '2.4', 'valuenum': 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'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': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, 'valueuom': 'mEq/L', 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None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': '___', 'valuenum': 122.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '115', 'valuenum': 115.0, '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': '21.7', 'valuenum': 21.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 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None}, {'value': '2.46', 'valuenum': 2.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '138', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<20.'}, {'value': 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___:. Upper limit (97.5th %ile) varies with ancestry and gender (male/female). whites 322/201 blacks 801/414 asians 641/313..'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 75.0, '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': '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': '2.6', 'valuenum': 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{'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '34.3', 'valuenum': 34.3, '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': '197', 'valuenum': 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'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': '9.4', 'valuenum': 9.4, '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': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, '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': '0.34', 'valuenum': 0.34, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', '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': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.7', 'valuenum': 21.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81.3', 'valuenum': 81.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '198', 'valuenum': 198.0, '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': '2.47', 'valuenum': 2.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, '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': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.84', 'valuenum': 0.84, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.62', 'valuenum': 5.62, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '7.1', 'valuenum': 7.1, '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': '___'}, {'value': '___', 'valuenum': 132.0, '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '8.6', 'valuenum': 8.6, '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': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, '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': '22.0', 'valuenum': 22.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.44', 'valuenum': 2.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.1', 'valuenum': 51.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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', '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': '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': '8.1', 'valuenum': 8.1, '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': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, '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': '32.5', 'valuenum': 32.5, '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': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.61', 'valuenum': 2.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\n\n- Mental Status - Awake, alert. Oriented to name, current\nlocation, year. Attention to examiner easily attained and\nmaintained. Somewhat slow (with pauses) with MOYB. Recalls a\ncoherent history. Speech is fluent with full sentences. Follows\nmidline and appendicular commands. Intact repetition. Intact \nhigh\nfrequency and low frequency naming. No paraphasias. Normal\nprosody. No dysarthria. Semantic registration ___ and recall ___\n(no recovery with categorical cue). No ideomotor apraxia. No\nhemineglect.\n\n- Cranial Nerves - [II] PERRL 4->2 brisk. VF full to number\ncounting. Funduscopy shows crisp disc margins, no papilledema.\n[III, IV, VI] Left eye incomplete abduction with horizontal\ndiplopia. Otherwise EOMI. No apparent nystagmus. [V] V1-V3\nwithout deficits to light touch bilaterally. [VII] No facial\nmovement asymmetry. [VIII] Hearing intact to finger rub and \nwatch\ntick bilaterally. [IX, X] Palate elevation symmetric. [XI]\nSCM/Trapezius strength ___ bilaterally. [XII] Tongue midline.\n\n- Motor - Normal bulk and tone. No pronation, no drift. No\ntremor, asterixis, or myoclonus.\n=[Delt] [Bic] [Tri] [ECR] [IO] [IP] [Quad] [Ham] [TA] [Gas] \n[___]\n [C5] [C5] [C7] [C6] [T1] [L2] [L3] [L5] [L4] [S1] [L5]\nL 5 5 5 5 5 5 5 5 5 5 5\nR 5 5 5 5 5 5 5 5 5 5 5\n\n- Sensory - Decreased pin left T5-T8 (around the area of his \nback\nsurgery) to 50%. Left S2 diminished pin to 40-60%. Normal\nproprioception. No length-dependent sensory gradient. \n\n- Reflexes\n[Bic] [Tri] [___] [Quad] [Gastroc]\nL 2 2 2 2 2\nR 2 2 2 2 2\nPlantar response flexor bilaterally.\n\n- Coordination - No dysmetria with finger to nose testing\nbilaterally. Intact cadence and accuracy with rapid alternating\nmovements (finger tap).\n\n- Gait - Normal initiation. Stable stance with narrow base.\nRomberg sign is absent. Normal stride length. Normal arm swing.\nNo sway with standard gait. No sway with turns.\n\n==============\nDISCHARGE EXAM:\nAt discharge, patient was alert, awake, fully oriented. No focal \nneurologic deficits found on exam.', 'diagnoses': [{'icd_code': 'K264', 'desc': 'Chronic or unspecified duodenal ulcer with hemorrhage'}, {'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'I132', 'desc': 'Hypertensive heart and chronic kidney disease with heart failure and with stage 5 chronic kidney disease, or end stage renal disease'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'N185', 'desc': 'Chronic kidney disease, stage 5'}, {'icd_code': 'I272', 'desc': 'Other secondary pulmonary hypertension'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'I5030', 'desc': 'Unspecified diastolic (congestive) heart failure'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I471', 'desc': 'Supraventricular tachycardia'}, {'icd_code': 'N141', 'desc': 'Nephropathy induced by other drugs, medicaments and biological substances'}, {'icd_code': 'Q2733', 'desc': 'Arteriovenous malformation of digestive system vessel'}, {'icd_code': 'Z720', 'desc': 'Tobacco use'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'T508X5A', 'desc': 'Adverse effect of diagnostic agents, initial encounter'}, {'icd_code': 'Y92238', 'desc': 'Other place in hospital as the place of occurrence of the external cause'}, {'icd_code': 'I4581', 'desc': 'Long QT syndrome'}, {'icd_code': 'I739', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'F1021', 'desc': 'Alcohol dependence, in remission'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'K2970', 'desc': 'Gastritis, unspecified, without bleeding'}, {'icd_code': 'I495', 'desc': 'Sick sinus syndrome'}, {'icd_code': 'K449', 'desc': 'Diaphragmatic hernia without obstruction or gangrene'}, {'icd_code': 'D638', 'desc': 'Anemia in other chronic diseases classified elsewhere'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': '___ 10:00AM BLOOD WBC-8.5 RBC-5.68 Hgb-16.4 Hct-48.5 MCV-85 \nMCH-28.9 MCHC-33.8 RDW-12.5 Plt ___\n___ 10:00AM BLOOD Plt ___\n___ 10:00AM BLOOD ___ PTT-33.5 ___\n___ 10:00AM BLOOD ALT-56* AST-32 AlkPhos-107 TotBili-0.7\n___ 06:20AM BLOOD Calcium-9.6 Phos-3.8 Mg-2.4\n___ 10:00AM BLOOD Albumin-4.8\n___ 10:11AM BLOOD Glucose-102 Na-140 K-3.9 Cl-102 \ncalHCO3-19*\n\n===\nIMAGING\n\nNCHCT ___: No acute intracranial abnormality.\n\nCXR ___: No acute intrathoracic abnormality.\n\nMRI Head w/ contrast ___: Normal MRI of the brain.\n\nRoutine EEG ___ (prelim read): No abnormalities seen.\nAssessment:\nMr. ___ is a ___ yo man with a history of chronic headaches, \nanxiety, thoracic schwannoma s/p resection who presented to \n___ with anxiety, inattention, disorientation, and tunnel \nvision on ___. He was admitted for evaluation of his cognitive \nsymptoms and workup for possible neurofibromatosis. \n\n# Neuro: Mr ___ had a normal neurological exam throughout \nthe course of his stay. He had a MRI brain that was \nunremarkable, without evidence for intracranial masses. He had a \nroutine EEG of the brain that was normal. It was determined that \nhe was medically stable. He has an appointment in the neurology \nclinic next week at which point further decisions on work up and \nmanagement can be made. He was discharged home in stable \ncondition. \n\n# Hospital care: Mr ___ received a regular diet during his \nadmission and was given Heparin SC TID, Docusate BID, Senna BID, \nBisacodyl PRN for prophylaxis.\n\n# Transitional issues:\n1. Mr. ___ will follow up in Neurology Clinic with Dr \n___.'}}
|
{'final_diagnoses': ['COGNITIVE CHANGES'], 'procedures': ['none'], 'visit_summary': 'Assessment:\nMr. ___ is a ___ yo man with a history of chronic headaches, \nanxiety, thoracic schwannoma s/p resection who presented to \n___ with anxiety, inattention, disorientation, and tunnel \nvision on ___. He was admitted for evaluation of his cognitive \nsymptoms and workup for possible neurofibromatosis. \n\n# Neuro: Mr ___ had a normal neurological exam throughout \nthe course of his stay. He had a MRI brain that was \nunremarkable, without evidence for intracranial masses. He had a \nroutine EEG of the brain that was normal. It was determined that \nhe was medically stable. He has an appointment in the neurology \nclinic next week at which point further decisions on work up and \nmanagement can be made. He was discharged home in stable \ncondition. \n\n# Hospital care: Mr ___ received a regular diet during his \nadmission and was given Heparin SC TID, Docusate BID, Senna BID, \nBisacodyl PRN for prophylaxis.\n\n# Transitional issues:\n1. Mr. ___ will follow up in Neurology Clinic with Dr \n___.', 'medications_prescribed': ['Sertraline 150 mg PO DAILY', 'Indomethacin 25 mg PO TID:PRN pain', 'Lorazepam 0.5 mg PO Q8H:PRN anxiety']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 77, 'gender': 'F', 'symptoms': 'Pancreatic mass', 'medical_history': ['# CAD s/p NSTEMI 2 weeks ago', '- s/p MI ___ yrs ago treated at ___', '- cardiac cath ___: 3VD, severe complex LAD stenosis', '# CHF, ECHO ___, EF ___, moderate MR, moderate TR, mod \npulm htn', '# DM2 ? not on any meds', '# htn', '# h/o prostate cancer, ? bone mets', '- per pt, receives shot every 3 months', '# h/o cholecystitis', '# h/o nephrolithiasis'], 'family_history': 'Denies family history of CAD. Parents died when he was ___. No \nknown h/o malignancy.', 'present_illness': '___ M h/o CAD s/p recent NSTEMI, Prostate ca, HTN, who is being \ndierctly admitted to the hospital for ERCP/EUS. The patient was \ntransferred to ___ last week for evaluation of the mass but \nERCP could not be done at that tine because pt is on Plavix. Pt \nhas not been taking Plavix for the last week. The mas was \nincidently found on CTA at ___. \n\nThe pt currently has no complaints. He denies abd pain, \nnausea/vomting, diarrhea, fever/chills. He has been tolerating \ngood po.', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', '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': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', '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', 'frequency': 'QHS', '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': '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': 'Metoclopramide', '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': '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', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '5X/DAY', 'doses_per_24_hrs': 5.0}, {'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', 'route': 'PO', 'frequency': 'Q8H: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': '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': '1.88', 'valuenum': 1.88, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, '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': '40.4', 'valuenum': 40.4, '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': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61.7', 'valuenum': 61.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.40', 'valuenum': 4.4, '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.50', 'valuenum': 0.5, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '42.6', 'valuenum': 42.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '10.0', 'valuenum': 10.0, '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': '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 = 70 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': 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': '93', 'valuenum': 93.0, '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': '2.6', 'valuenum': 2.6, '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': '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': '11', 'valuenum': 11.0, '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': 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': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 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': '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': '8.0', 'valuenum': 8.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, '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': 'Cloudy.'}, {'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': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, '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': '93', 'valuenum': 93.0, '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '19', 'valuenum': 19.0, '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 121.0, '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', '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '8.6', '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '1.8', 'valuenum': 1.8, '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': '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': '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': '28.7', 'valuenum': 28.7, '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': '29.4', 'valuenum': 29.4, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.09', 'valuenum': 3.09, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.7', 'valuenum': 43.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T: 96.6 BP: 106/74 HR: 84 RR: 20 O2 99% RA \nGen: Pleasant, well appearing, elderly male in NAD \nHEENT: No conjunctival pallor. No icterus. MMM. OP clear. \nNECK: Supple, No LAD, No elevated JVP. No thyromegaly. \nCV: RRR. nl S1, S2. Soft ___ holosys murmur at apex \nLUNGS: mild bibasilar crackles \nABD: Obese. NABS. Soft, NT, ND. No HSM. Negative ___ sign \nEXT: WWP, NO CCE. Full distal pulses \nSKIN: No rashes/lesions, ecchymoses. \nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. Moving all \nextremities.', 'diagnoses': [{'icd_code': 'S72002A', 'desc': 'Fracture of unspecified part of neck of left femur, initial encounter for closed fracture'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'W19XXXA', 'desc': 'Unspecified fall, initial encounter'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}], 'summary': "___ 10:40AM BLOOD Glucose-135* UreaN-24* Creat-1.1 Na-138 \nK-3.8 Cl-101 HCO3-29 AnGap-12\n___ 10:40AM BLOOD ALT-101* AST-53* AlkPhos-120* TotBili-1.0\n___ 10:40AM BLOOD Calcium-9.1 Phos-2.9 Mg-1.9\n___ 10:40AM BLOOD ___ PTT-26.3 ___\n___ M h/o CAD s/p recent NSTEMI, Prostate ca, HTN, who is being \ndierctly admitted to the hospital for ERCP/EUS.\n\n1. Pancreatic Mass - Pt was made NPO after midnight for \nERCP/EUS on ___. Pt was at high risk for procedure but had \nbeen cleared by Dr. ___ of cardiology. Routine 2D \necho done as inpatient per Cards request. CT abd with pancreas \nprotocol done per GI's request to betted visualize mass. Plavix \nand ___ was held for a week. Pt was on anitbiotic prophylaxis \nwith Cipro/Flagyl. Pt symptom free at presentation. ERCP \nshowed multiple stones ranging in size from 4-15 mm in the lower \nthird of the bile duct. The bile duct was diffusely dilated to \n10 mm. The rest of the biliary tree was normal. Some stones \nwere impacted at the ampullary orifice. A sphincterotomy was \nperformed in the 12 o'clock position using a sphincterotome over \nan existing guidewire. Mechanical lithotripsy of stones was \nperformed. Stones were extracted using balloon and a basket. \nDuring the procedure the patient desturated into the ___. High \nflow oxygen was given. Patient recovered and stabilized \nquickly. The desaturation may have been due to anetheia eddect. \nEKG showed no significant changes. Cardiac enzymes were \nnormal. Cardiology evaluated the patient and agreed. Pt \nremained stable on the floor. He denied abd pain, \nnausea/vomiting and remained afebrile. Pt seen by Surgery who \nrecommends outpatient cholecystectomy. Follow up will be \narranged with Dr. ___ general surgery for ___ weeks \nfrom now.\n\n2. CAD - Pt was continued on home cardiac medications, statin, \nbeta ___, Lisinopril. Holding Plavix for procedure \ntomorrow. He has arrangements to follow up with his \ncardiologist next week.\n\n3. Systolic CHF with EF ___ - Clinically stable. Lasix held \nfor procedure tomorrow. 2D echo done per cards request. It was \nnot signidicantly changed from previous. The report was as \nfollows: The left atrium is mildly dilated. There is mild \nsymmetric left ventricular hypertrophy. The left ventricular \ncavity is moderately dilated. There is moderate to severe global \nleft ventricular hypokinesis (LVEF = 30 %). There is no \nventricular septal defect. Right ventricular chamber size and \nfree wall motion are normal. The aortic valve leaflets (3) are \nmildly thickened but aortic stenosis is not present. Trace \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. An \neccentric, posteriorly directed jet of moderate (2+) mitral \nregurgitation is seen. [Due to acoustic shadowing, the severity \nof mitral regurgitation may be significantly UNDERestimated.] \nThe tricuspid valve leaflets are mildly thickened. There is \nmoderate pulmonary artery systolic hypertension. There is no \npericardial effusion. \n\n4. Borderline Type 2 DM - Appears to be diet controlled. Pt \nnot on medication. recent HbA1C was 6.3. Should follow up with \nPCP regarding this.\n\n5. HTN - Stable on beta ___ and ACE.\n\n6. Code Full"}}
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{'final_diagnoses': ['Choledocolithiasis'], 'procedures': ['ERCP ___'], 'visit_summary': "___ M h/o CAD s/p recent NSTEMI, Prostate ca, HTN, who is being \ndierctly admitted to the hospital for ERCP/EUS.\n\n1. Pancreatic Mass - Pt was made NPO after midnight for \nERCP/EUS on ___. Pt was at high risk for procedure but had \nbeen cleared by Dr. ___ of cardiology. Routine 2D \necho done as inpatient per Cards request. CT abd with pancreas \nprotocol done per GI's request to betted visualize mass. Plavix \nand ___ was held for a week. Pt was on anitbiotic prophylaxis \nwith Cipro/Flagyl. Pt symptom free at presentation. ERCP \nshowed multiple stones ranging in size from 4-15 mm in the lower \nthird of the bile duct. The bile duct was diffusely dilated to \n10 mm. The rest of the biliary tree was normal. Some stones \nwere impacted at the ampullary orifice. A sphincterotomy was \nperformed in the 12 o'clock position using a sphincterotome over \nan existing guidewire. Mechanical lithotripsy of stones was \nperformed. Stones were extracted using balloon and a basket. \nDuring the procedure the patient desturated into the ___. High \nflow oxygen was given. Patient recovered and stabilized \nquickly. The desaturation may have been due to anetheia eddect. \nEKG showed no significant changes. Cardiac enzymes were \nnormal. Cardiology evaluated the patient and agreed. Pt \nremained stable on the floor. He denied abd pain, \nnausea/vomiting and remained afebrile. Pt seen by Surgery who \nrecommends outpatient cholecystectomy. Follow up will be \narranged with Dr. ___ general surgery for ___ weeks \nfrom now.\n\n2. CAD - Pt was continued on home cardiac medications, statin, \nbeta ___, Lisinopril. Holding Plavix for procedure \ntomorrow. He has arrangements to follow up with his \ncardiologist next week.\n\n3. Systolic CHF with EF ___ - Clinically stable. Lasix held \nfor procedure tomorrow. 2D echo done per cards request. It was \nnot signidicantly changed from previous. The report was as \nfollows: The left atrium is mildly dilated. There is mild \nsymmetric left ventricular hypertrophy. The left ventricular \ncavity is moderately dilated. There is moderate to severe global \nleft ventricular hypokinesis (LVEF = 30 %). There is no \nventricular septal defect. Right ventricular chamber size and \nfree wall motion are normal. The aortic valve leaflets (3) are \nmildly thickened but aortic stenosis is not present. Trace \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. An \neccentric, posteriorly directed jet of moderate (2+) mitral \nregurgitation is seen. [Due to acoustic shadowing, the severity \nof mitral regurgitation may be significantly UNDERestimated.] \nThe tricuspid valve leaflets are mildly thickened. There is \nmoderate pulmonary artery systolic hypertension. There is no \npericardial effusion. \n\n4. Borderline Type 2 DM - Appears to be diet controlled. Pt \nnot on medication. recent HbA1C was 6.3. Should follow up with \nPCP regarding this.\n\n5. HTN - Stable on beta ___ and ACE.\n\n6. Code Full", 'medications_prescribed': ['1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours) for 5 days. ', '2. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 \ntimes a day) for 5 days. ', '3. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '6. Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 55, 'gender': 'F', 'symptoms': 'constipation', 'medical_history': ['Hypothyroidism', 'hypertension', 'adhesive capsulitis', 'sensorineural hearing loss', 'kidney stone in ___', 'anaphylactic shock ___', 'shingles', 'left shoulder surgery', 'vertigo', 'hyponatremia ___', 'bipolar disorder.'], 'family_history': 'Mother died at age ___ of "old age." Brother has\nhypertension. Dad died at age ___ of CHF, multiple MIs and AAA.\nShe had a very long smoking history.', 'present_illness': 'Ms. ___ is a ___ female with history of\nhypothyroidism, HTN, bipolar disorder, nephrolithiases who\npresented with constipation.\n\nThe patient states she was in usual state of health up until 9\ndays ago. At that time she had new lumbosacral pain/strain. She\nnever had that before. She decided to take oxycodone and\nlidocaine patch, which she typically does not use either. Then 7\ndays ago she developed a new left lower quadrant discomfort.\nSometimes a sharp intermittent pain, nonradiating. She had no\nnausea, vomiting or diarrhea, fever. It was at this time she\ndeveloped constipation. She did not have any further bowel\nmovements and lost her appetite during the past 7 days. She had\ndiscontinued her oxycodone already but the constipation\npersisted.\nShe went to ___ and 2 other hospitals at ___\narea. She went to ___ ED on ___. She was discharged from the \nED\ntrips each time. On the ___ ED visit ___ she had CTU scan to\nrule out kidney stones, it was negative so she was sent home.\n\nShe decided to present again to ___ ED on ___ due to \npersistent\npain and constipation, after calling her outpatient ___\noffice they had directed her to the ED. This time she had CT A/P\nthat showed large amounts of formed stool in the rectum, and\npossible enteritis in ascending/transverse colon due to a fluid\nfilled state.\nShe also underwent manually disimpaction in the ED, which was\nsuccessful. She had a subsequent large bowel movement upon\nadmission to the floor. She currently has no pain or discomfort.\n\nED: 1L NS, Mg citrate, Ativan 1 mg PO', 'medications': [{'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': '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': 'Polyethylene Glycol', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Venlafaxine XR', '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': 'Valsartan', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'QID: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}]}, 'clinical_findings': {'labs': [{'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 (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': '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', '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': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, '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}], 'exams': 'ADMISSION\nVITALS: Afebrile and vital signs stable (see eFlowsheet)\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: 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. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nPSYCH: pleasant, appropriate affect\nNEUROLOGIC:\nMENTATION: alert and cooperative. Oriented to person and place\nand time.\n\nDISCHARGE\n97.4 PO 134 / 71 61 18 97 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: 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. No HSM\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nPSYCH: pleasant, appropriate affect\nNEUROLOGIC:\nMENTATION: alert and cooperative. Oriented to person and place\nand time.', 'diagnoses': [{'icd_code': 'M1711', 'desc': 'Unilateral primary osteoarthritis, right knee'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6837', 'desc': 'Body mass index [BMI] 37.0-37.9, adult'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'I9581', 'desc': 'Postprocedural hypotension'}, {'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': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': "ADMISSION\n\n___ 01:15AM BLOOD WBC-14.0* RBC-4.57 Hgb-13.2 Hct-39.8 \nMCV-87 MCH-28.9 MCHC-33.2 RDW-13.5 RDWSD-42.5 Plt ___\n___ 01:15AM BLOOD ___ PTT-27.1 ___\n___ 01:15AM BLOOD Glucose-111* UreaN-11 Creat-0.9 Na-134* \nK-4.1 Cl-95* HCO3-21* AnGap-18\n___ 01:15AM BLOOD Lipase-18\n___ 01:15AM BLOOD Albumin-3.9\n___ 01:15AM BLOOD ALT-9 AST-26 AlkPhos-56 TotBili-0.4\n\nDISCHARGE\n\n___ 06:45AM BLOOD WBC-11.1* RBC-4.63 Hgb-13.4 Hct-41.2 \nMCV-89 MCH-28.9 MCHC-32.5 RDW-13.8 RDWSD-44.5 Plt ___\n\nCT abd/pel with contrast\n\n1. No evidence of obstruction. Oral contrast passes to the \nlevel of the \nrectum. \n2. Diffusely fluid-filled ascending and transverse colons may be \ncompatible with enteritis. Large amount of formed stool noted \nin the rectal vault.\n#Opioid induced constipation, resolved\n-Seemingly resolved since disimpaction in ED and passage of \nlarge\nbowel movement on day of admission and ongoing bowel movements \nand passing gas this morning.\n-Etiology is probably from her taking the oxycodone several days\nprior. She was counseled on this.\n-The patient was given an option of discharge yesterday but said \nshe preferred to stay until the morning to make sure she doesn't \nhave recurrent constipation\n-Given that she continues to move her bowels well, will \ndischarge with bowel regimen.\n-Regular diet\n-Daily miralax, senna, Colace - prescriptions given for \ndischarge\n\n#Question of enteritis\n-Fluid filled ascending/transverse colon on CT A/P. This is\nnonspecific and she does not likely have true inflammatory \ncolonic\npathology at this point; may have been related to her\nconstipation that is now relieved. Clinically she is afebrile, \nwell-appearing, and her slight leukocytosis yesterday is \ndowntrending.\n\n#Lower back pain\nPatient endorsed musculoskeletal lower back pain today. She was \nable to ambulate in the hall though she was concerned about \nmanaging at home, especially with her disabled husband, so \narranged home ___. She received toradol x1 and naproxen x1 which \nhelped her. Discharged with prescription for naproxen.\n\n#Hypothyroidism \n- continued home synthroid\n\n#HTN\n-Continued home lisionpril\n\n#Bipolar disorder\n-Continued home valproate"}}
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{'final_diagnoses': ['Constipation', 'Musculoskeletal back pain', 'Hypothyroidism', 'Bipolar disorder', 'Hypertension'], 'procedures': ['None'], 'visit_summary': "#Opioid induced constipation, resolved\n-Seemingly resolved since disimpaction in ED and passage of \nlarge\nbowel movement on day of admission and ongoing bowel movements \nand passing gas this morning.\n-Etiology is probably from her taking the oxycodone several days\nprior. She was counseled on this.\n-The patient was given an option of discharge yesterday but said \nshe preferred to stay until the morning to make sure she doesn't \nhave recurrent constipation\n-Given that she continues to move her bowels well, will \ndischarge with bowel regimen.\n-Regular diet\n-Daily miralax, senna, Colace - prescriptions given for \ndischarge\n\n#Question of enteritis\n-Fluid filled ascending/transverse colon on CT A/P. This is\nnonspecific and she does not likely have true inflammatory \ncolonic\npathology at this point; may have been related to her\nconstipation that is now relieved. Clinically she is afebrile, \nwell-appearing, and her slight leukocytosis yesterday is \ndowntrending.\n\n#Lower back pain\nPatient endorsed musculoskeletal lower back pain today. She was \nable to ambulate in the hall though she was concerned about \nmanaging at home, especially with her disabled husband, so \narranged home ___. She received toradol x1 and naproxen x1 which \nhelped her. Discharged with prescription for naproxen.\n\n#Hypothyroidism \n- continued home synthroid\n\n#HTN\n-Continued home lisionpril\n\n#Bipolar disorder\n-Continued home valproate", 'medications_prescribed': ['Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily Disp \n#*60 Tablet Refills:*4', 'Naproxen 500 mg PO Q12H:PRN Pain - Moderate \nRX *naproxen 500 mg 1 tablet(s) by mouth twice daily as needed \nDisp #*30 Tablet Refills:*0', 'Polyethylene Glycol 17 g PO DAILY \nRX *polyethylene glycol 3350 [Miralax] 17 gram 1 powder(s) by \nmouth daily as needed Disp #*30 Packet Refills:*4', 'Senna 8.6 mg PO BID \nRX *sennosides [senna] 8.6 mg 1 tab by mouth twice daily Disp \n#*60 Tablet Refills:*4', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN sob', 'Diazepam 10 mg PO QHS', 'Divalproex (EXTended Release) 500 mg PO QHS', 'Gabapentin 300 mg PO TID', 'Levothyroxine Sodium 112 mcg PO DAILY', 'Lisinopril 30 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'M', 'symptoms': 'Chest pain', 'medical_history': ['HTN', 'HLD', 'DM'], 'family_history': 'Family history of diabetes mellitus- older brother and aunt. No \nfamily history of endocrine disorders. No family history of \ncancer', 'present_illness': "___ with history of HTN, DM, HLD\nwho presents with chest pain: Pt reports 3 weeks of chest \npain,\ndescribed as substernal, radiates to the left shoulder,\nexertional, and associated with nausea and dyspnea. Symptoms are\nrelieved by rest. He was seen at his PCP's office on ___ with\nEKG checked which showed TWI in inferolateral leads. He was\nreferred to the ED for further evaluation. In the ED initial\nvitals were: 98.0 113 143/84 18 98% RA \n EKG: notable for TWI in leads I, III and v4-46\n Labs/studies notable for: troponin <0.01 x 2, BNP 98, normal \nCBC\nand chemistry. \n Patient was given: alum-mag-simethicone, donnatal, viscous \nlido,\nmetop 12.5mg, hctz 25 mg, asa 324mg. \n He was evaluated by cardiology and underwent an exercise stress\ntest which was positive (anginal equivalent with ischemic EKG\nchanges). A TTE performed with the stress test showed inducible\nischemia w/ exercise. Overall EF was normal. As a result, he was\ntaken for cardiac catheterization.", 'medications': [{'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID: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': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amphetamine-Dextroamphetamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amphetamine-Dextroamphetamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', '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': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'DULoxetine DR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amphetamine-Dextroamphetamine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'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': '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', '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 (eGFR) is likely between 72 and >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': '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': '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '8', 'valuenum': 8.0, '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': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.5', 'valuenum': 22.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '4.5', 'valuenum': 4.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86.3', 'valuenum': 86.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, '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': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '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': '4.0', 'valuenum': 4.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85.1', 'valuenum': 85.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.0, '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': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '9.2', 'valuenum': 9.2, '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': 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': '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': '183', 'valuenum': 183.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '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': '142', 'valuenum': 142.0, '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': '13', 'valuenum': 13.0, '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': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '186', 'valuenum': 186.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '33.0', 'valuenum': 33.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, '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': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.1', 'valuenum': 84.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', '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': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', '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': '1.016', 'valuenum': 1.016, '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': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'OCC*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'DONE', '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': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '8.9', 'valuenum': 8.9, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '40', 'valuenum': 40.0, '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': '1.9', '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': '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '14', 'valuenum': 14.0, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '187', 'valuenum': 187.0, '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': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86.2', 'valuenum': 86.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission exam\nExam: \n VS - 98.4 153/83 93 18 97%RA\n General: Alert and orientedx3, no apparent distress \n Neck: Carotids: Right: Bruit: (-) \n Left: Bruit: (-)\n CV: normal s1,s2, no murmurs\n Resp: clear bilaterally\n Abd: soft, NT, ND\n Peripheral Vascular - Right radial access site with TR band in\nplace, no bruising, bleeding or hematoma noted. 2+ radial pulse,\ndistal CSM intact. \n Pulses: \n Right: Radial:(+) Femoral bruit:(-) DP:(+) ___\n Left: Radial:(+) Femoral bruit:(-) DP:(+) ___\n\nDischarge Exam \nVS: 98.2 110/69 78 18 98%RA\nPhysical Exam: \n Gen: Middle age gentleman laying in bed in no apparent \ndistress \n Neuro: Alert and oriented x3, no focal deficits \n Neck/JVP: Supple, no JVD noted. No carotid bruits \n CV: regular rate and rhythm. No murmur noted \n Chest: RR even and non-labored. Lung sounds clear bilaterally \n ABD: Soft, NT, ND. +BSx4 \n Extr: No edema noted \n Skin: Warm and well perfused, no lesions or rashes noted \n Access sites: right radial cath site intact, no bruising, \nbleeding or hematoma noted. 2+ radial pulse, distal CSM intact.', 'diagnoses': [{'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I350', 'desc': 'Nonrheumatic aortic (valve) stenosis'}, {'icd_code': 'R55', 'desc': 'Syncope and collapse'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'F909', 'desc': 'Attention-deficit hyperactivity disorder, unspecified type'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'Z96643', 'desc': 'Presence of artificial hip joint, bilateral'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'K5903', 'desc': 'Drug induced constipation'}, {'icd_code': 'T402X5A', 'desc': 'Adverse effect of other opioids, initial encounter'}, {'icd_code': 'Y92009', 'desc': 'Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external cause'}], 'summary': 'Admission labs:\n___ 11:10PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 11:10PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n___ 09:20PM K+-GREATER TH\n___ 09:01PM WBC-9.0 RBC-4.47* HGB-12.0* HCT-38.8* MCV-87 \nMCH-26.8 MCHC-30.9* RDW-15.8* RDWSD-49.7*\n___ 09:01PM NEUTS-52.4 ___ MONOS-12.0 EOS-0.7* \nBASOS-0.6 IM ___ AbsNeut-4.71 AbsLymp-3.04 AbsMono-1.08* \nAbsEos-0.06 AbsBaso-0.05\n___ 09:01PM PLT SMR-NORMAL PLT COUNT-227\n___ 07:59PM GLUCOSE-115* UREA N-21* CREAT-0.8 SODIUM-138 \nPOTASSIUM-6.3* CHLORIDE-102 TOTAL CO2-21* ANION GAP-21*\n___ 07:59PM estGFR-Using this\n___ 07:59PM cTropnT-<0.01 proBNP-98\n___ 07:59PM ___ PTT-27.8 ___\n\n___ 12:10AM BLOOD TSH-<0.01*\n___ 07:10AM BLOOD T3-286* Free T4-4.2*\n___ 06:10PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n\n___ 07:55AM BLOOD WBC-8.4 RBC-4.16* Hgb-11.3* Hct-35.1* \nMCV-84 MCH-27.2 MCHC-32.2 RDW-15.4 RDWSD-46.4* Plt ___\n___ 07:55AM BLOOD Glucose-104* UreaN-26* Creat-0.8 Na-139 \nK-4.2 Cl-101 HCO3-24 AnGap-18\n___ 07:55AM BLOOD ALT-23 AST-17 AlkPhos-73 TotBili-0.4\n___ 07:55AM BLOOD Albumin-3.7 Mg-2.2\n___ 07:55AM BLOOD T4-13.7*\n___ 07:10AM BLOOD T3-286* Free T4-4.2*\n___ 12:10AM BLOOD TSH-<0.01*\n___ year old gentlemen who presented to the ED with complaints of \nchest pain on exertion that had been ongoing over the last three \nmonths. He was seen by cardiology and underwent a stress echo \nwhich was abnormal and was referred for cardiac catheterization. \nHe had normal LV function on stress echo. His cardiac \ncatheterization revealed microvascular disease with normal \nLVEDP. He had unexplained tachycardia during the procedure and \novernight he went into rapid atrial fibrillation. When in RAF, \nhe developed symptoms of CP and SOB, consistent with the \nsymptoms he had been experiencing over the last month. Urine \ntox screen was negative. A TSH was added on and found to be \n<0.01 and Free T4 and T3 were elevated. Endocrine was \nconsulted. He was started on methmiazole 20mg daily. He \nunderwent a thyroid u/s thatshowed heterogeneous gland without \ndiscrete nodules. Propranolol was also started for rate control \nwith good effect. The patient reports a history of rectal \nbleeding with multiple colonoscopies in the past. He believes \nhis last colonoscopy was normal. Given the patients \nrecollection and description of rectal bleeding, it appears it \nis more related to hemorrhoids, however this was not verified \nwith PCP. Given the risk of stroke he was discharged on \nrivaroxaban 20mg daily. He was discharged in stable condition.'}}
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{'final_diagnoses': ['Microvascular disease', 'Atrial fibrillation', 'Hyperthyroidism'], 'procedures': ['Cardiac catheterization ___'], 'visit_summary': '___ year old gentlemen who presented to the ED with complaints of \nchest pain on exertion that had been ongoing over the last three \nmonths. He was seen by cardiology and underwent a stress echo \nwhich was abnormal and was referred for cardiac catheterization. \nHe had normal LV function on stress echo. His cardiac \ncatheterization revealed microvascular disease with normal \nLVEDP. He had unexplained tachycardia during the procedure and \novernight he went into rapid atrial fibrillation. When in RAF, \nhe developed symptoms of CP and SOB, consistent with the \nsymptoms he had been experiencing over the last month. Urine \ntox screen was negative. A TSH was added on and found to be \n<0.01 and Free T4 and T3 were elevated. Endocrine was \nconsulted. He was started on methmiazole 20mg daily. He \nunderwent a thyroid u/s thatshowed heterogeneous gland without \ndiscrete nodules. Propranolol was also started for rate control \nwith good effect. The patient reports a history of rectal \nbleeding with multiple colonoscopies in the past. He believes \nhis last colonoscopy was normal. Given the patients \nrecollection and description of rectal bleeding, it appears it \nis more related to hemorrhoids, however this was not verified \nwith PCP. Given the risk of stroke he was discharged on \nrivaroxaban 20mg daily. He was discharged in stable condition.', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Methimazole 20 mg PO DAILY', 'Propranolol 40 mg PO TID', 'Rivaroxaban 20 mg PO DAILY \nTake with dinner or largest meal of the day', 'Glargine 40 Units Breakfast\nGlargine 40 Units Bedtime\nInsulin SC Sliding Scale using novolog Insulin', 'Ezetimibe 10 mg PO DAILY', 'Hydrochlorothiazide 25 mg PO DAILY', 'Losartan Potassium 100 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 70, 'gender': 'F', 'symptoms': 'fever', 'medical_history': ['1. Polyps.', "2. Barrett's esophagitis.", '3. Lyme disease during her teen years.', '4. Gastric bypass about ___ years ago.', '5. Status post cholecystectomy at the time of the \nbypass.', '6. Tranaminitis being worked up'], 'family_history': 'Family history is positive for juvenile rheumatoid arthritis. \nFather and mother in good health. Mother has \nhypercholesterolemia. Sister has hypertension and \nhypercholesterolemia. Grandmother passed away from lymphoma and \nbreast cancer.', 'present_illness': "The patient is a ___ year old female with a history of obesity \ns/p gastric bypass and transaminitis being worked up with liver \nbiopsy on the day of presentation who comes in with fever to 102 \nat home. \n.\nThe patinet was first noted to have transaminitis to 800 in ___ \nduring a hospitalization for chest pain/palpitiations, which \nimproved during her hospitalization. Per report, this normalized \nduring subsequent outpatient evaluation. The patient recently \nhad follow up blood work which showed continued tranaminitis, \nand she was seen for initial consultation with Dr. ___ on \n___. \n.\nThe patient reported continued palpitations, increased heart \nrate, constant tremors and sweats. She also described some \nepigastric pain that occurs across in a band-like fashion, which \nstarted recently, as well as arthralgias in multiple joints. It \nwas felt that her clinical picture, was most consistent with \nautoimmune hepititis, although her ___ was only positive 1:40, \nsmooth Ab negative, IgG normal. The patient underwent a liver \nbiopsy without complicaition today, but developed fever to 102 \nat home. Upon speaking to her provider's coverage, she was \ninstructed to come to the ED for further evaluation.\n. \nOn arrival to the ___ ED, the patient triggered for a HR of \n145, with a concurrent BP of 145/90, T 101.2, 100% on RA. She \nwas given morphine for pain control and motrin for her fever, in \naddition to 2L of IVF. She defervesed to 99.2, and her HR \nremained elevated, but improved to 100-110. Of note, during a \nhospitalization ___ for complaints of diaphoresis, she was \nsimilarly tachycardic. She was checked for a pheochromycytoma, \nwith negative blood work and had a a negative CTA for PE. Her \ntachycardia was attributed to anxiety. The patient had a CTA and \nwas admitted to the medical service for further evaluation.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'Artificial Tears Preserv. Free', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', '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': 'Atorvastatin', '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': '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', 'route': 'SC', 'frequency': 'DINNER', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': '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': '26.4', 'valuenum': 26.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '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': '9.0', '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': '___', 'valuenum': 65.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 159.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', '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': 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': '15', 'valuenum': 15.0, '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': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.2', '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, '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': '25.6', 'valuenum': 25.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '286', 'valuenum': 286.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '4.62', 'valuenum': 4.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '285', 'valuenum': 285.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, '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': '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': '4.6', 'valuenum': 4.6, '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': '145', 'valuenum': 145.0, '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': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'VS: 993, 138/97, 103, 100% on RA \nGENERAL: well-appearing woman, NAD, fine hand tremulations \nHEENT: No scleral icterus. PERRLA/EOMI. MMM. OP clear. Neck \nsupple, No LAD. \nCARDIAC: RR. Normal S1, S2. No m/r/g.\nLUNGS: CTA B, good air movement biaterally.\nABDOMEN: NABS. Soft, NT, ND. No HSM. Bx site c/d/i without \nerythema. \nEXTREMITIES: No c/c/e, 2+ dorsalis pedis/ posterior tibial \npulses. \nNEURO: A&Ox3. Appropriate. CN ___ grossly intact. Preserved \nsensation throughout. ___ strength throughout. ___ reflexes, \nequal ___. Gait assessment deferred. Resting and intention tremor \nnoted.', 'diagnoses': [{'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '78650', 'desc': 'Chest pain, unspecified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '71946', 'desc': 'Pain in joint, lower leg'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}], 'summary': "Admission labs:\n___ 09:00PM BLOOD WBC-7.6 RBC-4.13* Hgb-13.5 Hct-40.3 \nMCV-98 MCH-32.6* MCHC-33.4 RDW-13.1 Plt ___\n___ 09:00PM BLOOD Neuts-81.8* Lymphs-12.1* Monos-4.6 \nEos-1.2 Baso-0.4\n___ 09:00PM BLOOD ___ PTT-25.6 ___\n___ 09:00PM BLOOD Glucose-115* UreaN-7 Creat-0.6 Na-133 \nK-4.0 Cl-96 HCO3-25 AnGap-16\n___ 05:39AM BLOOD Calcium-8.2* Phos-3.4 Mg-1.6\n___ 03:40PM BLOOD HCG-<5\n.\nLiver studies:\n___ 03:40PM BLOOD ALT-500* AST-966* LD(LDH)-424* \nAlkPhos-236* TotBili-0.7\n___ 05:39AM BLOOD ALT-490* AST-1843* LD(LDH)-732* \nCK(CPK)-27* AlkPhos-202* TotBili-1.0\n___ 09:00PM BLOOD ALT-159* AST-269* LD(LDH)-242 \nAlkPhos-160* TotBili-0.4\n___ 03:40PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE \nHBcAb-NEGATIVE HAV Ab-NEGATIVE IgM HBc-NEGATIVE IgM HAV-NEGATIVE\n___ 10:05AM BLOOD Smooth-NEGATIVE\n___ 10:05AM BLOOD ___ * Titer-1:40 ___\n___ 03:40PM BLOOD IgG-909\n___ 03:40PM BLOOD HCV Ab-NEGATIVE\n___ 05:39AM BLOOD CERULOPLASMIN-22 (range ___\n.\nUrinalysis:\n___ 08:45PM URINE Color-Yellow Appear-Clear Sp ___\n___ 08:45PM URINE Blood-TR Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-50 Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-NEG\n___ 08:45PM URINE ___ Bacteri-OCC Yeast-NONE \n___\n.\nMicrobiology:\nBlood culture ___: no growth\nBlood culture ___: no growth\n.\nLiver biopsy ___:\n1. Marked, mixed micro/macrovesicular steatosis (involving >66% \nof the core biopsy), with mild to focally moderate mixed \ninflammation consisting of neutrophils, eosinophils and rare \nlymphocytes.\n2. Scattered ballooning degeneration and rare hepatocyte \nnecrosis without definite associated intracytoplasmic hyalin.\n3. Mild portal mixed inflammation consisting of neutrophils, \neosinophils and rare lymphocytes, with mild bile ductular \nproliferation and scattered pigment-laden macrophages, \nsuggestive of a component of prior/resolving injury.\n4. Trichrome stain demonstrates rare foci of delicate \nsinusoidal fibrosis and focal, minimal portal fibrosis (best \ninterpreted as Stage 1 in this sample).\n5. Iron stain is negative for iron deposition.\n* Note: The predominant features are those of an active \ntoxic/metabolic injury, including non-alcoholic steatohepatitis \n(NASH). If clinically NASH, the activity score (NAS) is as \nfollows: Steatosis 3 + lobular mixed inflammation 2 + \nballooning degeneration 1 = 6 out of 8 total possible. The \nfibrosis stage is 1 out of 4 in this sample.\n* The biliary features, portal pigment-laden macrophages and \neosinophils raise the possibility of a concomitant drug effect \nor biliary obstructive process, among other etiologies. Further \nclinical correlation is recommended. \n.\nAbdominal ultrasound ___: Echogenic liver consistent with \nfatty infiltration. Other forms of liver disease and more \nadvanced liver disease including significant hepatic \nfibrosis/cirrhosis cannot be excluded on this study.\n.\nCXR portable AP ___: No acute intrathoracic process.\n.\nCTA abdomen w/ and w/o contrast ___:\n1. Thickening of the colonic wall involving the distal \ntransverse colon, splenic flexure, and descending colon. This is \nnon-specific and may eflect infectious or inflammatory \netiologies. Clinical correlation is advised. \n2. Markedly low-attenuation liver. No evidence for \npseudoaneurysm or other vascular injury following liver biopsy. \nThere is no perihepatic or free intraperitoneal hemorrhage. \n3. Status post cholecystectomy, with prominence of the \nextrahepatic common bile duct, not unexpected.\n4. Status post gastric bypass, without evidence for \ncomplication.\nAssessment/Plan: ___ year old female with tranasminitis being \nevaluated by the hepatology service with a core liver biopsy on \nthe day of presentation who came in with a fever to 102.\n. \n# Fever: The patient's fever was thought to be related to \ncholangitis s/p liver biopsy. CTA abdomen/pelvis showed some \nthickening of the colonic wall involving the distal transverse \ncolon, splenic flexure, and descending colon. This was of \nunclear significance. The patient was treated with amoxicillin \nand ciprofloxacin, with a plan to continue this for a 7-day \ncourse.\n.\n# Elevated liver function tests: The patient presented with ALT \n490 and AST 1843. Outpatient work-up with HAV, HBsAg, HBsAb, \nHBcAb, HCVAb was negative in ___. ___ was positive (titer \n1:40) on ___. IgG was normal. The patient's only home \nmedication is Prevacid, although she was given \nsedation/analgesia for her liver biopsy. The patient denied any \nother medication ingestions, including acetaminophen. Repeat \nhepatitis serologies were negative. The patient's liver biopsy \nwas rushed and was read as NASH.\n The patient's transaminitis was thought to be due to acute \ncholangitis from her liver biopsy on top of chronic NASH. CTA \nabdomen/pelvis showed no evidence for pseudoaneurysm or other \nvascular injury following liver biopsy. The patient was treated \nwith amoxicillin and ciprofloxacin. Her transaminases trended \ndown, reaching ALT 500, AST 966 by the afternoon of admission. \n The patient had an important family function to attend on \n___ and looked quite well, so arrangements were made for the \npatient to be discharged on ___ and return the following \nmorning for outpatient labs. These labs showed further \nimprovement in the patient's transaminases. The patient will \nhave her labs checked again on ___ and follow up with Dr. \n___ on ___. \n.\n# Rectal bleeding: The patient has chronic mild rectal bleeding \nwhich is thought to be related to polyps. Her hematocrit \nremained stable. She will need a repeat colonoscopy as her last \ncolonoscopy was incomplete.\n.\n# Barrett's Esophagitis: Continued home Prevacid."}}
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{'final_diagnoses': ['Tranaminitis after liver biopsy', 'Non-alcholic steatohepatitis'], 'procedures': ['None'], 'visit_summary': "Assessment/Plan: ___ year old female with tranasminitis being \nevaluated by the hepatology service with a core liver biopsy on \nthe day of presentation who came in with a fever to 102.\n. \n# Fever: The patient's fever was thought to be related to \ncholangitis s/p liver biopsy. CTA abdomen/pelvis showed some \nthickening of the colonic wall involving the distal transverse \ncolon, splenic flexure, and descending colon. This was of \nunclear significance. The patient was treated with amoxicillin \nand ciprofloxacin, with a plan to continue this for a 7-day \ncourse.\n.\n# Elevated liver function tests: The patient presented with ALT \n490 and AST 1843. Outpatient work-up with HAV, HBsAg, HBsAb, \nHBcAb, HCVAb was negative in ___. ___ was positive (titer \n1:40) on ___. IgG was normal. The patient's only home \nmedication is Prevacid, although she was given \nsedation/analgesia for her liver biopsy. The patient denied any \nother medication ingestions, including acetaminophen. Repeat \nhepatitis serologies were negative. The patient's liver biopsy \nwas rushed and was read as NASH.\n The patient's transaminitis was thought to be due to acute \ncholangitis from her liver biopsy on top of chronic NASH. CTA \nabdomen/pelvis showed no evidence for pseudoaneurysm or other \nvascular injury following liver biopsy. The patient was treated \nwith amoxicillin and ciprofloxacin. Her transaminases trended \ndown, reaching ALT 500, AST 966 by the afternoon of admission. \n The patient had an important family function to attend on \n___ and looked quite well, so arrangements were made for the \npatient to be discharged on ___ and return the following \nmorning for outpatient labs. These labs showed further \nimprovement in the patient's transaminases. The patient will \nhave her labs checked again on ___ and follow up with Dr. \n___ on ___. \n.\n# Rectal bleeding: The patient has chronic mild rectal bleeding \nwhich is thought to be related to polyps. Her hematocrit \nremained stable. She will need a repeat colonoscopy as her last \ncolonoscopy was incomplete.\n.\n# Barrett's Esophagitis: Continued home Prevacid.", 'medications_prescribed': ['1. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet ___ Q12H (every 12 hours) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '2. Amoxicillin 500 mg Tablet Sig: One (1) Tablet ___ Q8H (every 8 \nhours) for 7 days.\nDisp:*21 Tablet(s)* Refills:*0*', '3. Lansoprazole 30 mg Tablet,Rapid Dissolve, ___ Sig: One (1) \nTablet,Rapid Dissolve, ___ ___ (2 times a day).', '4. Multivitamin Tablet Sig: One (1) Tablet ___ DAILY (Daily).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': '___ procedure to treat aortic stenosis', 'medical_history': ['CVD Risk Factors \n- HTN', 'Cardiac History \n- Severe MS, severe AS', 'Other PMH \nGERD\nSkin cancers\ns/p hysterectomy\ns/p back surgery\ns/p hernia repair\nCREST syndrome (Raynauds, esophageal dysfunction, sclerodactyly, \ntelangectasia)\nDecreased diffusion capacity\nCOPD\nDegenerative disk disease'], 'family_history': 'There was a family history of stroke, diabetes, hypertension. \nHer mother died at ___ of pneumonia; her father died in his ___ \nin a truck accident.', 'present_illness': '___ year old female with a history of HTN, COPD, CREST, severe \nAS, and mod/severe MS, and recent transient CHB during alcohol \nseptal ablation ___ requiring temporary transvenous \npacemaker but with recovery of AV conduction and removal of TVP \nwho is s/p ___ on ___ with transient intraoperative CHB. \n\nShe was recently seen by Dr. ___ in ___ after work-up at \n___ revealed severe AS and MS and she was deemed to be high \nrisk for surgical intervention. She underwent alcohol septal \nablation in preparation for possible ___ on ___. She \ndeveloped CHB during that procedure and required temporary\ntransvenous pacemaker however regained AV conduction and this \nwas removed. A pacemaker was recommended after being seen by the \nEP team (Dr. ___. There was reportedly some concern about \ndislodging fresh pacemaker leads during upcoming possible ___ \nand so this was not pursued. She presented for ___ (26mm\nEvolut Pro) and prior to valve deployment (wiring of the aortic \nroot), she developed complete heart block and required temporary \npacing via balloon catheter in her right groin. This was \nrelocated to the right IJ at the end of the procedure. \n\nShe has no history of syncope or presyncope. She had dyspnea \nwith minimal exertion prior to ___ and orthopnea (sleeps with \nhead at 30 degrees). She denies lower extremity edema or recent \nweight change.', 'medications': [{'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', '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': 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': 'Atorvastatin', '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/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', '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': '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': 'Clopidogrel', '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: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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LaMOTrigine', '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': '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': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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': 'Fish Oil (Omega 3)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol Inhaler', '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', 'route': 'IV', 'frequency': 'Q8H: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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Citalopram', '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 via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '9.0', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 200.0, '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': '18', 'valuenum': 18.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.32, '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': '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': '8.8', 'valuenum': 8.8, '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': '11', 'valuenum': 11.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': 131.0, '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': '4.7', 'valuenum': 4.7, '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': 0.87, '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': '23', 'valuenum': 23.0, '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': '11.4', 'valuenum': 11.4, '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': '33.2', 'valuenum': 33.2, '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': '213', 'valuenum': 213.0, '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': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '182', 'valuenum': 182.0, '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': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 135.0, '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': '5.4', 'valuenum': 5.4, '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVS: reviewed in metavision\nGENERAL: Well developed, well nourished in NAD. Oriented x3. \nFace tent in place\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\nNECK: Supple. JVP 11cm at 45 degrees. \nCARDIAC: Normal rate, regular rhythm. ___ systolic murmur at \n___\nLUNGS: Respiration slightly labored but no accessory muscle use.\nNo crackles/wheezes/rales\nABDOMEN: Soft, non-tender, non-distended. +BS\nEXTREMITIES: Warm, well perfused. No peripheral edema\nSKIN: No significant lesions or rashes. No hematoma at bilateral\nfemoral sites, soft and nontender \nPULSES: Distal pulses palpable and symmetric. Equal bilateral\nfemoral pulses \n\nDISCHARGE EXAM:\nVS: reviewed in OMR\nGENERAL: Well developed, well nourished in NAD on 2L. Oriented\nx3.\nHEENT: Normocephalic, atraumatic. Sclera anicteric. PERRL. EOMI. \n\nNECK: Supple. JVP not elevated 45 degrees. \nCARDIAC: Normal rate, regular rhythm. ___ systolic murmur at \n___\nLUNGS: Respiration slightly labored but no accessory muscle use.\nNo crackles/wheezes/rales\nABDOMEN: Soft, non-tender, non-distended. +BS\nEXTREMITIES: Warm, well perfused. No peripheral edema\nSKIN: No significant lesions or rashes. No hematoma at bilateral\nfemoral sites, soft and nontender \nPULSES: Distal pulses palpable and symmetric\nNeuro: no focal deficits', 'diagnoses': [{'icd_code': '41091', 'desc': 'Acute myocardial infarction of unspecified site, initial episode of care'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'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': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '25040', 'desc': 'Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '58381', 'desc': 'Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '29680', 'desc': 'Bipolar disorder, unspecified'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}], 'summary': 'ADMISSION LABS:\n___ 11:10AM BLOOD WBC-6.6 RBC-3.94 Hgb-10.1* Hct-33.3* \nMCV-85 MCH-25.6* MCHC-30.3* RDW-15.9* RDWSD-48.8* Plt ___\n___ 11:10AM BLOOD ___ PTT-32.4 ___\n___ 11:10AM BLOOD Glucose-105*\n___ 11:10AM BLOOD UreaN-21* Creat-0.9 Na-141 K-4.4 Cl-99 \nHCO3-26 AnGap-16\n___ 11:10AM BLOOD ALT-8 AST-19 AlkPhos-71 TotBili-0.4\n___ 11:10AM BLOOD Albumin-4.5\n\nSTUDIES:\n___ Echo:\nPrebypass: \n 1: Severe Aortic stenosis with valve area < 0.9\n 2: Moderate Mitral Stenosis with mean gradient of 5 mm hg\n\n The left atrium is markedly dilated. There is mild symmetric \nleft ventricular hypertrophy. There are three aortic valve \nleaflets. There is severe aortic valve stenosis (valve area \n<1.0cm2). Mild to moderate (___) aortic regurgitation is seen. \nThe mitral valve leaflets are moderately thickened. There is \nmoderate functional mitral stenosis (mean gradient 5 mmHg) due \nto mitral annular calcification. Mild to moderate (___) mitral \nregurgitation is seen. \n\n Post procedure\n 1. Well seated prosthesis noted in the aortic valve position, \nmild paravalvular regurgitation noted.\n 2. Biventricular function remains unchanged.\n\n___ TTE:\nThe left atrial volume index is SEVERELY increased. The right \natrium is moderately enlarged. There is no evidence for an \natrial septal defect by 2D/color Doppler. The estimated right \natrial pressure is ___. There is mild symmetric left \nventricular hypertrophy with a normal cavity size. There is \nnormal regional and global left ventricular systolic function. \nQuantitative biplane left ventricular ejection fraction is 61 %. \nLeft ventricular cardiac index is normal (>2.5 L/min/m2). There \nis no resting left ventricular outflow tract gradient. No \nventricular septal defect is seen. Normal right ventricular \ncavity size with normal free wall motion. The aortic sinus \ndiameter is normal for gender with mildly dilated\nascending aorta. The aortic arch is mildly dilated. An Evolut \naortic valve bioprosthesis is present. The prosthesis is well \nseated with normal disc motion and transvalvular gradient. There \nis trace aortic\nregurgitation. The mitral valve leaflets are mildly thickened \nwith no mitral valve prolapse. There is severe mitral annular \ncalcification. There is mild functional mitral stenosis from the \nprominent mitral annular calcification. There is mild [1+] \nmitral regurgitation. Due to acoustic shadowing, the severity of \nmitral regurgitation could be UNDERestimated. There is trivial \npulmonic valve stenosis. The tricuspid valve leaflets appear \nstructurally normal. There is moderate [2+] tricuspid \nregurgitation. Due to acoustic shadowing, the severity of \ntricuspid regurgitation may be UNDERestimated. There is SEVERE \npulmonary artery systolic hypertension. There is a small focal \npericardial effusion measuring up to 0.8 cm in greatest \ndimension inferolateral to the left ventricle.\n\nIMPRESSION: Biatrial enlargement. Well-seated, normally \nfunctioning Evolut aortic bioprosthesis with very small \nparavalvular leak. Mild functional mitral stenosis secondary to \nmitral annular\ncalcification. Moderate tricuspid regurgitation in the setting \nof severe pulmonary hypertension.\n\n___ Cardiac Structure/Morph:\nIMPRESSION: \n1. Status post aortic valve replacement. \n2. Dense mitral annular calcifications. \n3. Unchanged compression deformity of L1. \n4. Dilated and debris-filled esophagus, in keeping with history \nof CREST. \n5. Cluster of calcified granulomas in the right upper lobe has \na small 5 mm soft tissue component. \n \nRECOMMENDATION(S): For incidentally detected nodules smaller \nthan 6mm in the setting of an incomplete chest CT, no CT \nfollow-up is recommended. \n\nDISCHARGE LABS:\n___ 05:47AM BLOOD ___-5.3 RBC-2.72* Hgb-7.1* Hct-22.8* \nMCV-84 MCH-26.1 MCHC-31.1* RDW-16.0* RDWSD-48.6* Plt ___\n___ 05:47AM BLOOD ___ PTT-35.3 ___\n___ 05:47AM BLOOD Glucose-91 UreaN-14 Creat-0.8 Na-141 \nK-4.1 Cl-103 HCO3-24 AnGap-14\n___ 05:47AM BLOOD Calcium-8.9 Phos-3.6 Mg-1.___\nyear old female with a history of HTN, COPD, CREST, severe \nAS, and mod/severe MS, and recent transient CHB during alcohol \nseptal ablation ___ requiring temporary transvenous \npacemaker but with recovery of AV conduction and removal of TVP \nwho is now s/p ___ on ___ with transient intraoperative \nCHB. She is s/p temporary pacer removal after resolution of CHB \nand improved functional status s/p ___. Going home with follow \nup with Dr. ___ to assess need for future intervention for MS \nwith ___. \n\n#CORONARIES: no significant CAD\n#PUMP: EF 61%, preserved biventricular systolic function, \nnormally functioning Evolut aortic bioprosthesis with very small \nparavalvular leak, mild functional MS\n#RHYTHM: NSR \n \nACUTE ISSUES: \n============= \n# Severe AS s/p ___ ___:\nPatient with mean gradient <5mmHg post ___ iso prior AS (after \na pre-procedure mean gradient of 35mmHg). On discharge patient \nwas ambulating without issues. Discharged on aspirin, and Plavix \nto take for at least three months. Started Lasix 80 PO bid for \nnew diuretic dose and had remained euvolemic with this. \n\n# CHB during ___ with no escape\n# S/p EtOH septal ablation ___\n# S/p balloon catheter temporary pacemaker RIJ:\nPatient s/p ___ ___ with brief intraoperative CHB with an \nescape, with initial episode prior to valve deployment. After \nprocedure patient demonstrated intrinsic conduction without any \nAV block. R IJ temporary pacemaker was removed ___. Although \nwith underlying conduction disease with RBBB, only had \nsignificant issues periprocedurally with no events noted as an \noutpatient, so permanent PPM deferred. Can be readdressed as an \noutpatient. Discharged with ___ of ___ monitor. PPM deferred \nin setting of possible future ___. Would likely need elective \nscrew in pacer if planned to go for this procedure. \n\n# Mitral stenosis/mitral regurgitation: \nDue to subjective improvement on ambulation s/p ___ defer \n___ this admission. To follow up with Dr. ___ as an \noutpatient. s/p structural heart CT this admission showing dense \nmitral annular calcifications. \n\n# Normocytic anemia: \nHgb 10 on admission, down to 8.5 post-procedure. No evidence of \nbleeding/hematoma on exam and remained HD stable. No evidence of \nhematoma at bilateral groin sites. Iron studies suggestive of \n___, s/p IV iron per HF protocol. Hgb slightly downtrending from \n7.9 -> 7.1 with no overt signs of bleeding. Will need outpatient \nCBC at PCP.\n\n# Asymptomatic bacteriuria:\nUA negative but UCx ___ growing E coli10-100K units. Did not \ntreat. \n\nCHRONIC ISSUES: \n=============== \n# HTN: \nHeld Lisinopril\n\n# CREST\n# GERD: \nNotably, ___ CTA showed concern for esophageal motility \ndisorder, in accordance with CREST diagnosis. Continued \nomeprazole and calcium carbonate. \n \n# Depression: \nContinued citalopram.\n\n# Vitamin deficiency: \nContinued MVI/minerals and vitamin D.\n\nTRANSITIONAL ISSUES\n===================\nDISCHARGE WT: 66.7 kg (147.05 lb) \nDISCHARGE HGB: 7.1\nDISCHARGE CR: 0.8\n\nNEW MEDICATIONS: Plavix 75 mg daily\n\nCHANGED MEDICATIONS: \nFurosemide 120 AM and 80 pm -> 80 BID\n\nSTOPPED MEDICATIONS: \nLisinopril 10 mg'}}
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{'final_diagnoses': ['Complete heart block', 'Severe aortic stenosis s/p ___ ___', 'Mitral stenosis/mitral regurgitation', 'Anemia', 'HTN', 'CREST', 'GERD', 'Depression', 'Vitamin deficiency'], 'procedures': ['___ ___'], 'visit_summary': 'year old female with a history of HTN, COPD, CREST, severe \nAS, and mod/severe MS, and recent transient CHB during alcohol \nseptal ablation ___ requiring temporary transvenous \npacemaker but with recovery of AV conduction and removal of TVP \nwho is now s/p ___ on ___ with transient intraoperative \nCHB. She is s/p temporary pacer removal after resolution of CHB \nand improved functional status s/p ___. Going home with follow \nup with Dr. ___ to assess need for future intervention for MS \nwith ___. \n\n#CORONARIES: no significant CAD\n#PUMP: EF 61%, preserved biventricular systolic function, \nnormally functioning Evolut aortic bioprosthesis with very small \nparavalvular leak, mild functional MS\n#RHYTHM: NSR \n \nACUTE ISSUES: \n============= \n# Severe AS s/p ___ ___:\nPatient with mean gradient <5mmHg post ___ iso prior AS (after \na pre-procedure mean gradient of 35mmHg). On discharge patient \nwas ambulating without issues. Discharged on aspirin, and Plavix \nto take for at least three months. Started Lasix 80 PO bid for \nnew diuretic dose and had remained euvolemic with this. \n\n# CHB during ___ with no escape\n# S/p EtOH septal ablation ___\n# S/p balloon catheter temporary pacemaker RIJ:\nPatient s/p ___ ___ with brief intraoperative CHB with an \nescape, with initial episode prior to valve deployment. After \nprocedure patient demonstrated intrinsic conduction without any \nAV block. R IJ temporary pacemaker was removed ___. Although \nwith underlying conduction disease with RBBB, only had \nsignificant issues periprocedurally with no events noted as an \noutpatient, so permanent PPM deferred. Can be readdressed as an \noutpatient. Discharged with ___ of ___ monitor. PPM deferred \nin setting of possible future ___. Would likely need elective \nscrew in pacer if planned to go for this procedure. \n\n# Mitral stenosis/mitral regurgitation: \nDue to subjective improvement on ambulation s/p ___ defer \n___ this admission. To follow up with Dr. ___ as an \noutpatient. s/p structural heart CT this admission showing dense \nmitral annular calcifications. \n\n# Normocytic anemia: \nHgb 10 on admission, down to 8.5 post-procedure. No evidence of \nbleeding/hematoma on exam and remained HD stable. No evidence of \nhematoma at bilateral groin sites. Iron studies suggestive of \n___, s/p IV iron per HF protocol. Hgb slightly downtrending from \n7.9 -> 7.1 with no overt signs of bleeding. Will need outpatient \nCBC at PCP.\n\n# Asymptomatic bacteriuria:\nUA negative but UCx ___ growing E coli10-100K units. Did not \ntreat. \n\nCHRONIC ISSUES: \n=============== \n# HTN: \nHeld Lisinopril\n\n# CREST\n# GERD: \nNotably, ___ CTA showed concern for esophageal motility \ndisorder, in accordance with CREST diagnosis. Continued \nomeprazole and calcium carbonate. \n \n# Depression: \nContinued citalopram.\n\n# Vitamin deficiency: \nContinued MVI/minerals and vitamin D.\n\nTRANSITIONAL ISSUES\n===================\nDISCHARGE WT: 66.7 kg (147.05 lb) \nDISCHARGE HGB: 7.1\nDISCHARGE CR: 0.8\n\nNEW MEDICATIONS: Plavix 75 mg daily\n\nCHANGED MEDICATIONS: \nFurosemide 120 AM and 80 pm -> 80 BID\n\nSTOPPED MEDICATIONS: \nLisinopril 10 mg', 'medications_prescribed': ['Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth Daily Disp #*30 \nTablet Refills:*3', 'Furosemide 80 mg PO BID \nRX *furosemide 80 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*3', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 20 mg PO QPM', 'Calcium 500 (calcium carbonate) 500 mg calcium (1,250 mg) \noral QAM', 'Centrum Silver \n(multivit-min-FA-lycopen-lutein;<br>mv-min-folic acid-lutein) 1 \ntab oral QAM', 'Citalopram 20 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Tylenol ___ Extra Strength (diphenhydrAMINE-acetaminophen) \n___ mg oral QHS', 'Vitamin D 1000 UNIT PO BID', 'Outpatient Lab Work\nD___ Anemia\nPlease forward result to ___\nAddress: ___., ___, ___\nPhone: ___\nFax: ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 46, 'gender': 'F', 'symptoms': 'Left-sided facial droop', 'medical_history': ['HTN', 'HLD', 'CAD (s/p 3x RCA stent)', 'Hep C currently on Havroni', 's/p gastric bypass in ___ ', 's/p CCY'], 'family_history': 'Denies FH of GI malignancy', 'present_illness': '___ y M with hep C, hx of IV drug use, s/p gastric bypass, HTN, \nCAD, and recent admission ___ - ___ for contained \nduodenal perforation/GI bleed, who presented with left-sided \nfacial droop. Pt says he was doing well since his discharge \nyesterday, but then felt nauseas/diaphoretic/short of breath, \nand when he looked in the mirror he noticed a left-sided facial \ndroop. No melena, hematochezia, hematemesis. No weakness, no \nchest pain, no vision change, no dysarthria. \n\nOf note, during prior hospitalization, patient as noted to have \nwhat was thought to be a duodenal perforation via CT imaging. He \ninitially was managed conservatively with IV antibiotics, IVF, \nand NPO. He did have acute drop in H/H on ___, with CTA showing \n"new hyperdense material compatible with hemorrhage within the \nexcluded portion of the stomach status post Roux-en-Y gastric \nbypass without evidence of active bleed into the remnant or \nduodenum." He subsequently went to the ___ where he received \nseveral transfusions of packed red blood cells with subsequent \nstabilization of H/H. There was no surgical intervention \nperformed during the hospitalization. His discharge Hgb was 8.2 \non ___. \n\nIn the ED:\n- Initial vitals were: 97.7, 109, 131/74, 22, 100% on RA. \n- Exam notable for left nasolabial fold flattening, heme \npositive brown stool initially prior to large episode of BRBPR \n- Labs notable for: Hgb 6.7, Cre 1.4 (baseline 1.0), lactate 4.0 \n\n- Imaging: CT Head without contrast was performed which showed \n"no evidence of acute intracranial abnormalities, chronic \nfracture of the left zygomatic arch. No acute fracture seen." \nCXR showed no acute cardiopulmonary abnormality. CTA Abdomen and \npelvis showed no evidence of active extravasation. \n- Consults: Neurology who believed etiology of the facial droop \n___ have been in the setting of hypotension, anemia; Surgery, \nwho felt that given his negative CTA abd/pelvis there is no \nindication for surgical intervention; GI, who did not believe \nendoscopic intervention is warranted given concern for worsening \na duodenal perforation; ___, who did not believe any ___ \nintervention was necessary given hemodynamic stability and CTA \nwhich did not demonstrate active extravasation. \n- He received 2 units PRBCs, and then had a witnessed syncopal \nepisode as well as large outpouring of BRBPR followed by a SBP \nin the ___ in the 170s. A cordis was placed, and he received \nan additional 2 units PRBCs with stabilization of his VS. \n- also received 80 IV pantoprazole, 2L NS\n- VS on transfer: 98.0 95 134/94 16 100% RA \n\nOn arrival to the MICU, he is tearful and anxious, with \ncontinued back pain as well as abdominal cramping. No chest \npain, no SOB, no new weakness or numbness.', 'medications': [{'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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', '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': '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'ValACYclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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}]}, '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': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.026', 'valuenum': 1.026, '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': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': 'UNABLE TO ESTIMATE DUE TO PLATELET CLUMPS.'}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.43', 'valuenum': 4.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '___', 'valuenum': 6.1, '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': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '85', 'valuenum': 85.0, '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': '123', 'valuenum': 123.0, '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': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': '___', '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': '184', 'valuenum': 184.0, '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': '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': '3.8', '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': '___', 'valuenum': 241.0, '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': '13', 'valuenum': 13.0, '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': '10.3', 'valuenum': 10.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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.'}], 'exams': 'ADMISSION:\nVITALS: 98.9 107 104/64 100% on RA\nGENERAL: anxious, NAD\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: CTAB\nCV: tachycardic, regular, no murmurs \nABD: soft, non-tender, no rebound, no guarding \nEXT: WWP, no edema \nSKIN: no rashes\nNEURO: mild left droop of mouth, mild flattening of NLF. \nSensation to light touch intact bilateral. Tongue midline, \nvisual fields intact, speech clear, no dysarthria. Upper and \nlower extremity strength symmetric and intact. \n\nDISCHARGE:\nVS: T: 98.4 PO BP: 162/89 L Sitting HR: 81 RR: 17 O2: 98% Ra \nGEN: A+Ox3, NAD\nHEENT: MMM, no scleral icterus\nCV: RRR\nPULM: CTA b/l\nABD: soft, mildly distended, mildly tender at incision to \npalpation, no rebound or guarding. Midline abdominal incision \nwith staples OTA, wound well-approximated with no s/s infection. \n RUQ JP intact with moderate amount of serosanguinous drainage \nin bulb\nEXT: warm, well-perfused, no edema b/l', 'diagnoses': [{'icd_code': '3510', 'desc': "Bell's palsy"}, {'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': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2440', 'desc': 'Postsurgical hypothyroidism'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}], 'summary': "ADMISSION:\n___ 06:08AM BLOOD WBC-5.4 RBC-3.26* Hgb-8.2* Hct-26.5* \nMCV-81* MCH-25.2* MCHC-30.9* RDW-18.5* RDWSD-54.3* Plt ___\n___ 08:24AM BLOOD Neuts-88.1* Lymphs-7.2* Monos-3.2* \nEos-0.1* Baso-0.2 Im ___ AbsNeut-14.42*# AbsLymp-1.18* \nAbsMono-0.53 AbsEos-0.01* AbsBaso-0.03\n___ 06:08AM BLOOD Plt ___\n___ 08:24AM BLOOD ___ PTT-26.3 ___\n___ 06:08AM BLOOD Glucose-101* UreaN-9 Creat-1.0 Na-141 \nK-3.8 Cl-104 HCO3-25 AnGap-16\n___ 08:24AM BLOOD ALT-28 AST-33 AlkPhos-88 TotBili-0.2\n___ 08:24AM BLOOD cTropnT-<0.01\n___ 08:24AM BLOOD Lipase-29\n___ 06:08AM BLOOD Calcium-8.4 Phos-3.6 Mg-1.7\n___ 08:24AM BLOOD Albumin-3.1* Calcium-8.3* Phos-3.9 Mg-1.7\n___ 07:18PM BLOOD ___ pO2-32* pCO2-35 pH-7.35 \ncalTCO2-20* Base XS--6\n___ 08:43AM BLOOD Lactate-4.0*\n___ 05:38PM BLOOD Lactate-1.7\n___ 07:18PM BLOOD O2 Sat-58\n___ 01:12PM BLOOD Hgb-10.2* calcHCT-31\n___ 08:20PM BLOOD freeCa-1.04*\n\nDISCHARGE:\n___ 04:50AM BLOOD Calcium-8.2* Phos-4.1 Mg-2.0\n___ 04:50AM BLOOD Glucose-100 UreaN-10 Creat-0.9 Na-140 \nK-3.7 Cl-103 HCO3-28 AnGap-13\n___ 04:31AM BLOOD Plt ___\n___ 04:31AM BLOOD WBC-6.5 RBC-3.06* Hgb-8.9* Hct-27.5* \nMCV-90 MCH-29.1 MCHC-32.4 RDW-14.8 RDWSD-47.8* Plt ___\n\nMICRO:\n___ 11:10AM URINE Color-Yellow Appear-Clear Sp ___\n___ 11:10AM URINE Blood-NEG Nitrite-NEG Protein-100 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-0.2 pH-6.0 Leuks-NEG\n___ 11:10AM URINE RBC-2 WBC-2 Bacteri-FEW Yeast-NONE Epi-0 \nTransE-<1\n___ 11:10AM URINE CastHy-5*\n___ 11:10AM URINE Mucous-FEW\n___ 11:10AM URINE bnzodzp-NEG barbitr-NEG opiates-POS* \ncocaine-NEG amphetm-NEG oxycodn-POS* mthdone-NEG\n\n___ 1:56 am SEROLOGY/BLOOD Source: Line-CVL. \n\n **FINAL REPORT ___\n\n HELICOBACTER PYLORI ANTIBODY TEST (Final ___: \n NEGATIVE BY EIA. \n (Reference Range-Negative). \n\nIMAGING:\nCT HEAD W/O CONTRAST Study Date of ___ \nIMPRESSION: \n1. No evidence of acute intracranial abnormalities. \n2. Chronic fracture of the left zygomatic arch. No acute \nfracture seen. \n\nCHEST (PA & LAT) Study Date of ___ \nIMPRESSION: No acute cardiopulmonary abnormality. \n\nCTA ABD & PELVIS Study Date of ___ \nIMPRESSION: No evidence of active contrast extravasation. \n\n___: Mesenteric Arteriogram:\nReplaced left hepatic artery from the left gastric artery. \nReplaced right \nhepatic artery from the superior mesenteric artery. \n \nNo evidence of active extravasation of contrast material on \narteriograms \nperformed in the left gastric artery, gastroduodenal artery, \nsuperior \nmesenteric artery, and inferior mesenteric artery. \n\n___: ECG:\nNormal sinus rhythm. J point elevation across the precordium \nwith notching \nconsistent with early repolarization. However, acute myocardial \ninfarction \nshould be excluded. No previous tracing available for \ncomparison. \n\n___: CXR:\nMild left basilar atelectasis. Shallow inspiration.\n\n___: CXR:\nIn comparison with the study of ___, the monitoring and \nsupport devices are stable. Continued low lung volumes without \nvascular congestion, pleural effusion, or acute focal pneumonia. \n\n\n___: Portable PICC Placement:\nIn comparison with the earlier study of this date, there is an \nplacement of right subclavian PICC line that extends into the \nright atrium. If the desired position is at or above the \ncavoatrial junction, it could be pulled back approximately 3 cm. \nOtherwise, little change except for removal of the endotracheal \ntube. \n\n___: CT Abdomen/Pelvis without contrast:\n1. Post partial gastrectomy, with mild postsurgical changes in \nthe upper \nabdomen. No evidence of contrast extravasation to suggest active \nbleed. \n2. Post Roux-en-Y gastric bypass. No evidence for bowel \nobstruction. \n3. Small bilateral, left greater than right, pleural effusions. \n4. Stable left adrenal myelolipoma.\nMr. ___ is a ___ y/o M with hep C, hx of IV drug use, s/p \ngastric bypass, HTN, CAD, and recent admission ___ \nfor contained duodenal perforation/GI bleed. He presented to \n___ this admission with left-sided facial droop, acute drop in \nHgb, and an episode of large BRBPR in the ED with subsequent HD \ninstability. Neurology was consulted to evaluate for TIA, \nstroke. The patient had a CT head which was negative. The \npatient reported return to baseline and was neurologically \nintact on physical exam. Neurology recommended deferring CTA \nhead and neck to get CT abdomen pelvis. He was monitored on \ntelemetry, neuro exams were trended. It was recommended he have \nCT vs MR once HD stable, a carotid US, ECHO when stable and \ncontinuing on statin. Recommended conting home Harvoni and \ntemporarily holding home antihypertensives. There was no \nevidence of infection, but the patient was discharged from last \nhospital visit on augmenten, so ceftriaxone and flagyl were \ninitiated in the acute setting. \n\nACS was consulted for GI bleed and recommended CTA \nabdomen/pelvis which showed no evidence of active contrast \nextravasation. The patient received 4 units of PRBCs in the ED \nwithout appropriate increase in Hgb. Due to RYGB, ACS \nrecommended advanced scope vs ___ embolization for UGIB. The \npatient 2 units FFP/2 units PRBCs on admission. \n\nGastroenterology was consulted recommended against endoscopic \nintervention given recent duodenal perforation and due to \ndifficulty in reaching duodenum due to Roux en Y. On HD2, the \npatient underwent right common femoral artery access, celiac \narteriogram, left gastric arteriogram, superior mesenteric \narteriogram, GDA arteriogram, inferior mesenteric arteriogram by \nInterventional Radiology. There was no evidence of active \nextravasation of contrast material on arteriograms performed in \nthe left gastric artery, gastroduodenal artery, superior \nmesenteric artery, and inferior mesenteric artery. He received \n2U PRBC for hct drop. \n\nOn HD3, the patient was taken to the OR w/ ACS for gastrectomy \nof the remnant stomach. This procedure went well (reader, \nplease refer to operative note for further details). An \nabdominal JP drain was left in place. A NGT was placed for bowel \ndecompression. Post-operatively, the patient remained intubated \nand received 1L LR and 250cc albumin for marginal UOP and \nincreased lactate. He was admitted to the SICU for further \nmonitoring. In the SICU, he had melena x2. HCTs were trended. \nThe patient as switched to precedex. Unasyn was started \npost-operatively. \n\nAfter extubation in the SICU, the patient remained \nhemodynamically stable. He was transferred to the surgical floor \non POD #2 for further monitoring and to await return of bowel \nfunction. He was written for PCA hydromorphone for pain \ncontrol. On POD #2, the patient's foley and NGT were removed. On \nPOD #3, the patient passed flatus and was started on a clear \nliquid diet which was well-tolerated. Diet was then advanced to \na regular diet which was well-tolerated. PCA was discontinued \nand the patient was written for oral oxycodone and acetaminophen \nwith good effect. On POD#4, SQH was started for DVT prophylaxis. \nUnasyn course was completed and discontinued. The patient \nreported increased abdominal and back pain and he underwent CT \nabdomen/pelvis which was unremarkable. On POD #5, oxycodone dose \nwas increased for better pain control and gabapentin was \ninitiated. Hematocrits remained stable. \n\nSince being on the surgical floor, the patient was alert and \noriented. He remained stable from a cardiovascular and pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. Intake and output were \nclosely monitored\nThe patient's fever curves were closely watched for signs of \ninfection, of which there were none. The patient's blood counts \nwere closely watched for signs of bleeding, of which there were \nnone. The patient received subcutaneous heparin and ___ dyne \nboots were used during this stay and was encouraged to get up \nand ambulate as early as possible.\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. ___ services were established \nfor home drain care."}}
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{'final_diagnoses': ['Gastrointestinal bleed'], 'procedures': ['___: Interventional Radiology:\n1. Right common femoral artery access. \n2. Celiac arteriogram. \n3. Left gastric arteriogram \n4. Superior mesenteric arteriogram. \n5. GDA arteriogram \n6. Inferior mesenteric arteriogram', '___: Exploratory laparotomy, remnant completion gastrectomy'], 'visit_summary': "Mr. ___ is a ___ y/o M with hep C, hx of IV drug use, s/p \ngastric bypass, HTN, CAD, and recent admission ___ \nfor contained duodenal perforation/GI bleed. He presented to \n___ this admission with left-sided facial droop, acute drop in \nHgb, and an episode of large BRBPR in the ED with subsequent HD \ninstability. Neurology was consulted to evaluate for TIA, \nstroke. The patient had a CT head which was negative. The \npatient reported return to baseline and was neurologically \nintact on physical exam. Neurology recommended deferring CTA \nhead and neck to get CT abdomen pelvis. He was monitored on \ntelemetry, neuro exams were trended. It was recommended he have \nCT vs MR once HD stable, a carotid US, ECHO when stable and \ncontinuing on statin. Recommended conting home Harvoni and \ntemporarily holding home antihypertensives. There was no \nevidence of infection, but the patient was discharged from last \nhospital visit on augmenten, so ceftriaxone and flagyl were \ninitiated in the acute setting. \n\nACS was consulted for GI bleed and recommended CTA \nabdomen/pelvis which showed no evidence of active contrast \nextravasation. The patient received 4 units of PRBCs in the ED \nwithout appropriate increase in Hgb. Due to RYGB, ACS \nrecommended advanced scope vs ___ embolization for UGIB. The \npatient 2 units FFP/2 units PRBCs on admission. \n\nGastroenterology was consulted recommended against endoscopic \nintervention given recent duodenal perforation and due to \ndifficulty in reaching duodenum due to Roux en Y. On HD2, the \npatient underwent right common femoral artery access, celiac \narteriogram, left gastric arteriogram, superior mesenteric \narteriogram, GDA arteriogram, inferior mesenteric arteriogram by \nInterventional Radiology. There was no evidence of active \nextravasation of contrast material on arteriograms performed in \nthe left gastric artery, gastroduodenal artery, superior \nmesenteric artery, and inferior mesenteric artery. He received \n2U PRBC for hct drop. \n\nOn HD3, the patient was taken to the OR w/ ACS for gastrectomy \nof the remnant stomach. This procedure went well (reader, \nplease refer to operative note for further details). An \nabdominal JP drain was left in place. A NGT was placed for bowel \ndecompression. Post-operatively, the patient remained intubated \nand received 1L LR and 250cc albumin for marginal UOP and \nincreased lactate. He was admitted to the SICU for further \nmonitoring. In the SICU, he had melena x2. HCTs were trended. \nThe patient as switched to precedex. Unasyn was started \npost-operatively. \n\nAfter extubation in the SICU, the patient remained \nhemodynamically stable. He was transferred to the surgical floor \non POD #2 for further monitoring and to await return of bowel \nfunction. He was written for PCA hydromorphone for pain \ncontrol. On POD #2, the patient's foley and NGT were removed. On \nPOD #3, the patient passed flatus and was started on a clear \nliquid diet which was well-tolerated. Diet was then advanced to \na regular diet which was well-tolerated. PCA was discontinued \nand the patient was written for oral oxycodone and acetaminophen \nwith good effect. On POD#4, SQH was started for DVT prophylaxis. \nUnasyn course was completed and discontinued. The patient \nreported increased abdominal and back pain and he underwent CT \nabdomen/pelvis which was unremarkable. On POD #5, oxycodone dose \nwas increased for better pain control and gabapentin was \ninitiated. Hematocrits remained stable. \n\nSince being on the surgical floor, the patient was alert and \noriented. He remained stable from a cardiovascular and pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. Intake and output were \nclosely monitored\nThe patient's fever curves were closely watched for signs of \ninfection, of which there were none. The patient's blood counts \nwere closely watched for signs of bleeding, of which there were \nnone. The patient received subcutaneous heparin and ___ dyne \nboots were used during this stay and was encouraged to get up \nand ambulate as early as possible.\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. ___ services were established \nfor home drain care.", 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild \nRX *acetaminophen 500 mg 2 tablet(s) by mouth every eight (8) \nhours Disp #*60 Tablet Refills:*0 ', '2. Artificial Tears ___ DROP BOTH EYES PRN dry eyes ', '3. Docusate Sodium 100 mg PO BID \nplease hold for loose stool \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp \n#*30 Tablet Refills:*0 ', '4. Gabapentin 300 mg PO TID \nRX *gabapentin 300 mg 1 capsule(s) by mouth three times a day \nDisp #*42 Capsule Refills:*1 ', '5. Pantoprazole 40 mg PO Q12H \nRX *pantoprazole 40 mg 1 tablet(s) by mouth every twelve (12) \nhours Disp #*56 Tablet Refills:*1 ', '6. Senna 8.6 mg PO BID:PRN constipation \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth twice a day Disp \n#*20 Tablet Refills:*0 ', '7. OxyCODONE (Immediate Release) ___ mg PO Q3H:PRN Pain - \nModerate \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*100 Tablet Refills:*0 ', '8. Ledipasvir/Sofosbuvir 1 TAB PO DAILY ', '9. Lisinopril 10 mg PO DAILY ', '10. Simvastatin 20 mg PO QPM ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 76, 'gender': 'F', 'symptoms': 'Fall, dizziness', 'medical_history': ['HTN', 'Mild AR', 'GERD', 'LBP', 'Sciatica', 'Hypothyroidism', 'Depression', 'Anxiety', 'Insomnia', 'Allergic rhinitis'], 'family_history': 'Family hx of DM2, CAD, colon cancer, thyroid CA.', 'present_illness': '___ yo F, living independently, w/PMH mild AR, HTN, HLD,\ndepression who presents after a fall.\n\nDay prior to admission, patient began feeling unsteady on her\nfeet. This persisted, and at 4PM the patient fell at home. \nUnsure\nif any LOC or head strike. Patient was initially unable to get\nup, and a neighbor helped her up. Approximately 1H after her \nfall\nshe began to feel dizzy. Due to the issues, she presented to the\nED. Denies recent fevers, chills, headache, SOB, cough, chest\npain, abdominal pain, n/v/d, dysuria, numbness, tingling, or\nweakness, although patient is poor historian.\n\nIn the ED, patient was found to have creatinine elevated to 1.7\nwith potassium 6.1. She received IVF (~4L total prior to\nadmission), calcium gluconate, and insulin/dextrose, with\nimprovement of creatinine to 1.1 and K downtrending to 5.2. CTA\nhead/neck was negative for any acute changes. CXR clear. Also\nnoted to be bradycardic while in ED. Admitted for further\nmanagement ___ and dizziness.\n\nOn arrival to the floor, patient reports feeling well, no \ncurrent\nlight-headedness or dizziness. Denies any pain, fevers, chills,\nvision changes, SOB, chest pain, palpitations, n/v/d, abdominal\npain, or dysuria.\n\nREVIEW OF SYSTEMS:\n==================\nPer HPI, otherwise, 10-point review of systems was within normal\nlimits.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dofetilide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', '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': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': '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': 'Dofetilide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'EVERY OTHER DAY', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Xopenex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Psyllium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'PredniSONE', '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': 'Diltiazem Extended-Release', '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}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Psyllium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY16', '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}]}, 'clinical_findings': {'labs': [{'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, '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': '34.1', 'valuenum': 34.1, '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': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79.5', 'valuenum': 79.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '206', 'valuenum': 206.0, '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': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '23.0', 'valuenum': 23.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': 10.2, 'flag': 'abnormal', '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': '69', 'valuenum': 69.0, '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': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', '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': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.016', 'valuenum': 1.016, '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': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'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': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '31', 'valuenum': 31.0, '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': 10.2, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, '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': '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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': '23.6', 'valuenum': 23.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, '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': '8.2', 'valuenum': 8.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '211', 'valuenum': 211.0, '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': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '93', 'valuenum': 93.0, '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': '___', 'valuenum': 1824.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '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': '4.2', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, '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}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '34.2', 'valuenum': 34.2, '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': '98', 'valuenum': 98.0, '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': '83.0', 'valuenum': 83.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '231', 'valuenum': 231.0, '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', 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None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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': '26.3', 'valuenum': 26.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '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': 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 = 61 if non African-American (mL/min/1.73 m2). Estimated GFR = 73 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': '105', 'valuenum': 105.0, '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': '3.1', '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': '135', 'valuenum': 135.0, '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': '34.0', 'valuenum': 34.0, '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': '33.7', 'valuenum': 33.7, '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '291', 'valuenum': 291.0, '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': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\n___ Temp: 98.0 PO BP: 193/84 R Lying HR: 67 RR: 18 O2\nsat: 98% O2 delivery: Ra \nGENERAL: WDWN older woman sitting in bed in NAD\nHEENT: NCAT, sclerae anicteric, normal conjunctivae, PERRL, \nEOMI.\nSclera anicteric and without injection. MMM.\nNECK: Supple, JVP not elevated at 90 degrees\nCARDIAC: RRR, normal S1/S2, II/VI systolic murmur audible\nthroughout\nLUNGS: CTAB, no increased work of breathing\nABDOMEN: Soft, non-tender, non-distended, normoactive BS\nEXTREMITIES: Warm, DP pulses 2+ bilaterally, no edema\nNEUROLOGIC: AOx3, CN grossly intact, strength ___ in upper and\nlower extremities bilaterally\n\nDISCHARGE PHYSICAL EXAM:\n========================\n24 HR Data (last updated ___ @ 815)\n Temp: 98.1 (Tm 98.7), BP: 124/63 (124-178/63-84), HR: 62\n(62-138), RR: 16 (___), O2 sat: 96% (95-97), O2 delivery: Ra,\nWt: 165.34 lb/75 kg \n\nGENERAL: Sitting up in bed, alert and interactive, no apparent\ndistress\nHEENT: NCAT, sclerae anicteric, normal conjunctivae, PERRL, \nEOMI.\nMMM.\nNECK: Supple, JVP not elevated at 30 degrees\nCARDIAC: RRR, normal S1/S2, II/VI systolic murmur audible\nthroughout\nLUNGS: CTAB, no increased work of breathing\nABDOMEN: Soft, non-tender, non-distended, normoactive BS\nEXTREMITIES: Warm, DP pulses 2+ bilaterally, no edema\nNEUROLOGIC: AAOx3, CN grossly intact, strength ___ in upper and\nlower extremities bilaterally, able repeat months of year\nbackwards', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '42833', 'desc': 'Acute on chronic diastolic heart failure'}, {'icd_code': '49121', 'desc': 'Obstructive chronic bronchitis with (acute) exacerbation'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2440', 'desc': 'Postsurgical hypothyroidism'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': 'ADMISSION LABS:\n===============\n___ 07:06PM BLOOD WBC-10.4* RBC-3.65* Hgb-11.1* Hct-34.7 \nMCV-95 MCH-30.4 MCHC-32.0 RDW-13.5 RDWSD-47.0* Plt ___\n___ 07:06PM BLOOD Neuts-63.0 ___ Monos-10.3 Eos-1.3 \nBaso-0.9 Im ___ AbsNeut-6.54* AbsLymp-2.47 AbsMono-1.07* \nAbsEos-0.13 AbsBaso-0.09*\n___ 07:06PM BLOOD ___ PTT-25.8 ___\n___ 07:06PM BLOOD Glucose-101* UreaN-53* Creat-1.7* Na-130* \nK-7.2* Cl-99 HCO3-23 AnGap-8*\n___ 07:06PM BLOOD ALT-11 AST-45* AlkPhos-60 TotBili-0.3\n___ 07:06PM BLOOD cTropnT-<0.01\n___ 07:06PM BLOOD Albumin-4.2 Calcium-9.5 Phos-2.9 Mg-3.1*\n___ 07:06PM BLOOD TSH-0.66\n___ 07:13PM BLOOD Lactate-1.3 Creat-1.8* K-6.1*\n___ 07:15PM URINE Color-Straw Appear-Clear Sp ___\n___ 07:15PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-LG*\n___ 07:15PM URINE RBC-<1 WBC-4 Bacteri-FEW* Yeast-NONE \nEpi-1 TransE-<1\n___ 07:15PM URINE Hours-RANDOM UreaN-402 Creat-39 Na-40 \nK-30 Cl-38\n___ 07:15PM URINE Osmolal-294\n\nDISCHARGE LABS:\n===============\n___ 07:06AM BLOOD WBC-8.4 RBC-3.41* Hgb-10.4* Hct-32.7* \nMCV-96 MCH-30.5 MCHC-31.8* RDW-13.0 RDWSD-45.3 Plt ___\n___ 07:06AM BLOOD Glucose-91 UreaN-38* Creat-1.3* Na-141 \nK-4.9 Cl-104 HCO3-25 AnGap-12\n___ 07:06AM BLOOD Calcium-9.3 Phos-4.0 Mg-2.1\n\nMICROBIOLOGY:\n=============\n___ 7:15 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n PRESUMPTIVE STREPTOCOCCUS BOVIS. 10,000-100,000 CFU/mL. \n\n\nIMAGING/REPORTS:\n================\nCXR ___:\nIMPRESSION: \n \nNo acute cardiopulmonary abnormality. \n\nCTA Head/Neck ___:\nIMPRESSION: \n \n \n1. No evidence of high-grade stenosis, occlusion, or aneurysm \nformation within \nthe head and neck vessels. \n\nCT C-Spine ___:\nIMPRESSION: \n \n \n1. No acute fracture or traumatic malalignment. \n2. Moderate cervical spondylosis. Multilevel subluxations are \nunchanged and degenerative in etiology. \n\nTTE ___:\nIMPRESSION: 1) No structural cardiac cause of syncope \nidentified. 2) Moderate systolic systemic arterial hypertension.\nSUMMARY:\n========\nMs. ___ is an ___ year old woman, currently living \nindependently, w/ PMHx mild AR, HTN,\nHLD, depression, who presented after a fall at home, found on \nadmission to have positive orthostatics, ___, and hyperkalemia. \nPatient noted to be oriented only to self and ___ \n___ on morning after admission, was unable to say \nwhy she came to the hospital, unable to state months of year \nbackwards. Occupational therapy was consulted for cognitive \nevaluation and performed Moca, patient scored ___. Further \nevaluation revealed that patient has been receiving assistance \nwith medication administration from her son, having meals \ndelivered at home, likely chronic component to cognitive \ndecline. Per discussion with her PCP and her son this level of \ndisorientation and confusion was out of the ordinary for her. By \n___ mental status had improved to baseline with correction of \nhypovolemia and metabolic abnormalities (hyperkalemia). She was \nalso noted on admission to have sinus bradycardia with \nintermittent pauses seen on Telemetry. Her metoprolol was \ninitially held on admission with resolution of bradycardia and \npauses. Evening of ___ patient seen to have sustained SVT \nwith rates in 130s. Metoprolol tartrate restarted at 12.5 mg \nevery 6 hours. No further episodes of SVT seen after initiation \nof metoprolol therapy, no further episodes of bradycardia or \nsinus pauses either. Her ___ and hypovolemia on admission were \nfelt to be most likely in the setting of dual diuretic therapy \nwith Lasix and spironolactone at home. These were initially held \nalong with her losartan given hyperkalemia and ___. Patient was \npersistently hypertensive and home Lasix was restarted with \naddition of amlodipine as a new antihypertensive agent. Patient \nwas evaluated by physical therapy who felt she would benefit \nfrom a discharge to rehab before returning home. Additionally, \npatient seem to be taking acyclovir 400 mg twice daily when \nadmitted. Patient stated for shingles prophylaxis. PCP patient \nshould only be on acyclovir for treatment of shingles and not on \nchronic suppressive therapy. Acyclovir was held.'}}
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{'final_diagnoses': ['Mechanical fall', 'Acute kidney injury', 'Hyperkalemia', 'Hypertension', 'SVT', 'Pauses on telemetry', 'Cognitive deficits', 'Hypothyroidism', 'Neuropathy', 'GERD', 'Allergic rhinitis', 'Depression', 'Anxiety', 'Insomnia'], 'procedures': ['None'], 'visit_summary': 'SUMMARY:\n========\nMs. ___ is an ___ year old woman, currently living \nindependently, w/ PMHx mild AR, HTN,\nHLD, depression, who presented after a fall at home, found on \nadmission to have positive orthostatics, ___, and hyperkalemia. \nPatient noted to be oriented only to self and ___ \n___ on morning after admission, was unable to say \nwhy she came to the hospital, unable to state months of year \nbackwards. Occupational therapy was consulted for cognitive \nevaluation and performed Moca, patient scored ___. Further \nevaluation revealed that patient has been receiving assistance \nwith medication administration from her son, having meals \ndelivered at home, likely chronic component to cognitive \ndecline. Per discussion with her PCP and her son this level of \ndisorientation and confusion was out of the ordinary for her. By \n___ mental status had improved to baseline with correction of \nhypovolemia and metabolic abnormalities (hyperkalemia). She was \nalso noted on admission to have sinus bradycardia with \nintermittent pauses seen on Telemetry. Her metoprolol was \ninitially held on admission with resolution of bradycardia and \npauses. Evening of ___ patient seen to have sustained SVT \nwith rates in 130s. Metoprolol tartrate restarted at 12.5 mg \nevery 6 hours. No further episodes of SVT seen after initiation \nof metoprolol therapy, no further episodes of bradycardia or \nsinus pauses either. Her ___ and hypovolemia on admission were \nfelt to be most likely in the setting of dual diuretic therapy \nwith Lasix and spironolactone at home. These were initially held \nalong with her losartan given hyperkalemia and ___. Patient was \npersistently hypertensive and home Lasix was restarted with \naddition of amlodipine as a new antihypertensive agent. Patient \nwas evaluated by physical therapy who felt she would benefit \nfrom a discharge to rehab before returning home. Additionally, \npatient seem to be taking acyclovir 400 mg twice daily when \nadmitted. Patient stated for shingles prophylaxis. PCP patient \nshould only be on acyclovir for treatment of shingles and not on \nchronic suppressive therapy. Acyclovir was held.', 'medications_prescribed': ['amLODIPine 10 mg PO DAILY', 'Metoprolol Succinate XL 50 mg PO DAILY', 'Pantoprazole 40 mg PO Q24H', 'Acetaminophen 650 mg PO DAILY:PRN Pain - Mild/Fever', 'Diclofenac Sodium ___ ___ sodium) 1 % topical BID', 'Fish Oil (Omega 3) 1000 mg PO DAILY', 'Fluticasone Propionate NASAL 2 SPRY NU DAILY', 'Furosemide 20 mg PO DAILY', 'Gabapentin 300 mg PO TID', 'levocetirizine 5 mg oral DAILY', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN Constipation - First \nLine', 'Ranitidine 300 mg PO QHS', 'TraZODone 50 mg PO QHS', 'HELD- Losartan Potassium 100 mg PO DAILY This medication \nwas held. Do not restart Losartan Potassium until you are told \nto do so by your primary physician']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'LUE AVF thrombosis', 'medical_history': ['ESRD on HD MWH for hypertensive nephropathy', 'Fistula repair, ___ thrombectomy revision of left \nbrachiocephalic AV fistula, left brachiocephalic AV fistula', 'HTN', 'ACD', 'GERD', 'Secondary hyperparathyroidism', 'Hemoptysis', 'Bilateral PEs: Unclear etiology of hypercoagulable state. \nStudies unrevealing for etiology (ANCA, ___, Protein c and s, \nACA Ig and \nIgM, lupus anticoagulant, antithrombin, anti-GBM, \nmethylenetetrahydrofolate).'], 'family_history': 'No family history of kidney failure. No clotting or bleeding \ndisorders.', 'present_illness': ' This is a ___ ___ female with ESRD \n(on HD MWF) s/p revision of a LUE brachiocephalic AVF, and \nbilateral PEs who presented with a non-functioning, thrombosed \nLUE AVF, admitted for ___ thrombectomy. She came in for HD and \nwas found to have a non-functioning AVF. She did not notice any \nLUE tenderness or swelling, but did report that she felt the \nfistula had an absent thrill. She denies having any shortness \nof breath, chest pain, lightheadeness, or calf tenderness. She \ndoes not use OCPs and has never smoked. \n\nShe presented in ___ at ___ with LUE AVF thrombosis and \nunderwent a thrombectomy revision of her AVF with a \ngraft-to-brachial artery on ___. Per OMR, her AVF was \ncreated at ___ in ___ and failed about a year \nlater, for reasons that need to be reconciled with her OSH \nrecords, and this required R IJ placement for HD. Subsequently \nthereafter, she presented to ___ with hemoptysis on \n___ in the setting of bilateral PEs detected on CTA, \nrequiring a brief MICU admission for observation. She was \nstarted on heparin gtt and transferred to ___ for \n___, where she was admitted briefly in the MICU for \nobservation, during which her hct was stable and her hemoptysis \nresolved. She also underwent an extensive, though unrevealing \nhypercoagulability ___, including bilateral upper/lower \nextremity ultrasounds and MRV pelvis which were negative for \nclots, as well as ANCA, ___, protein C/S, ACA Ig and IgM, lupus \nanticoagulant, antithrombin, anti-GBM, and \nmethylenetetrahydrofolate. Coumadin 7.5 mg was initiated with \ngoal INR ___ after successful revision of her left sided \nfistula. \n\nIn the ED, initial vitals: 98.1 78 135/75 20 99% on RA. Her \nlabs were notable for hct 11.5, Cr 8.7, INR 0.9. Renal \ntransplant and ___ were consulted in the ED and she underwent a \nLUE doppler which revealed an intraluminal echogenicity of the \ngraft and draining vein with absent waveforms were appreciated, \nc/w outflow occlusion. She was admitted to medicine for further \n___ with plan for ___ thrombectomy and AV fistulogram. \n\nVitals prior to transfer: 97.9 68 123/83 16 100% on RA. \n\nCurrently, she is not complaining of any tenderness at the AV \nfistula site.', 'medications': [{'medication': 'Potassium Chloride', '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': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Potassium Chloride (Powder)', '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': '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': '4X/WEEK', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Furosemide', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fludrocortisone Acetate', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', '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/NG', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': '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': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'MWF', 'doses_per_24_hrs': None}, {'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': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, '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': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.86', 'valuenum': 2.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.8', 'valuenum': 60.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', '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': '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': '___', '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': '1.9', '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': '3.2', 'valuenum': 3.2, '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': '21', 'valuenum': 21.0, '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': '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': '36.0', 'valuenum': 36.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LARGE PLTS SEEN.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'CHECKED FOR NRBC.'}, {'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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.6', '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '20.2', 'valuenum': 20.2, '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': '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': '7.8', 'valuenum': 7.8, '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': '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': 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': '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': '3.9', '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': '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': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.7', 'valuenum': 22.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '5.1', 'valuenum': 5.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': 'AVAILABLE AT THE ___ LAB.'}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '62.6', 'valuenum': 62.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR. LARGE PLATELETS PRESENT.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'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', 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100.0, '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': 0.4, 'ref_range_upper': 1.1, '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, '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}, {'value': '35.3', 'valuenum': 35.3, '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': '36.0', 'valuenum': 36.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '114', 'valuenum': 114.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.10', 'valuenum': 3.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, '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': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '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': '___', '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': '1.9', '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': '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': '31', 'valuenum': 31.0, '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': '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': 0.4, '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 0.9,. Estimated GFR = 60 if non African-American (mL/min/1.73 m2). Estimated GFR = 72 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': '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': '3.7', 'valuenum': 3.7, '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': '144', 'valuenum': 144.0, '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': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.5', 'valuenum': 20.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.0', 'valuenum': 36.0, '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': '114', 'valuenum': 114.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW. LARGE PLTS SEEN.'}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '145', 'valuenum': 145.0, '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': 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': 'MOD.'}, {'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': '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': 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': 'POS.'}, {'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': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': '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': 'Cloudy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'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': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '>182*.'}, {'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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS: T 98.2 BP-NR HR 60 RR 16 100% RA Wt 77.9kg\nGENERAL: NAD, comfortable, appropriate\nHEENT: NC/AT, sclerae anicteric, MMM\nNECK: Supple, no JVD\nHEART: RRR, split S1, nl S2, no rubs/gallops\nLUNGS: CTAB, no r/rh/wh, good air movement, resp unlabored\nABDOMEN: Soft/NT/ND.\nEXTREMITIES: WWP, no c/c/e, radial pulses palpable bilaterally. \nNo palpable thrill. Soft bruit on auscultation. No engorged \nveins or swelling B/L UE. \nSKIN: No rashes or lesions\nNEURO: A&Ox3, CNs II-XII grossly intact.\n\nDISCHARGE EXAM:\nVS: T 97.9 BP 103/66 HR 62 RR 18 100% RA \nGENERAL: NAD, comfortable, appropriate\nHEENT: Sclerae anicteric, MMM\nNECK: Supple, no JVD\nHEART: RRR, split S1, nl S2, no rubs/gallops\nLUNGS: CTAB, no r/rh/wh, good air movement, resp unlabored\nABDOMEN: Soft/NT/ND.\nEXTREMITIES: WWP, no c/c/e. Thrill palpable, bruit present on \nauscultation. No engorged veins or swelling B/L UE. \nSKIN: no rashes or lesions\nNEURO: A&Ox3, CNs II-XII grossly intact', 'diagnoses': [{'icd_code': '42843', 'desc': 'Acute on chronic combined systolic and diastolic heart failure'}, {'icd_code': '73313', 'desc': 'Pathologic fracture of vertebrae'}, {'icd_code': '28419', 'desc': 'Other pancytopenia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': 'V103'}, {'icd_code': 'V4364'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'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': '2116', 'desc': 'Benign neoplasm of pancreas, except islets of Langerhans'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '3373', 'desc': 'Autonomic dysreflexia'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}], 'summary': "ADMISSION LABS:\n___ 01:26AM GLUCOSE-83 UREA N-44* CREAT-8.7*# SODIUM-139 \nPOTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-30 ANION GAP-13\n___ 01:26AM CALCIUM-9.3 PHOSPHATE-3.0# MAGNESIUM-2.7*\n___ 01:26AM WBC-9.4 RBC-3.77*# HGB-11.5*# HCT-35.7*# \nMCV-95 MCH-30.4 MCHC-32.2 RDW-13.2\n___ 01:26AM NEUTS-64.6 ___ MONOS-6.7 EOS-2.9 \nBASOS-0.7\n___ 01:26AM PLT COUNT-155#\n___ 01:26AM ___ PTT-25.6 ___\n\nIMAGING:\n___: Duplex and color Doppler of the patient's left upper \nextremity AV fistula was performed. The feeding brachial artery \nis widely patent, demonstrating peak systolic velocities \nproximal to the AV anastomosis of 41-49 centimeters/second. \nThere is Gortex graft at the arterial anastomosis which then \nlegs to the draining vein. The graft and draining vein appears \nbended with intraluminal echogenic material and no color Doppler \nor spectral waveforms appreciated. Furthermore, the brachial \nartery now demonstrated normal triphasic waveform with a \nmonophasic waveform would be expected. \nIMPRESSION: Occluded outflow of this patient's left upper \nextremity arterial venous fistula.\n\n___: AV fistulogram\nFINDINGS: \n1. Complete thrombosis of brachial artery to cephalic vein jump \ngraft and \nproximal 10cm of the outflow cephalic vein. \n2. Significant stenosis in the mid portion of the fistula and \nthe venous \nanastomosis of the jump graft which were addressed by 7-mm \nballoon dilatation. \n3. Persistent relative stenosis at the arterial and venous jump \ngraft \nanastomoses which could be addressed in a separate session. \n \nIMPRESSION: \nSuccessful chemical and mechanical thrombectomy of a completetly \nthrombosed \nleft upper arm AV fistula with balloon dilatation of significant \npredominantly \ninflow stenoses. \nA total of 10mg of tPA, 4,000 IU of heparin and 100 mcg of \nnitroglycerin was \nadministered. \nThe fistula had a strong thrill at the completion of the \nprocedure however a \nrepeat fistulogram in the short to medium term is advised to \nfurther evaluate \nthe jump graft stenoses as described above. \n\nDISCHARGE LABS:\n___ 01:18PM BLOOD WBC-8.7 RBC-3.48* Hgb-10.8* Hct-32.6* \nMCV-94 MCH-31.2 MCHC-33.2 RDW-13.6 Plt ___\n___ 01:18PM BLOOD Plt ___\n___ 01:18PM BLOOD Glucose-109* UreaN-58* Creat-10.2*# \nNa-135 K-4.6 Cl-98 HCO3-23 AnGap-19\n___ 01:18PM BLOOD Calcium-8.9 Phos-3.6 Mg-2.7*\n___ F with ESRD (on HD MWF) s/p revision of a LUE AVF, bilateral \nPEs who presented with a thrombosed LUE AVF, now s/p ___ \nthrombectomy and AV fistulogram on ___. \n\n# LUE AVF thrombosis: Patient initially presented with a \nnon-functional AVF at HD yesterday, though largely asymptomatic \nwithout evidence of pain or swelling, and found on Doppler to \nhave an intraluminal echogenicity c/w AVF clot. She was seen by \ntransplant and ___, with plan for ___ thrombectomy today. This is \nher second AVF clot s/p thrombectomy revision in ___ \nrequiring creation of a graft-to-brachial artery c/b seroma at \nrepair site. She underwent ___ thrombectomy and AV fistulogram \nwith return of palpable thrill, bruit on auscultation, and was \nsuccessfully accessed during HD. Her post-procedure course was \nuncomplicated without e/o hematoma or seroma. She was given \noxycodone 4mg PRN Q8H and Tylenol ___ mg PRN for pain. Her \npurse-string sutures were removed by ___ will contact patient \nregarding follow-up of fistula. \n\n# Coagulopathy: She had completed 6 months of Coumadin \nanticoagulation in the setting of bilateral PEs on CTA \nidentified in ___. Etiology still unclear, as she has \nundergone an extensive, though unrevealing hypercoagulability \nw/u during her admission at ___ in ___, including ANCA, \n___, protein C/S, ACA Ig and IgM, lupus anticoagulant, \nantithrombin, anti-GBM, and methylenetetrahydrofolate, as well \nas upper/lower extremity ultrasounds and MRV pelvis which were \nnegative for clots. \nPatient to follow-up with PCP regarding additional ___. \nFeel that thrombosis of graft is likely mechanical in nature, \nnot due to coagulopathy. \n\n# CKD V/ESRD on HD: Etiology unclear, thought to be secondary to \nhypertensive nephropathy, though her BPs have not been elevated \nand prior TTE without e/o chronic hypertensive changes. She is \ndialyzed MWF and underwent successful HD while inpatient. We \ncontinued her on sevelamer, cholecalciferol, and a renal low \nsalt diet.\n\n# Anemia: Hct 11.5, at baseline. She has a prior workup c/w ACD."}}
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{'final_diagnoses': ['Thrombosis of the left upper extremity arteriovenous fistula', 'End-stage renal disease on hemodialysis', 'Coagulopathy'], 'procedures': ['___ thrombectomy'], 'visit_summary': '___ F with ESRD (on HD MWF) s/p revision of a LUE AVF, bilateral \nPEs who presented with a thrombosed LUE AVF, now s/p ___ \nthrombectomy and AV fistulogram on ___. \n\n# LUE AVF thrombosis: Patient initially presented with a \nnon-functional AVF at HD yesterday, though largely asymptomatic \nwithout evidence of pain or swelling, and found on Doppler to \nhave an intraluminal echogenicity c/w AVF clot. She was seen by \ntransplant and ___, with plan for ___ thrombectomy today. This is \nher second AVF clot s/p thrombectomy revision in ___ \nrequiring creation of a graft-to-brachial artery c/b seroma at \nrepair site. She underwent ___ thrombectomy and AV fistulogram \nwith return of palpable thrill, bruit on auscultation, and was \nsuccessfully accessed during HD. Her post-procedure course was \nuncomplicated without e/o hematoma or seroma. She was given \noxycodone 4mg PRN Q8H and Tylenol ___ mg PRN for pain. Her \npurse-string sutures were removed by ___ will contact patient \nregarding follow-up of fistula. \n\n# Coagulopathy: She had completed 6 months of Coumadin \nanticoagulation in the setting of bilateral PEs on CTA \nidentified in ___. Etiology still unclear, as she has \nundergone an extensive, though unrevealing hypercoagulability \nw/u during her admission at ___ in ___, including ANCA, \n___, protein C/S, ACA Ig and IgM, lupus anticoagulant, \nantithrombin, anti-GBM, and methylenetetrahydrofolate, as well \nas upper/lower extremity ultrasounds and MRV pelvis which were \nnegative for clots. \nPatient to follow-up with PCP regarding additional ___. \nFeel that thrombosis of graft is likely mechanical in nature, \nnot due to coagulopathy. \n\n# CKD V/ESRD on HD: Etiology unclear, thought to be secondary to \nhypertensive nephropathy, though her BPs have not been elevated \nand prior TTE without e/o chronic hypertensive changes. She is \ndialyzed MWF and underwent successful HD while inpatient. We \ncontinued her on sevelamer, cholecalciferol, and a renal low \nsalt diet.\n\n# Anemia: Hct 11.5, at baseline. She has a prior workup c/w ACD.', 'medications_prescribed': ['Vitamin D 800 UNIT PO DAILY', 'Renagel *NF* (sevelamer HCl) 800 mg Oral TID w/meals']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 89, 'gender': 'M', 'symptoms': 'Gastric mass', 'medical_history': ['Hypertension', '? TIA', 'GERD', 'BPH', 'osteoarthritis', 'elevated \ncholesterol', 'Appendectomy and lipoma excision.'], 'family_history': 'NC', 'present_illness': 'The is a ___ very lovely patient who was found to have \nanemia and was found to have GI bleeding. Upon endoscopy, he was \nfound to have a 3 cm ulcer in the prepyloric region. He \nunderwent imaging that demonstrated prepyloric lesion with some \nassociated lymphadenopathy. The patient was evaluated by Dr. \n___ in her ___ ___ for possible gastectomy. \nAfter all risks, benefits and possible outcomes were discussed \nwith the patient, he was scheduled for elective partial \ngastrectomy on ___.', 'medications': [{'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': '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-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Carvedilol', '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}]}, '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.0, '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': '10', 'valuenum': 10.0, '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': '1.9', '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': '4.0', 'valuenum': 4.0, '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': '64', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, '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': '2.75', 'valuenum': 2.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.5', 'valuenum': 57.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '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': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '___', 'valuenum': 137.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '57.8', 'valuenum': 57.8, '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': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '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': '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': '57.3', 'valuenum': 57.3, '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': 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': '8.2', 'valuenum': 8.2, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '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, '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '62', 'valuenum': 62.0, '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': '75.4', 'valuenum': 75.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75.3', 'valuenum': 75.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '73.6', 'valuenum': 73.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.7', 'valuenum': 24.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.48', 'valuenum': 2.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.0', 'valuenum': 57.0, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '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': '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': '148', 'valuenum': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '1.8', '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78.5', 'valuenum': 78.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', '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': '127', 'valuenum': 127.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '2.47', 'valuenum': 2.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56.5', 'valuenum': 56.5, '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': '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': '8.2', 'valuenum': 8.2, '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': '2.1', 'valuenum': 2.1, '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': '7', 'valuenum': 7.0, '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, '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': '3.8', 'valuenum': 3.8, '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': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '16', 'valuenum': 16.0, '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': '8.0', 'valuenum': 8.0, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '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': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, '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': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '30.7', 'valuenum': 30.7, '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': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '2.54', 'valuenum': 2.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53.2', 'valuenum': 53.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '98.2', 'valuenum': 98.2, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': '63', 'valuenum': 63.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '2.74', 'valuenum': 2.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.7', 'valuenum': 54.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Prior Discharge:\nVS: 98.5, 94, 131/58, 18, 98% RA\nGEN: Pleasant with NAD, AAO x 3\nCV: RRR, no m/r/g\nPULM: Diminished BS bilateraly on bases.\nABD: Midline and right subcostal incisions open to air with \nsteri strips and c/d/i. G-J - tube capped, site c/d/i with dry \ndressing. \nEXTR: Warm, no edema. + peripheral pulses.', 'diagnoses': [{'icd_code': 'I2699', 'desc': 'Other pulmonary embolism without acute cor pulmonale'}, {'icd_code': 'I5023', 'desc': 'Acute on chronic systolic (congestive) heart failure'}, {'icd_code': 'J910', 'desc': 'Malignant pleural effusion'}, {'icd_code': 'E870', 'desc': 'Hyperosmolality and hypernatremia'}, {'icd_code': 'N184', 'desc': 'Chronic kidney disease, stage 4 (severe)'}, {'icd_code': 'D539', 'desc': 'Nutritional anemia, unspecified'}, {'icd_code': 'C3490', 'desc': 'Malignant neoplasm of unspecified part of unspecified bronchus or lung'}, {'icd_code': 'I82492', 'desc': 'Acute embolism and thrombosis of other specified deep vein of left lower extremity'}, {'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': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'D630', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I255', 'desc': 'Ischemic cardiomyopathy'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'Z95810', 'desc': 'Presence of automatic (implantable) cardiac defibrillator'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'R062', 'desc': 'Wheezing'}], 'summary': " Pathology Examination \n\nName ___ Age Sex Pathology # ___ MRN# \n___ ___ ___ Male ___ ___\n\nReport to: ___. ___\n___ by: ___. ___\n\nSPECIMEN SUBMITTED: GALLBLADDER, DOUDENAL LYMPH NODE, DISTAL \nGASTRECTOMY.\nProcedure date Tissue received Report Date Diagnosed \nby \n___ ___. ___/___\nPrevious biopsies: ___ GI BX'S, 2 JARS. \n ___ left femoral and tibial bones. \n ___ right knee bones. \n\nDIAGNOSIS: \n1. Gallbladder (A): Chronic cholecystitis and cholelithiasis. \n2. Lymph nodes, ___ (B-E):\nMetastatic adenocarcinoma present in one of the three lymph \nnodes (___.):\nGastrectomy, distal (F-AC):\nGastric adenocarcinoma; see synoptic report.\n\nChronic inactive gastritis with intestinal metaplasia; \nimmunohistochemical stain for Helicobacter is negative with \nadequate controls. \n\nStomach: Resection Synopsis\nStaging according to ___ Joint Committee on Cancer Staging \nManual -- ___ Edition, ___\n\nMACROSCOPIC\nSpecimen Type: Partial gastrectomy: distal.\nTumor Site: Antrum: Anterior wall.\nTumor configuration: Ulcerating.\nTumor Size: Greatest Dimension: 4.3 cm. Additional ___: \n 3.5 cm.\n\nMICROSCOPIC\nHistologic Type: Adenocarcinoma, intestinal type.\nHistologic Grade: G2: Moderately differentiated.\nPrimary Tumor: pT4a: Tumor invades serosa (visceral \nperitoneum).\nRegional Lymph Nodes: pN1: Metastasis in 1 to 2 perigastric \nlymph nodes.\nLymph Nodes\n Number examined: 11.\n Number involved: 1 (includes specimen #2).\n \nDistant metastasis: pMX: Cannot be assessed.\n \nMARGINS\nProximal margin: Uninvolved by invasive carcinoma.\nDistal margin: Uninvolved by invasive carcinoma.\nOmental (radical) margin: Uninvolved by invasive carcinoma.\nDistance from closest margin: 5 mm.\nSpecified margin: Distal.\nTreatment Effect: No prior treatment.\nLymphatic (Small Vessel) Invasion: Indeterminate.\nVenous (Large vessel) invasion: Absent.\nPerineural invasion: Absent.\nComments: The tumor secondarily involves the proximal duodenum. \n\nClinical: Stomach cancer.\n\n___ 09:10AM BLOOD WBC-11.3* RBC-3.66* Hgb-10.2* Hct-30.7* \nMCV-84 MCH-27.8 MCHC-33.2 RDW-14.7 Plt ___\n___ 09:10AM BLOOD Glucose-127* UreaN-37* Creat-0.9 Na-136 \nK-5.5* Cl-102 HCO3-26 AnGap-14\n___ 09:10AM BLOOD Calcium-8.1* Phos-3.8 Mg-2.1\n\n___ ABD CT:\nIMPRESSION: \n1. Gastric outlet obstruction at the ___ II anastomosis. \nConsequent fluid-filled dilation of the esophagus. \n2. Large bilateral pleural effusions. \n3. No free intraperitoneal air.\nThe patient with malignant gastric ulcer was admitted to the \nSurgical Oncology Service for elective gastrectomy. On ___, \nthe patient underwent distal gastrectomy with cholecystectomy \nand placement of gold fiducials for possible Cyberknife \nradiotherapy, 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 \nNPO, on IV fluids and antibiotics, with a foley catheter, and \nepidural catheter for pain control. The patient was \nhemodynamically stable.\nNeuro: The patient received Hydromorphone/Bupivacaine via \nepidural with good effect and adequate pain control. Epidural \nwas discontinued on POD # 3 and patient was started on Dilaudid \nPCA. When tolerating oral intake, the patient was transitioned \nto oral pain medications. The patient has a history of chronic \nback/neck and Lidocaine patch was applied on his back for better \npain control.\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\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.\nGI/GU/FEN: Post operatively patient was NPO with IV fluids. Diet \nwas advanced to sips on POD # 2 and to clears on POD # 3. \nPatient developed severe nausea and vomiting with bilious fluid \nand was made NPO. The patient was unable to tolerate any food \nand Nutritional consult was obtained for TPN recommendations. \nTPN was started on POD # 6. Patient's diet was advanced to \nclears on POD # 7 and patient was able to tolerate small amount \nof clears without nausea. Diet was progressively advanced to \nregular soft on POD # 10, the patient developed persistent \nnausea and vomiting and abdominal CT scan was obtained on POD # \n11 (___.): CT scan demonstrated gastric outlet obstruction at \nthe Billroth II anastomosis. The patient was made NPO with TPN \nand NGT tube was placed for stomach decompression. On ___, \nupper GI with KUB was concerned for continuous obstruction. EGD \nwas done on ___ showed gastric outlet obstruction, and on ___ \npatient was taken in OR. He underwent full exploration of \ngastric remnant with resection of omentum and mobilization of \nthe transverse colon off of the posterior wall of the \nanastomosis, draining gastrostomy and feeding jejunostomy \n(please see OP note for details). Post operatively patient was \ntransferred back on the floor in stable condition. He was \ncontinued on TPN, NPO with NGT, Foley catheter and pain was \ncontrolled with Dilaudid PCA. Tubefeed was started on ___ and \nadvanced to goal on ___. The patient's NGT was removed on \n___, his G-tube was continued to gravity drainage until ___ \nand was capped on ___. Patient continued to have intermittent \nnausea and G-tube was kept to gravity drainage overnight. During \ndaytime, G-tube capped and patient was able to tolerated sips of \nclears. \nID: The patient's white blood count and fever curves were \nclosely watched for signs of infection. Wound was evaluated \ndaily and no signs or symptoms of infection were noticed prior \ndischarge. Staples were removed and steri strips were applied \nprior discharge.\nEndocrine: The patient's blood sugar was monitored throughout \nhis stay; insulin dosing was adjusted accordingly. After weaning \noff TPN, insulin sliding scale was discontinued.\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required.\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 Physical Therapy.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a tubefeed \nat goal and sips of clears for comfort, ambulating with assist, \nvoiding without assistance, and pain was well controlled. The \npatient received discharge teaching and follow-up instructions \nwith understanding verbalized and agreement with the discharge \nplan."}}
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{'final_diagnoses': ['Metastatic gastric adenocarcinoma', 'Chronic cholecystitis and cholelithiasis', 'Gastric outlet obstruction'], 'procedures': ['Distal gastrectomy with cholecystectomy and catheter exploration \nof the common duct. Placement of gold fiducials for possible \nCyberknife radiotherapy.', 'Exploratory laparotomy.', 'Lysis of adhesions.', 'Full exploration of gastric remnant with resection of omentum \nand mobilization of the transverse colon off of the posterior \nwall of the anastomosis.', 'Draining gastrostomy.', 'Feeding jejunostomy.'], 'visit_summary': "The patient with malignant gastric ulcer was admitted to the \nSurgical Oncology Service for elective gastrectomy. On ___, \nthe patient underwent distal gastrectomy with cholecystectomy \nand placement of gold fiducials for possible Cyberknife \nradiotherapy, 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 \nNPO, on IV fluids and antibiotics, with a foley catheter, and \nepidural catheter for pain control. The patient was \nhemodynamically stable.\nNeuro: The patient received Hydromorphone/Bupivacaine via \nepidural with good effect and adequate pain control. Epidural \nwas discontinued on POD # 3 and patient was started on Dilaudid \nPCA. When tolerating oral intake, the patient was transitioned \nto oral pain medications. The patient has a history of chronic \nback/neck and Lidocaine patch was applied on his back for better \npain control.\nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\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.\nGI/GU/FEN: Post operatively patient was NPO with IV fluids. Diet \nwas advanced to sips on POD # 2 and to clears on POD # 3. \nPatient developed severe nausea and vomiting with bilious fluid \nand was made NPO. The patient was unable to tolerate any food \nand Nutritional consult was obtained for TPN recommendations. \nTPN was started on POD # 6. Patient's diet was advanced to \nclears on POD # 7 and patient was able to tolerate small amount \nof clears without nausea. Diet was progressively advanced to \nregular soft on POD # 10, the patient developed persistent \nnausea and vomiting and abdominal CT scan was obtained on POD # \n11 (___.): CT scan demonstrated gastric outlet obstruction at \nthe Billroth II anastomosis. The patient was made NPO with TPN \nand NGT tube was placed for stomach decompression. On ___, \nupper GI with KUB was concerned for continuous obstruction. EGD \nwas done on ___ showed gastric outlet obstruction, and on ___ \npatient was taken in OR. He underwent full exploration of \ngastric remnant with resection of omentum and mobilization of \nthe transverse colon off of the posterior wall of the \nanastomosis, draining gastrostomy and feeding jejunostomy \n(please see OP note for details). Post operatively patient was \ntransferred back on the floor in stable condition. He was \ncontinued on TPN, NPO with NGT, Foley catheter and pain was \ncontrolled with Dilaudid PCA. Tubefeed was started on ___ and \nadvanced to goal on ___. The patient's NGT was removed on \n___, his G-tube was continued to gravity drainage until ___ \nand was capped on ___. Patient continued to have intermittent \nnausea and G-tube was kept to gravity drainage overnight. During \ndaytime, G-tube capped and patient was able to tolerated sips of \nclears. \nID: The patient's white blood count and fever curves were \nclosely watched for signs of infection. Wound was evaluated \ndaily and no signs or symptoms of infection were noticed prior \ndischarge. Staples were removed and steri strips were applied \nprior discharge.\nEndocrine: The patient's blood sugar was monitored throughout \nhis stay; insulin dosing was adjusted accordingly. After weaning \noff TPN, insulin sliding scale was discontinued.\nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required.\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 Physical Therapy.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a tubefeed \nat goal and sips of clears for comfort, ambulating with assist, \nvoiding without assistance, and pain was well controlled. The \npatient received discharge teaching and follow-up instructions \nwith understanding verbalized and agreement with the discharge \nplan.", 'medications_prescribed': ['1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H', '2. Bisacodyl 10 mg PR HS:PRN constipation', '3. Heparin 5000 UNIT SC Q12H', '4. Lansoprazole Oral Disintegrating Tab 30 mg PO DAILY', '5. Lidocaine 5% Patch 1 PTCH TD DAILY', '6. Metoclopramide 5 mg PO Q6H', '7. Ondansetron 4 mg IV Q8H:PRN nausea/vomiting', '8. OxycoDONE-Acetaminophen Elixir ___ mL PO Q4H:PRN pain \nRX *oxycodone-acetaminophen [Roxicet] 5 mg-325 mg/5 mL ___ mLs \nJ-tube every four (4) hours Disp #*500 Milliliter Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'weakness, fever', 'medical_history': ['hyperlipidemia', 'cataracts', 'lymphadenopathy (supraclavicular, mediastinal, RP, pelvic sidewall, iliac, cervical)'], 'family_history': 'Mother, healthy.\nFather, treated for colon cancer in the past.\nNo other malignancies in the family which he is aware.', 'present_illness': "Mr. ___ is a ___ year old male with rectal cancer on C3D10 \nof FOLFIRI, history of C diff ___, who presents with fever to \n103.7 and generalized weakness x 1 week. The night prior to \nadmission (approx 1am on ___ the patient's temperature spiked \nto 103.7, associated with diaphoresis and shaking chills. \nPatient reported approx 2 days of diarrhea and ___ days of \nintermitent abdominal pain just below the umbilicus. He reports \nchanging his ostomy bag Q2-3H (usual Q5-6H). He denied cough, \nCP, SOB, though his urine was darker than usual. The patient \ncalled the oncology fellow on call and was referred to the ED.\n \nThe patient has a suprapubic catheter in place that has been \ndraining orange colored urine. His colostomy bag has been \ncollecting diarrhea, which his girlfriend reported to the ED had \nspecks of blood on the morning of presenation. \n\nOf note, this patient was recently admitted ___ with fever \nand abdominal pain at which time he was diagnosed with C diff \nand also a pseudomonal UTI. UA at that time showed pyuria and \nbacteriuria. Pt was discharged with 6 additional days of cipro \nfor UTI and PO flagyl until ___. \n\nIn the ED, initial vitals were: T 98.4, Tmax 101.5, P ___, BP \n104/76 RR 16 O2 sat 100% RA. Labs were significant for: WBC 7.1 \n(66%N, 4%bands), Hb 12.3, plt 155, Na 131, BUN/Cr ___. UA \nwith lg leuks, >182 WBC, no bacteria. CTA with motion artifact \nso no large PE found. The patient was given: 1L NS, Vanc/zosyn, \nPO vanc, nystatin cream, 650 PO tylenol and transferred to the \nfloor.", 'medications': [{'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': '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', 'doses_per_24_hrs': 2.0}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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': 'Sulfameth/Trimethoprim DS', '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/NG', 'frequency': 'BID: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}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'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': '29', 'valuenum': 29.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '4.6', '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': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.2', 'valuenum': 42.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '313', 'valuenum': 313.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.97', 'valuenum': 4.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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}], 'exams': 'ADMISSION PHYSICAL EXAM\nVitals: 98.8, 116/62, 98, 18, 97% RA \nGeneral: middle-aged asian male, nontoxic, sitting up in bed in \nNAD \nHEENT: Sclera anicteric, dry MM with yellowish coating on R side \nof tongue \nNeck: Supple \nCV: RRR, no murmurs \nLungs: CTAB, breathing comfortably \nAbdomen: soft, suprapubic catheter in RLQ, ostomy bag full of \nyellowish brown stool in LLQ, TTP in LUQ, inferior to umbilicus \nand LLQ, scar inferior to umbilicus. Hyperactive BS \nExt: Warm, well perfused, no ___ edema, R calf slightly larger \nthan left \nNeuro: grossly intact, alert and answers questions appropriately\nSkin: numerous ulcerations on scrotum with serous drainage and \nresidue of recent nystatin cream application, large 2-2.5cm \nulcer on R lateral scrotum is largest \n\nDISCHARGE PHYSICAL EXAM\nVS: T98.3 BP 123/68, P 80, RR 18, O2 98% on RA\nGENERAL: NAD, alert\nHEENT: sclerae anicteric \nLUNGS: Clear to auscultation in posterior/anterior lung fields\nHART: RRR nl S1 S2, no M/R/G\nABDOMEN: soft, nondistended, nontender to palpation, +firmness \nover laparotomy scar, + ostomy in place with output of formed \nstool, + suprapubic catheter in place\nGU: gauze dressing over scrotum with minimal serosang drainage \n\nEXTREMITIES: warm and well perfused, DP 2+ b/l\nNEURO: awake, A&Ox3', 'diagnoses': [{'icd_code': '6826', 'desc': 'Cellulitis and abscess of leg, except foot'}, {'icd_code': '4571', 'desc': 'Other lymphedema'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}], 'summary': "___ 04:20PM BLOOD WBC-7.1 RBC-3.95* Hgb-12.3* Hct-36.1* \nMCV-91 MCH-31.1 MCHC-34.1 RDW-14.2 RDWSD-47.4* Plt ___\n___ 04:20PM BLOOD Neuts-66 Bands-4 Lymphs-12* Monos-17* \nEos-1 Baso-0 ___ Myelos-0 AbsNeut-4.97 AbsLymp-0.85* \nAbsMono-1.21* AbsEos-0.07 AbsBaso-0.00*\n___ 04:20PM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 04:20PM BLOOD Glucose-121* UreaN-11 Creat-0.6 Na-131* \nK-3.7 Cl-95* HCO3-24 AnGap-16\n___ 04:20PM BLOOD ALT-24 AST-23 AlkPhos-102 TotBili-0.9\n___ 05:17AM BLOOD Calcium-8.1* Phos-2.2* Mg-1.9\n___ 04:35PM BLOOD Lactate-1.5\n \nURINE CULTURE (Final ___: PSEUDOMONAS AERUGINOSA >100,000 \nORGANISMS/ML. CIPROFLOXACIN sensitivity testing confirmed by \n___. \n\nC. difficile DNA amplification assay (Final ___: Reported \nto and read back by ___ ___ ___ @12:36 ___. CLOSTRIDIUM \nDIFFICILE. Positive for toxigenic C. difficile by the Illumigene \nDNA amplification(Reference Range-Negative). \n\nIMAGING:\n\nCTA ___:\n1. Limited evaluation of the segmental and subsegmental \npulmonary arteries. No main, lobar, or large segmental pulmonary \nembolus. \n2. Mediastinal lymphadenopathy is overall unchanged compared to \nthe prior exam. \n3. Multiple small bilateral pulmonary nodules are seen, overall \nunchanged \ncompared to the prior exam. \n\nCT ABD PELVIS ___:\n1. Diffuse colonic wall thickening is more than expected due to \nunderdistention alone, and more conspicuous compared to the \nprior study from ___, concerning for pseudomembranous \ncolitis due to Clostridium difficile. \n2. Small bowel-containing peristomal hernia adjacent to left \nlower quadrant end ostomy, with no evidence of obstruction. \n3. Cholelithiasis. \n\n___ DOPPLER ___:\nNo evidence of deep venous thrombosis in the right lower \nextremity veins.\n\nDISCHARGE LABS:\n\n___ 05:33AM BLOOD WBC-4.2 RBC-2.90* Hgb-9.0* Hct-26.5* \nMCV-91 MCH-31.0 MCHC-34.0 RDW-14.6 RDWSD-49.1* Plt ___\n___ 05:33AM BLOOD Glucose-95 UreaN-8 Creat-1.2 Na-145 K-3.7 \nCl-110* HCO3-21* AnGap-18\n___ 05:33AM BLOOD Calcium-8.0* Phos-3.1 Mg-1.8\n___ 04:20PM URINE Blood-TR Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG\nMr. ___ is a ___ y.o. male with rectal cancer on C3D10 of \nFOLFIRI, h/o C diff ___, presents with fever to 103.7 and \ngeneralized weakness. \n\n# Sepsis\nThe patient met ___ SIRS criteria on admission with fevers and \ntachycardia. The patient was found to have a recurrence of his \nC.diff infection, as well as a pseudomonal UTI. There was a low \nindex of suspicion for superinfection of scrotal ulcerations \n(see below), CTA of chest was negative for pneumonia and blood \ncultures were negative. The patient was treated with IV \nvancomycin, piperacillin/tazobactam, narrowed to ciprofloxacin \nto treat the patient's pseudomonal UTI. The patient was \ndiagnosed with severe C. diff infection, given the degree of his \nfever, acute kidney injury (see below) and relative \nimmunocompromised status. C. diff was treated with PO vancomycin \nand a short course of IV metronidazole, which was ultimately \nnarrowed to just PO vancomycin. Given the patient's \ncomorbidities and high likelihood of recurrence, the patient was \ndischarged on a long taper of PO vancomycin. The patient's home \nmed of loperamide was held and discontinued. The patient should \ncontinue ciprofloxacin until ___. \n\n# Hyponatremia: \nThe patient was found to have hyponatremia to 126. This was \nthought to be secondary to hypovolemia caused by sepsis. The \npatient was treated with IVF and his Na remained within normal \nlimits for the rest of his hospital course. \n\n# ___: \nThe patient's Cr increased from 0.5 to 2.9 following CTA and CT \nabd/pelvis with PO and IV contrast The patient was evaluated by \nnephrology, who suspected his ___ was due to a combination of \nprerenal state and contrast induced nephropathy. His urine \nstudies were consistent with this diagnosis. The patient was \ntreated with IVF and his Cr normalized. The patient's home \nmedication of furosemide was stopped given the patient's volume \ndepletion. The patient should follow up with his PCP for further \nmanagement of this medication and for further monitoring of \nrenal function \n\n# Scrotal ulcerations: \nThe patient had scrotal ulcerations and scrotal fungal \ndermatitis from previous scrotal metastasis. Wound care was \nconsulted and the patient was treated with his home regimen of \nketoconazole cream. \n \n# Rectal cancer: The patient has a history of stage IV rectal \ncancer, on C3D10 of FOLFIRI. His CBC was monitored for \nneutropenia. He was continued on his home pain regimen of \nhydromorphone ___ PO q4hrs PRN pain, prochlorperazine 10mg PO \nq6hrs PRN nausea, ondansetron 8mg PO q8hrs PRN nausea. The \npatient will follow up with his surgeon and oncologist following \ndischarge. \n\n# Anemia: The patient had a mild anemia, which was thought to be \ndilution vs. due to underproduction. The patient had guiac \nnegative stools throughout his admission. His reticulyte index \nwas low, this was thought to be due to his cancer and \nchemotherapy."}}
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{'final_diagnoses': ['Severe recurrent clostridium difficile infection', 'Complicated pseudomonal urinary tract infection', 'Rectal cancer', 'Scrotal ulcerations', 'Acute Kidney Injury'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ y.o. male with rectal cancer on C3D10 of \nFOLFIRI, h/o C diff ___, presents with fever to 103.7 and \ngeneralized weakness. \n\n# Sepsis\nThe patient met ___ SIRS criteria on admission with fevers and \ntachycardia. The patient was found to have a recurrence of his \nC.diff infection, as well as a pseudomonal UTI. There was a low \nindex of suspicion for superinfection of scrotal ulcerations \n(see below), CTA of chest was negative for pneumonia and blood \ncultures were negative. The patient was treated with IV \nvancomycin, piperacillin/tazobactam, narrowed to ciprofloxacin \nto treat the patient's pseudomonal UTI. The patient was \ndiagnosed with severe C. diff infection, given the degree of his \nfever, acute kidney injury (see below) and relative \nimmunocompromised status. C. diff was treated with PO vancomycin \nand a short course of IV metronidazole, which was ultimately \nnarrowed to just PO vancomycin. Given the patient's \ncomorbidities and high likelihood of recurrence, the patient was \ndischarged on a long taper of PO vancomycin. The patient's home \nmed of loperamide was held and discontinued. The patient should \ncontinue ciprofloxacin until ___. \n\n# Hyponatremia: \nThe patient was found to have hyponatremia to 126. This was \nthought to be secondary to hypovolemia caused by sepsis. The \npatient was treated with IVF and his Na remained within normal \nlimits for the rest of his hospital course. \n\n# ___: \nThe patient's Cr increased from 0.5 to 2.9 following CTA and CT \nabd/pelvis with PO and IV contrast The patient was evaluated by \nnephrology, who suspected his ___ was due to a combination of \nprerenal state and contrast induced nephropathy. His urine \nstudies were consistent with this diagnosis. The patient was \ntreated with IVF and his Cr normalized. The patient's home \nmedication of furosemide was stopped given the patient's volume \ndepletion. The patient should follow up with his PCP for further \nmanagement of this medication and for further monitoring of \nrenal function \n\n# Scrotal ulcerations: \nThe patient had scrotal ulcerations and scrotal fungal \ndermatitis from previous scrotal metastasis. Wound care was \nconsulted and the patient was treated with his home regimen of \nketoconazole cream. \n \n# Rectal cancer: The patient has a history of stage IV rectal \ncancer, on C3D10 of FOLFIRI. His CBC was monitored for \nneutropenia. He was continued on his home pain regimen of \nhydromorphone ___ PO q4hrs PRN pain, prochlorperazine 10mg PO \nq6hrs PRN nausea, ondansetron 8mg PO q8hrs PRN nausea. The \npatient will follow up with his surgeon and oncologist following \ndischarge. \n\n# Anemia: The patient had a mild anemia, which was thought to be \ndilution vs. due to underproduction. The patient had guiac \nnegative stools throughout his admission. His reticulyte index \nwas low, this was thought to be due to his cancer and \nchemotherapy.", 'medications_prescribed': ['Vancomycin Oral Liquid ___ mg PO Q6H \nRX *vancomycin 125 mg 1 capsule(s) by mouth daily Disp #*85 \nCapsule Refills:*0', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN pain', 'Prochlorperazine 10 mg PO Q6H:PRN nausea', 'Ondansetron 8 mg PO Q8H:PRN nausea', 'Potassium Chloride 10 mEq PO DAILY', 'Ketoconazole 2% 1 Appl TP BID to scrotum \nRX *ketoconazole 2 % apply to scrotal area twice a day \nRefills:*0', 'Ciprofloxacin HCl 500 mg PO Q12H \nRX *ciprofloxacin HCl [Cipro] 500 mg 1 tablet(s) by mouth twice \na day Disp #*5 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 43, 'gender': 'M', 'symptoms': 'Fever', 'medical_history': ['SCC of the Left Tonsil- Follows at ___', '?Renal metastasis', 'Headaches'], 'family_history': 'Father - ___ cancer\nMother - ___ Cancer\nExtensive family history of diabetes', 'present_illness': '___ man with history of stage IV SCC of the left tonsil\ncancer, 40+ pack year smoker, who initially presented to an\noutside hospital with thrush as well as likely retropharyngeal\nabscess 1.2 cm x 1 cm on CT scan. Was given IV fluconazole and\nceftriaxone at OSH and transferred here for evaluation by ENT. \n\nPatient is a poor historian and has no records in ___. He states\nthat he is unsure of the primary site of his head and neck \ncancer\nbut that he thinks its from his tonsils and that it was \ninitially\ndiagnosed within the last three months or so. He was being\ntreated with chemo-radiation but had to stop the chemo therapy\ndue to toxicity and recurrent hospitalizations for dehydration,\nfever, and neck pain. On ___ he was at an appointment at his\nradiation oncology center and as noted to be febrile to 101.5\nwith changes in his blood pressure and he was sent to the\nemergency department at ___. There he was found to\nhave a 1.2cm x 0.6cm x 1.0 cm retropharyngeal fluid collection\nconcerning for a retropharyngeal abscess and was sent to ___ \nfor further evaluation.\n\nOn arrival to ___ patient reports that he is currently feeling\nbetter than when he came into this hospital. He has a L frontal\nheadache and throat pain which he describes as chronic over the\nlast three months. He also has abdominal pain near the insertion\nsite of his ___ which is also chronic. Currently denies\ndifficulty breathing, fevers, chills, nausea.', 'medications': [{'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY: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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H: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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H: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': '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', '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': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': '1', 'valuenum': 1.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.99, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.8', 'valuenum': 12.8, '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': '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': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '105', 'valuenum': 105.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, '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': '2', 'valuenum': 2.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.01', 'valuenum': 1.01, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '228', 'valuenum': 228.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, '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': '25', 'valuenum': 25.0, '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': '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 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 179.0, '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': '5.1', 'valuenum': 5.1, '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': '140', 'valuenum': 140.0, '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': '35.9', 'valuenum': 35.9, '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': '29.6', 'valuenum': 29.6, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '329', 'valuenum': 329.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.6', 'valuenum': 34.6, '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': '309', 'valuenum': 309.0, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 163.0, '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': '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': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '10.0', 'valuenum': 10.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.9', 'valuenum': 34.9, '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': '346', 'valuenum': 346.0, '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': '3.91', 'valuenum': 3.91, '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': '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': '8.1', 'valuenum': 8.1, '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': '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': 229.0, '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': '3.7', 'valuenum': 3.7, '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': '135', 'valuenum': 135.0, '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}, {'value': '35.6', 'valuenum': 35.6, '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': '28.5', 'valuenum': 28.5, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '399', 'valuenum': 399.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '15', 'valuenum': 15.0, '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': '8.9', 'valuenum': 8.9, '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': '___', 'valuenum': 156.0, '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': '4.1', '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\nVS: T 98.7, HR 75, BP 109/78, RR 19, Sat 99% RR\nGEN: Chronically ill appearing man, no apparent distress\nEYES: Sclera anicteric, PERRLA, EOMI\nHENNT: NC/AT, MMM, posterior oropharynx w/ white plaque like\nlesions L > R, L sides cervical lymphadenopathy\nCV: RRR, +S1/S2, no m/g/r\nRESP: CTAB, no wheezing/rhonchi/rales\nGI: Soft, nontender, ___ tube in place w/\ninstertion site clean and dry\nMSK: Extremities WWP, no clubbing/cyanosis/edema\nSKIN: Neck/upper back erythematous \nNEURO: AAOx3, face symmetric, moving all extermities with \npurpose', 'diagnoses': [{'icd_code': '1911', 'desc': 'Malignant neoplasm of frontal lobe'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '95901', 'desc': 'Head injury, unspecified'}, {'icd_code': 'V8541', 'desc': 'Body Mass Index 40.0-44.9, adult'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'E8889'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}], 'summary': "ON ADMISSION:\n___ 10:23PM WBC-7.7 RBC-3.05* HGB-9.8* HCT-29.9* MCV-98 \nMCH-32.1* MCHC-32.8 RDW-13.9 RDWSD-49.4*\n___ 10:23PM PLT COUNT-180\n___ 10:23PM GLUCOSE-90 UREA N-9 CREAT-0.5 SODIUM-133* \nPOTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-25 ANION GAP-11\n___ 10:31PM LACTATE-0.6\n\nON DISCHARGE:\n=============\n___ 06:13AM BLOOD WBC-3.4* RBC-3.05* Hgb-9.8* Hct-30.3* \nMCV-99* MCH-32.1* MCHC-32.3 RDW-13.8 RDWSD-49.6* Plt ___\n___ 06:13AM BLOOD Neuts-79.7* Lymphs-7.2* Monos-11.6 \nEos-0.9* Baso-0.3 AbsNeut-2.76 AbsLymp-0.25* AbsMono-0.40 \nAbsEos-0.03* AbsBaso-0.01\n___ 02:41PM BLOOD ___ PTT-25.2 ___\n___ 06:13AM BLOOD Glucose-116* UreaN-10 Creat-0.5 Na-140 \nK-4.3 Cl-101 HCO3-29 AnGap-10\n___ 06:13AM BLOOD ALT-16 AST-17 AlkPhos-74 TotBili-<0.2\n___ 06:13AM BLOOD Calcium-8.5 Phos-3.9 Mg-1.9\n___ with history of recently diagnosed T4N2 squamous cell\ncarcinoma of the left tonsil extending to L hypopharynx (likely\nmetastatic to lung and liver, receiving palliative XRT given\nintolerance to chemo) c/b dysphagia and dehydration s/p ___\nplacement transferred from ___ with fever and c/f\nperitonsillar abscess, ultimately thought to be post-XRT edema\nrather than infection. \n\n# Fever:\n# Dysphagia/odynopaghia:\n# C/f peritonsillar abscess:\n# Oropharyngeal candidiasis:\n# Squamous cell carcinoma L tonsil, metastatic:\n# Severe protein-calorie malnutrition:\nMr. ___ was recently diagnosed with squamous cell carcinoma\nof the L tonsil, extending to hypopharynx and likely metastatic\nto lung and liver. He was followed by oncologist Dr. ___ at\n___ but discontinued chemo a few weeks ago given\nintolerance. He continues with M-F palliative XRT with radiation\noncologist Dr. ___ at ___. A ___ was placed a few weeks\nago given dysphagia and c/f dehydration. He reported ~3 days of\ndysphagia/odynophagia thought to be due to orophyargneal\ncandidiasis and for which he was prescribed nystatin 2 days\nbefore admission. He subsequently presented to radiation \noncology\non ___ with fever and was referred to the ___ ED.\nCXR there showed no e/o PNA. CT neck there showed approximately\n1.2x0.6x1.0 cm focus of fluid within the L mucosal pharyngeal\nspace, thought to be neoplastic disease vs post-radiation \nchanges\nvs abscess. He was therefore referred to ___ for ENT\nevaluation. He was evaluated by ENT in the ED on arrival and\nfound to have thick purulent mucus and secretions in the\nnasopharygnx and oropharynx with supraglottic fullness vs edema\nwith limited view of the TVF. Exam was also suggestive of\norophyarngeal candidiasis, for which he was treated with\nclotrimazole troches (given nystatin shortage) with resolution.\nHe was admitted to the ICU for <24 hours for airway monitoring,\nwhere he received decadron 10mg q8h x 3 doses and was treated\ninitially with Vancomycin and Unasyn. He was called out to the\nfloor on ___. ENT re-evaluation at that time showed fullness of\nthe L piriform/hypopharynx, likely baseline, with widely patent\nairway and clearly visible cords. ENT reviewed the OSH CT neck\nwith neuroradiology and thought the fluid collection in the L\nmucosal pharyngeal space to be most consistent with radiation\nchanges rather than an abscess. No intervention was recommended.\nFever was therefore attributed to aspiration pneumonitis\n(although CXR negative at OSH) vs postradiation changes vs\nmalignancy. At ENT's recommendation, Vancomycin was discontinued\nand Unasyn was transitioned to augmentin suspension to complete \na\n7d course through ___. Home nystatin will be resumed on\ndischarge, with course to be determined by outpatient radiation\noncology. Dysphagia, odynophagia, and obvious thrush had \nresolved\nat discharge with low suspicion for aspiration PNA. Mr. ___\nwas insistent on discharge on ___, despite extensive discussion\nof risks and benefits; therefore, SLP evaluation could not be\ncompleted prior to discharge. Recommend that Mr. ___ be\nevaluated by SLP as outpatient. In the interim, advised strict\nNPO with PO meds limited to nystatin. He will be continued at\ndischarge on home TFs of Jevity 1.5 6 cans per day (with TFs by\npump as desired at goal rate of 85cc/hr) with 150cc free water\nq4h. Home liquid dilaudid, Zofran ODT, and promethazine were \ncontinued with\naddition of liquid Tylenol 1g q8h PRN. QTC 433 on d/c. He was \nencouraged to\nschedule f/u with his radiation oncologist (Dr. ___ treatment scheduled for ___ and with his medical\noncologist (Dr. ___ within 1 week of discharge. \n\n# Leukopenia:\n# Normocytic anemia:\nWBC 7.7 on admission ___, down to 3.4 on discharge (with ANC\n2760). Hgb 9.8 on admission, stable at 9.8 on discharge. Unclear\nbaseline, but suspect may have component of leukopenia/anemia\nfrom chemotherapy (last a few weeks prior to admission). As\nabove, lower suspicion for infection, and no e/o bleeding or\nhemolysis. Would repeat CBC within 1 week to assess for \nstability\nof anemia and improvement in leukopenia.\n\n# Constipation:\nNo BM in 6 days. Likely due to minimal PO intake. Abdominal exam \nbenign, \npassing flatus. Prescribed liquid Colace and bisacodyl \nsuppositories PRN \non discharge.\n\n# Tobacco use:\nOngoing. Nicotine patch prescribed on discharge.\n\n** TRANSITIONAL **\n[ ] f/u BCx pending at discharge; NGTD from ___ and ___\n[ ] would recommend swallow eval as outpatient to determine \nsafety of PO intake (NPO except nystatin on d/c)\n[ ] repeat CBC within 1 week to assess leukopenia/anemia\n[ ] assess thrush on nystatin and determine course; consider \nfluconazole if recurrence\n[ ] f/u constipation\n[ ] f/u with radiation oncology and medical oncology for further \nmanagement of metastatic squamous cell carcinoma of L tonsil"}}
|
{'final_diagnoses': ['Post-radiation changes L hypopharynx', 'SCC of the left tonsil', 'Oropharyngeal candidiasis'], 'procedures': ['None'], 'visit_summary': "___ with history of recently diagnosed T4N2 squamous cell\ncarcinoma of the left tonsil extending to L hypopharynx (likely\nmetastatic to lung and liver, receiving palliative XRT given\nintolerance to chemo) c/b dysphagia and dehydration s/p ___\nplacement transferred from ___ with fever and c/f\nperitonsillar abscess, ultimately thought to be post-XRT edema\nrather than infection. \n\n# Fever:\n# Dysphagia/odynopaghia:\n# C/f peritonsillar abscess:\n# Oropharyngeal candidiasis:\n# Squamous cell carcinoma L tonsil, metastatic:\n# Severe protein-calorie malnutrition:\nMr. ___ was recently diagnosed with squamous cell carcinoma\nof the L tonsil, extending to hypopharynx and likely metastatic\nto lung and liver. He was followed by oncologist Dr. ___ at\n___ but discontinued chemo a few weeks ago given\nintolerance. He continues with M-F palliative XRT with radiation\noncologist Dr. ___ at ___. A ___ was placed a few weeks\nago given dysphagia and c/f dehydration. He reported ~3 days of\ndysphagia/odynophagia thought to be due to orophyargneal\ncandidiasis and for which he was prescribed nystatin 2 days\nbefore admission. He subsequently presented to radiation \noncology\non ___ with fever and was referred to the ___ ED.\nCXR there showed no e/o PNA. CT neck there showed approximately\n1.2x0.6x1.0 cm focus of fluid within the L mucosal pharyngeal\nspace, thought to be neoplastic disease vs post-radiation \nchanges\nvs abscess. He was therefore referred to ___ for ENT\nevaluation. He was evaluated by ENT in the ED on arrival and\nfound to have thick purulent mucus and secretions in the\nnasopharygnx and oropharynx with supraglottic fullness vs edema\nwith limited view of the TVF. Exam was also suggestive of\norophyarngeal candidiasis, for which he was treated with\nclotrimazole troches (given nystatin shortage) with resolution.\nHe was admitted to the ICU for <24 hours for airway monitoring,\nwhere he received decadron 10mg q8h x 3 doses and was treated\ninitially with Vancomycin and Unasyn. He was called out to the\nfloor on ___. ENT re-evaluation at that time showed fullness of\nthe L piriform/hypopharynx, likely baseline, with widely patent\nairway and clearly visible cords. ENT reviewed the OSH CT neck\nwith neuroradiology and thought the fluid collection in the L\nmucosal pharyngeal space to be most consistent with radiation\nchanges rather than an abscess. No intervention was recommended.\nFever was therefore attributed to aspiration pneumonitis\n(although CXR negative at OSH) vs postradiation changes vs\nmalignancy. At ENT's recommendation, Vancomycin was discontinued\nand Unasyn was transitioned to augmentin suspension to complete \na\n7d course through ___. Home nystatin will be resumed on\ndischarge, with course to be determined by outpatient radiation\noncology. Dysphagia, odynophagia, and obvious thrush had \nresolved\nat discharge with low suspicion for aspiration PNA. Mr. ___\nwas insistent on discharge on ___, despite extensive discussion\nof risks and benefits; therefore, SLP evaluation could not be\ncompleted prior to discharge. Recommend that Mr. ___ be\nevaluated by SLP as outpatient. In the interim, advised strict\nNPO with PO meds limited to nystatin. He will be continued at\ndischarge on home TFs of Jevity 1.5 6 cans per day (with TFs by\npump as desired at goal rate of 85cc/hr) with 150cc free water\nq4h. Home liquid dilaudid, Zofran ODT, and promethazine were \ncontinued with\naddition of liquid Tylenol 1g q8h PRN. QTC 433 on d/c. He was \nencouraged to\nschedule f/u with his radiation oncologist (Dr. ___ treatment scheduled for ___ and with his medical\noncologist (Dr. ___ within 1 week of discharge. \n\n# Leukopenia:\n# Normocytic anemia:\nWBC 7.7 on admission ___, down to 3.4 on discharge (with ANC\n2760). Hgb 9.8 on admission, stable at 9.8 on discharge. Unclear\nbaseline, but suspect may have component of leukopenia/anemia\nfrom chemotherapy (last a few weeks prior to admission). As\nabove, lower suspicion for infection, and no e/o bleeding or\nhemolysis. Would repeat CBC within 1 week to assess for \nstability\nof anemia and improvement in leukopenia.\n\n# Constipation:\nNo BM in 6 days. Likely due to minimal PO intake. Abdominal exam \nbenign, \npassing flatus. Prescribed liquid Colace and bisacodyl \nsuppositories PRN \non discharge.\n\n# Tobacco use:\nOngoing. Nicotine patch prescribed on discharge.\n\n** TRANSITIONAL **\n[ ] f/u BCx pending at discharge; NGTD from ___ and ___\n[ ] would recommend swallow eval as outpatient to determine \nsafety of PO intake (NPO except nystatin on d/c)\n[ ] repeat CBC within 1 week to assess leukopenia/anemia\n[ ] assess thrush on nystatin and determine course; consider \nfluconazole if recurrence\n[ ] f/u constipation\n[ ] f/u with radiation oncology and medical oncology for further \nmanagement of metastatic squamous cell carcinoma of L tonsil", 'medications_prescribed': ['Acetaminophen (Liquid) 1000 mg PO Q8H:PRN Pain - Mild/Fever \nRX *acetaminophen 500 mg/15 mL 1000 mg by mouth every 8 hours as \nneeded Disp #*1 Bottle Refills:*0 ', 'Amoxicillin-Clavulanate Susp. 500 mg PO Q8H \nRX *amoxicillin-pot clavulanate 250 mg-62.5 mg/5 mL 500 mg by \nmouth every 8 hours Refills:*0 ', 'Bisacodyl 10 mg PR QHS:PRN Constipation - Second Line \nRX *bisacodyl 10 mg 1 suppository(s) rectally daily as needed \nDisp #*3 Suppository Refills:*0 ', 'Docusate Sodium (Liquid) 100 mg PO BID \nRX *docusate sodium 50 mg/5 mL 100 mg by mouth twice daily \nRefills:*0 ', 'Nicotine Patch 14 mg/day TD DAILY \nRX *nicotine 14 mg/24 hour Apply 1 patch daily Disp #*14 Patch \nRefills:*0 ', 'Hydromorphone (Oral Solution) 1 mg/1 mL 4 mg PO Q4H:PRN pain ', 'Jevity 1.5 Cal (lactose-reduced food with fibr) 6 cans oral \ndaily ', 'Metoclopramide 10 mg PO Q8H:PRN nausea ', 'Nystatin Oral Suspension 5 mL PO QID ', 'Ondansetron ODT 8 mg PO Q8H:PRN Nausea/Vomiting - First \nLine ', 'Promethazine 6.25 mg/5 mL oral Q6H:PRN nausea ', 'HELD- Polyethylene Glycol 17 g PO DAILY This medication was \nheld. Do not restart Polyethylene Glycol until instructed by \noutpatient doctors']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'M', 'symptoms': 'Right upper quadrant abdominal pain', 'medical_history': ['anxiety', 'insomnia'], 'family_history': '+ ovarian cancer, - pancreatic cancer', 'present_illness': '___ w/ no prior history of RUQ pain presents to the ED today \nwith a night of RUQ pain, six hours after having a plate of \nnachos. She had one episode of emesis and has had no other \nconstitutional sypmtoms (no fevers, chills, nausea, altered \nbowel habits, reflux symptoms) other than persistent RUQ pain. \nShe\npresented to an OSH today, where hse was found to have a wbc \ncount of 16.5k, CBD dilation to 1cm, and no evidence of \ngallstones on CT and RUQ U/S as well as no evidence of panc \nmass. She was transferred here for definitive care. She is \nfound to be without jaundice, to have a positive ___ sign, \nbut otherwise\ncomfortable.', 'medications': [{'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID: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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraMADol', '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': 'Q4H:PRN', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', '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': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Docusate Sodium', '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 via patient discharge', 'route': 'PO', 'frequency': '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': '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxymetazoline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H: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': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'STAT', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1.05', 'valuenum': 1.05, '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': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '8.6', 'valuenum': 8.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.3', 'valuenum': 79.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '4.40', 'valuenum': 4.4, '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': '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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}, {'value': '332', 'valuenum': 332.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '471', 'valuenum': 471.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.3, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'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': '3.7', 'valuenum': 3.7, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 89.0, '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': '178', 'valuenum': 178.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 69.0, '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': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': '109', 'valuenum': 109.0, 'valueuom': 'IU/L', 'ref_range_lower': 8.0, 'ref_range_upper': 61.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, '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': '385', 'valuenum': 385.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', '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': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, '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': '2.9', 'valuenum': 2.9, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '254', 'valuenum': 254.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '218', 'valuenum': 218.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '3.6', 'valuenum': 3.6, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 99.0, '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': '188', 'valuenum': 188.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Negative.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Negative.'}, {'value': '___', 'valuenum': 365.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPECIMEN SLIGHTLY HEMOLYZED.. HEMOLYSIS FALSELY ELEVATES LDH..'}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.310', 'valuenum': 0.31, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.032', 'valuenum': 0.032, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '270', 'valuenum': 270.0, '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': '4.40', 'valuenum': 4.4, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.8', 'valuenum': 45.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '12.7', 'valuenum': 12.7, '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': '199', 'valuenum': 199.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '156', 'valuenum': 156.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '125', 'valuenum': 125.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: 96.8 90 112.80 16 100RA\nNAD a+o x 3\nCTAB\nRRR\nsoft, tender to the RUQ, + ___, no jaundice, no evidence of\ncirrhosis sequelae\nMAE', 'diagnoses': [{'icd_code': 'I639', 'desc': 'Cerebral infarction, unspecified'}, {'icd_code': 'G8194', 'desc': 'Hemiplegia, unspecified affecting left nondominant side'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'Z9884', 'desc': 'Bariatric surgery status'}, {'icd_code': 'Z86718', 'desc': 'Personal history of other venous thrombosis and embolism'}, {'icd_code': 'Z86711', 'desc': 'Personal history of pulmonary embolism'}], 'summary': 'admission: \n___ 02:55PM BLOOD WBC-8.2 RBC-3.97* Hgb-12.1 Hct-36.1 \nMCV-91 MCH-30.5 MCHC-33.6 RDW-12.2 Plt ___\n___ 07:40AM BLOOD WBC-6.3 RBC-3.44* Hgb-10.9* Hct-31.9* \nMCV-93 MCH-31.6 MCHC-34.1 RDW-11.7 Plt ___\n___ 02:55PM BLOOD ALT-169* AST-220* AlkPhos-60 TotBili-0.6\n___ 07:40AM BLOOD ALT-106* AST-82* LD(LDH)-128 AlkPhos-71 \nAmylase-36 TotBili-0.5 DirBili-0.2 IndBili-0.3\n___ 02:55PM BLOOD Lipase-33\n___ 07:40AM BLOOD Lipase-23\n\ndischarge: \n\n___ 07:40AM BLOOD WBC-6.3 RBC-3.44* Hgb-10.9* Hct-31.9* \nMCV-93 MCH-31.6 MCHC-34.1 RDW-11.7 Plt ___\n___ 07:40AM BLOOD Plt ___\n___ 07:40AM BLOOD Glucose-90 UreaN-3* Creat-0.6 Na-139 \nK-3.8 Cl-108 HCO3-26 AnGap-9\n___ 06:50AM BLOOD ALT-79* AST-42* AlkPhos-73 TotBili-0.5\n___ 07:40AM BLOOD Lipase-23\n___ 06:50AM BLOOD Albumin-3.3*\n\nimaging: \nEndoscopic Ultrasound (___):\nThe bile duct was dilated to 8 mm. \nA 5 mm hyerechoic density was noted within the ampullary segment \nof the bile duct. This did not shadow and had the same \nechotexture as the surrounding ampulla. This most likely \nrepresented normal ampullary anatomy and unlikely to represent a \nstone. \nThe rest of the bile duct was dilated but well imaged and \nnormal.\nNormal limited exam of the pancreas and the main pancreatic \nduct.\n\n___ \nSerial images over the abdomen show uptake of tracer into the \nhepatic parenchyma. At 36 minutes, the gallbladder is visualized \nwith tracer activity noted in the small bowel at 7 minutes. CCK \nwas administered and post CCK there is contraction of the gall \nbladder with \na 44% EF, measured 57 minutes post administration. \nThe above findings are consistent with no evidence of acute \ncholecystitis.\nPatient was admitted to the surgical service from the Emergency \nDepartment. She underwent endoscopic ultrasound, results of \nwhich are listed below, and then came to the floor. She was \nkept NPO with IVF and treated for her pain with IV dilaudid. \nHer pain improved and on HD2 she underwent a HIDA scan which was \nfound to be normal. Her abdominal pain was much improved and \nshe was not having any nausea or vomiting. She was started on \nclears which she tolerated well and transitioned to oral pain \nmedications. She was discharged to home on ___, tolerated \nregular diet and instructed to follow-up to discuss elective \nsurgery if pain attacks continued. \n\nEndoscopic Ultrasound (___):\nThe bile duct was dilated to 8 mm. \nA 5 mm hyerechoic density was noted within the ampullary segment \nof the bile duct. This did not shadow and had the same \nechotexture as the surrounding ampulla. This most likely \nrepresented normal ampullary anatomy and unlikely to represent a \nstone. \nThe rest of the bile duct was dilated but well imaged and \nnormal.\nNormal limited exam of the pancreas and the main pancreatic \nduct.\n\nHIDA (___):\nINTERPRETATION: Serial images over the abdomen show uptake of \ntracer into the \nhepatic parenchyma. At 36 minutes, the gallbladder is visualized \nwith tracer \nactivity noted in the small bowel at 7 minutes. \nCCK was administered and post CCK there is contraction of the \ngall bladder with \na 44% EF, measured 57 minutes post administration. \nThe above findings are consistent with no evidence of acute \ncholecystitis.'}}
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{'final_diagnoses': ['Biliary colic'], 'procedures': ['Endoscopic ultrasound (___)'], 'visit_summary': 'Patient was admitted to the surgical service from the Emergency \nDepartment. She underwent endoscopic ultrasound, results of \nwhich are listed below, and then came to the floor. She was \nkept NPO with IVF and treated for her pain with IV dilaudid. \nHer pain improved and on HD2 she underwent a HIDA scan which was \nfound to be normal. Her abdominal pain was much improved and \nshe was not having any nausea or vomiting. She was started on \nclears which she tolerated well and transitioned to oral pain \nmedications. She was discharged to home on ___, tolerated \nregular diet and instructed to follow-up to discuss elective \nsurgery if pain attacks continued. \n\nEndoscopic Ultrasound (___):\nThe bile duct was dilated to 8 mm. \nA 5 mm hyerechoic density was noted within the ampullary segment \nof the bile duct. This did not shadow and had the same \nechotexture as the surrounding ampulla. This most likely \nrepresented normal ampullary anatomy and unlikely to represent a \nstone. \nThe rest of the bile duct was dilated but well imaged and \nnormal.\nNormal limited exam of the pancreas and the main pancreatic \nduct.\n\nHIDA (___):\nINTERPRETATION: Serial images over the abdomen show uptake of \ntracer into the \nhepatic parenchyma. At 36 minutes, the gallbladder is visualized \nwith tracer \nactivity noted in the small bowel at 7 minutes. \nCCK was administered and post CCK there is contraction of the \ngall bladder with \na 44% EF, measured 57 minutes post administration. \nThe above findings are consistent with no evidence of acute \ncholecystitis.', 'medications_prescribed': ['1. Trazodone 50 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) \nas needed for sleep. ', '2. Quetiapine 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '3. Clonazepam 1 mg Tablet Sig: One (1) Tablet PO QID (4 times a \nday) as needed for anxiety. ', '4. Adderall 20 mg Tablet Sig: One (1) Tablet PO three times a \nday. ', '5. Hydromorphone 2 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.\nDisp:*15 Tablet(s)* Refills:*0*', '6. Ciprofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours) for 5 days.\nDisp:*10 Tablet(s)* Refills:*0*', '7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO Q8H (every \n8 hours) for 5 days.\nDisp:*15 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 86, 'gender': 'F', 'symptoms': 'STEMI', 'medical_history': ['No known (no medical care for ___ years).'], 'family_history': 'Brother with stents and DM2.', 'present_illness': 'Mr. ___ is a ___ y/o gentleman with little past medical \nhistory who presented with chest pain around 1pm today with \nradiation down his L arm and diaphoresis. \n.\nOn arrival to the ED, initial vitals were pain ___, temperature \n97.8, heart rate 75, blood pressure 99/75, 16 respirations, \n100%. Labs with leukocytosis to 13.2 with neutrophil \npredominance, Hct and plts normal. Chem significant for Cr 1.3 \nwithout known baseline. Trop 0.03 with no CK/MB measured. EKG \nwith minimal EKG changes (ST depression in III, aVF with TWI; \nslight STE in aVL, V2). Pt was started on ASA 324, Plavix 75 \nbid. \n.\nSTEMI called in ED, so pt went to cath lab where ___ was found to \nhave ostial LAD occlusion and received BMS. LMCA with minimal \ndisease, LCx with 30% proximal, RCA with minor disease. \nHemodynamics showing elevated L and R pressures with RA 15, mean \nPA 30, wedge pressure 30. Prominenet V waves on PCWP tracing, \npossible MR. ___ low at 85 mmHg. \n.\nPt transferred to CCU for further monitoring.', 'medications': [{'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}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Omeprazole', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins W/minerals', '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': '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': 'Q6H:PRN', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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}]}, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '142', 'valuenum': 142.0, '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': '1.2', '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': '31.3', 'valuenum': 31.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, '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': '4.24', 'valuenum': 4.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '96.3 90/63 68 15\nMiddle aged man in no distress, daughter at bedside, pleasant \nconversant\nOriented to time and place.\nNo JVD noted, no hepatojugular reflux, no carotid bruits. \nCTAB anteriorly, no w/c/r/r, good air movement, no labored \nbreathing\nRRR but faint S1 S2, no murmurs appreciated. \nRadial and DP pulses palpable bilaterally\nAbd slightly obese, NT ND, no AAA palpable.\nSwan Ganz catheter in place\nNo BLE edema noted. Extremities warm, well perfused. \nNo groin bruits, normal distal pulses.', 'diagnoses': [{'icd_code': '78650', 'desc': 'Chest pain, unspecified'}, {'icd_code': '99672', 'desc': 'Other complications due to other cardiac device, implant, and graft'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': 'V1052', 'desc': 'Personal history of malignant neoplasm of kidney'}, {'icd_code': 'V4573', 'desc': 'Acquired absence of kidney'}], 'summary': "CARDIAC CATH performed on ___ demonstrated:\nCOMMENTS: \n1. Coronary angiography in this right dominant system revealed \none \nvessel coronary artery disease. The LMCA had minimal disease. \nThe LAD was totally occluded at the origin. The LCX had a \nproximal 30% \nstenosis. The RCA had minor disease. \n2. Resting hemodynamics revealed significantly elevated left- \nand \nright-sided filling pressures, with mean PCW pressure of 30 mmHg \nand \nmean RA pressure of 15 mmHg. There was moderate pulmonary \nhypertension, with mean PA pressure of 30 mmHg. There were \nprominant v waves on the PCW tracing, consistent with possible \nmitral regurgitation. There was systemic hypotension, with SBP \nof 85 mmHg. \nFINAL DIAGNOSIS: \n1. One vessel coronary artery disease. \n2. Severe left- and right-sided filling pressures. \n3. Moderate pulmonary artery hypertension. \n4. Systemic hypotension. \n\nTTE (Complete) Done ___ at 7:40:13 ___\nThe left atrium and right atrium are normal in cavity size. Left \nventricular wall thicknesses and cavity size are normal. There \nis severe regional left ventricular systolic dysfunction with \nhypokinesis of basal segments and near akinesis of the distal \n___ of the anterior septum and anterior walls and apex. The \nremaining segments contract normally (LVEF = 30 %). No masses or \nthrombi are seen in the left ventricle. There is no ventricular \nseptal defect. Right ventricular chamber size and free wall \nmotion are normal. The aortic valve leaflets (3) appear \nstructurally normal with good leaflet excursion and no aortic \nregurgitation. No aortic regurgitation is seen. The mitral valve \nappears structurally normal with trivial mitral regurgitation. \nThe estimated pulmonary artery systolic pressure is normal. \nThere is an anterior space which most likely represents a \nprominent fat pad. \nIMPRESSION: Normal left ventricular cavity size with regional \nsystolic dysfunction c/w CAD (proximal LAD distribution). No \nventricular septal defect or pathologic flow identified. \n.\nCBC\n___ 03:37AM BLOOD WBC-11.1* RBC-4.26* Hgb-13.2* Hct-38.8* \nMCV-91 MCH-30.9 MCHC-34.0 RDW-13.7 Plt ___\n___ 04:25PM BLOOD WBC-13.9* RBC-4.77 Hgb-15.1 Hct-43.9 \nMCV-92 MCH-31.7 MCHC-34.5 RDW-14.1 Plt ___\n.\nChemistry\n___ 03:37AM BLOOD Glucose-118* UreaN-13 Creat-1.0 Na-139 \nK-4.0 Cl-105 HCO3-27 AnGap-11\n___ 04:25PM BLOOD Glucose-138* UreaN-16 Creat-1.3* Na-140 \nK-4.2 Cl-\n102 HCO3-27 AnGap-15\n___ 03:37AM BLOOD Calcium-8.3* Phos-3.2 Mg-2.1 Cholest-PND\n___ 04:25PM BLOOD Calcium-9.3 Phos-3.3 Mg-2.2\n.\nCardiac Enzymes\n___ 03:37AM BLOOD CK(CPK)-1662*\n___ 04:25PM BLOOD CK(CPK)-177\n___ 03:37AM BLOOD CK-MB-195* MB Indx-11.7*\n___ 04:25PM BLOOD cTropnT-0.03*\n.\nHbA1c\n___ 03:37AM BLOOD %HbA1c-5.7 eAG-___\nwithout any major cardiac history or other known medical \ncomorbidities presents with chest pain and found to have LAD \nocclusion, s/p BMS with good results; also with elevated L and R \nsided filling pressures and asymptomatic hypotension. \n.\n1. STEMI: Pt presented with minimal EKG changes (ST elevation in \nV2-minimal in V3 that looked more like repolarization changes \nand not true STE, however ___ had some elevation in aVL) however \nwith high clinical suspicion, was taken to cath lab where ___ was \nfound to have ostial occlusion of his LAD and ___ received BMS x1 \nto LAD. Minimal disease in rest of coronaries. ___ tolerated the \nprocedure well and did well post procedure. ___ was transferred \nto CCU for further monitoring and was started on ASA, Plavix 75 \nbid x1 week then daily thereafter, Statin, ACEi, and long acting \nbeta blocker. A1c was 5.7% and lipid panel with total \ncholesterol 200, LDL 138, HDL 43, Trigly 95. Appointments were \nmade for the pt to f/u. ___ was started on coumadin for apical \nakinesis, will have his coumadin level followed by the ___ \n___ clinic at discharge. \n.\n2. Elevated filling pressures: The pt was noted to have elevated \nR and L sided filling pressure during catheterization and \nprominent V waves concerning for MR. ___ received a formal echo \non ___ which showed ___ has systolic failure and akinesis of \nthe anterior wall from base to apex (which corresponds to his \nLAD occlusion) however does not appear volume overloaded on exam \nand did not start a diuretic regimen. ___ will need a repeat echo \nin ___ weeks to further evaluate any recovery of his systolic \nfunction. His medication regimen for heart failure is as above. \n.\n3. Hypotension: With evidence of elevated filling pressures and \ndepressed EF in setting of STEMI, likely due to heart failure. \nHis blood pressures were stable in the 90's through admission \nand ___ was totally asymptomatic. ACEi and beta blockade for the \nSTEMI and heart failure were added cautiously."}}
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{'final_diagnoses': ['ST elevation Myocardial Infarction', 'Acute Systolic Dysfunction'], 'procedures': ['Cardiac catheterization'], 'visit_summary': "without any major cardiac history or other known medical \ncomorbidities presents with chest pain and found to have LAD \nocclusion, s/p BMS with good results; also with elevated L and R \nsided filling pressures and asymptomatic hypotension. \n.\n1. STEMI: Pt presented with minimal EKG changes (ST elevation in \nV2-minimal in V3 that looked more like repolarization changes \nand not true STE, however ___ had some elevation in aVL) however \nwith high clinical suspicion, was taken to cath lab where ___ was \nfound to have ostial occlusion of his LAD and ___ received BMS x1 \nto LAD. Minimal disease in rest of coronaries. ___ tolerated the \nprocedure well and did well post procedure. ___ was transferred \nto CCU for further monitoring and was started on ASA, Plavix 75 \nbid x1 week then daily thereafter, Statin, ACEi, and long acting \nbeta blocker. A1c was 5.7% and lipid panel with total \ncholesterol 200, LDL 138, HDL 43, Trigly 95. Appointments were \nmade for the pt to f/u. ___ was started on coumadin for apical \nakinesis, will have his coumadin level followed by the ___ \n___ clinic at discharge. \n.\n2. Elevated filling pressures: The pt was noted to have elevated \nR and L sided filling pressure during catheterization and \nprominent V waves concerning for MR. ___ received a formal echo \non ___ which showed ___ has systolic failure and akinesis of \nthe anterior wall from base to apex (which corresponds to his \nLAD occlusion) however does not appear volume overloaded on exam \nand did not start a diuretic regimen. ___ will need a repeat echo \nin ___ weeks to further evaluate any recovery of his systolic \nfunction. His medication regimen for heart failure is as above. \n.\n3. Hypotension: With evidence of elevated filling pressures and \ndepressed EF in setting of STEMI, likely due to heart failure. \nHis blood pressures were stable in the 90's through admission \nand ___ was totally asymptomatic. ACEi and beta blockade for the \nSTEMI and heart failure were added cautiously.", 'medications_prescribed': ['1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).', '2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day) for 1 weeks: Last day on ___. .', '3. Warfarin 2 mg Tablet Sig: 2.5 Tablets PO once a day.', '4. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO once a day.', '5. Metoprolol Succinate 25 mg Tablet Sustained Release 24 hr \nSig: 0.5 Tablet Sustained Release 24 hr PO once a day.', '6. Outpatient Lab Work\nPlease check Chem-7 and ___ on ___ and call \nresults to ___ clinic at ___.\nPlease get your blood drawn at the ___.', '7. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO once a day: \nStart on ___.', '8. Nitroglycerin 0.4 mg Tablet, Sublingual Sig: One (1) tablet \nSublingual every 5 minutes for a total of 3 doses: call ___ if \nyou still have chest pressure after 3 doses.', '9. Simvastatin 80 mg Tablet Sig: One (1) Tablet PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'F', 'symptoms': 'Fall from knee weakness', 'medical_history': ['PAST ONCOLOGIC HISTORY: \n- ___: intermittent postmenopausal vaginal spotting \n- ___: Gynecologic evaluation: cervical polyp noted that was\nbiopsy positive for neuroendocrine small cell carcinoma.\n- ___: Pelvic MRI: large 2.4 x 2.6 cm cervical mass, as well\nas a large left external iliac lymph node suspicious for a nodal\nmetastasis. \n- ___: PET-CT scan: FDG avid cervical mass (SUV max of 6.1)\nand left external iliac lymphadenopathy (SUV max 11.8). \n- ___ - ___: 4 cycles of 75 mg/m2 of cisplatin (day 1)\nand 100 mg/m2 of etoposide (days 1, 2, and 3 of a 21-day cycle)\ncompleted.\n- ___: Pelvic EBRT, followed by low-dose rate\nintracavitary brachytherapy via tandem and ovoid. \n- ___ - PET CT cervical mass and L external iliac LAD, no\nlonger FDG-avid\n- ___ - PET CT Right frontal lobe metastasis with \nsurrounding\nvasogenic edema. New right supraclavicular soft tissue mass and\nright axillary lymph node\nwhich are both FDG avid. FDG avid pleural thickening at the \nright\nbase. New non-avid 1cm soft tissue nodules posterior to the \nright\nkidney. Focal area of FDG uptake adjacent to the left psoas\nmuscle may be normal activity\nwithin bowel, however cannot exclude metastasis.New fracture of\nright posterior 8th rib. Patchy uptake in the bilateral humeri\nand femurs which maybe due to metastatic disease. Scattered FDG\navid soft tissue nodules. \n___ - admitted for headache, started on WBRT\n___ - readmitted for encephalopathy, underwent\ncomplete work up including EEG and LP, which were negative for\nseizures and infection. Discharged on steroids and Keppra.\nCompleted WBRT on ___ -readmitted for generalized weakness and\narthralgias. Had cycle 1 day 1 of taxol inpatient on ___.\n\nPAST MEDICAL HISTORY: \n-Hypertension. \n-Morbid obesity. \n-OA'], 'family_history': 'She has a paternal cousin with breast cancer, diagnosed at age \n___, and a maternal cousin with breast cancer diagnosed in her \nearly ___. There is no other family history of cancer.', 'present_illness': '___ with neuroendocrine small cell cancer of the cervix (stage\nIIIB, limited) diagnosed ___ with diffuse metastatic disease \nwith known brain mets s/p WBRT (completed ___, now on C1D19 \nof taxol presenting after mechanical fall. Pt walking up steps \nand felt knee weakness and subsequently fell, landing on both \nknees. Pt with reported h/o unrepaired R torn meniscus and OA. \nPt denies LOC/head strike or preceding chest pain, SOB, \nlightheadedness. Pt was unable to lift self after fall and was \nhelped up by medics. Pt has since walked a few steps \nintermittently.\n\nPt does report DOE with minimal walking over the past month. She \nreports it has not been worsening but rather just persistent. \nShe denies CP, but reports intermittent dizziness and \ngeneralized weakness. Pt reports nausea with dry heaves this \nmorning. Reports poor PO intake due to low appetite and poor \ntaste. Pt reports dry mouth. Denies fevers, urinary symptoms, \nblood in stool.\n\nIn ED/Clinic, initial vitals were: 97.3 92 134/63 18 98% RA.\nExam was significant for spontaneous movement of all \nextremities. Strength ___ in lower extremities. Reflexes +2 w/ \nneg Babinski. No sensation deficits. Labs were significant for \nHb of 7.1, WBC count of 13.5 with early myeloid cells on diff. K \n3.1. Pt given 5mg oxycodone and K repletion with 40mEq. CXR and \nbilateral knee plan films done in ED. Pt type and crossed for 2u \nof pRBCs in ED. First unit transfused in ED.\n\nPt recently admitted ___ for back pain with imaging showing \nprogression of metastatic disease. Pt given C1 of taxol during \nadmission. Pt received neulasta ___.\n\nOn arrival to the floor, pt reports bilateral knee pain, R>L. Pt \nreports chronic R knee pain from OA. Pt otherwise without \ncomplaints.', 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Triamterene-Hydrochlorothiazide', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Opium Tincture', '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID: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': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QID: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}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', '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': 'Multivitamins', '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', 'frequency': 'Q4H: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': 'Pentoxifylline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ascorbic Acid', '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Triamterene-Hydrochlorothiazide', '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE MR1', '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': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '145', 'valuenum': 145.0, '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': '4.05', 'valuenum': 4.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, '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': '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': '3.6', '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': '1.6', 'valuenum': 1.6, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE BY INDIRECT IMMUNOFLUORESCENCE.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': 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': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '___', 'valuenum': 4.0, 'valueuom': 'units', 'ref_range_lower': 0.0, 'ref_range_upper': 19.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE <20, BORDERLINE 20-30, POSITIVE >30. METHOD IS ___ (IGA ANTI-HUMAN TTG). IN IGA DEFICIENCY, MAY BE FALSELY NEGATIVE.'}, {'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': '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': '___', 'valuenum': 81.0, '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': '255', 'valuenum': 255.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '836', 'valuenum': 836.0, 'valueuom': 'mg/dL', 'ref_range_lower': 700.0, 'ref_range_upper': 1600.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 40.0, 'ref_range_upper': 230.0, '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': '140', 'valuenum': 140.0, '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': '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': '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': '139', 'valuenum': 139.0, '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': '3.79', 'valuenum': 3.79, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, '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': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '7.0', 'valuenum': 7.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.010', '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '7.3', 'valuenum': 7.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64.3', 'valuenum': 64.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, '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': '13.1', 'valuenum': 13.1, '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': '7.2', 'valuenum': 7.2, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '3.3', 'valuenum': 3.3, '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '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': '___', 'valuenum': 159.0, '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': '3.3', 'valuenum': 3.3, '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': '36.3', 'valuenum': 36.3, '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': '33.9', 'valuenum': 33.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.04', 'valuenum': 4.04, '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}], 'exams': 'Admission PE:\nVitals - T:98 BP: 118/88 HR: 85 RR: 18 02 sat: 100% RA \nGENERAL: obese AA female with thin arms, lying in bed, in NAD \nHEENT: AT/NC, PERRLA, anicteric sclera, pink conjunctiva, dry \nMM, NECK: nontender neck with large palpable \nmass(supraclavicular LN) at the base of the R neck approx 6cm in \ndiameter\nCARDIAC: RRR, S1/S2, no murmers, gallops, or rubs\nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles\nABDOMEN: soft, obese, nondistended, +BS, nontender\nEXTREMITIES: moving all extremities well, trace edema, small \nabrasion over L knee; full ROM of knees bilaterally with no pain \non passive ROM; negative ant drawers bilaterally and no pain \nwith int/ext rotation of knees\nPULSES: 2+ DP pulses bilaterally \nNEURO: ___ strength in UE and ___ bilaterally\nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes \n\nDischarge PE:\nVitals - T:98.1 BP: 100/50 HR: 85 RR: 18 02 sat: 99% RA \nGENERAL: AOx3, NAD \nHEENT: AT/NC, PERRLA, anicteric sclera, pink conjunctiva, dry \nMM, NECK: nontender neck with large palpable \nmass(supraclavicular LN) at the base of the R neck approx 6cm in \ndiameter\nCARDIAC: RRR, S1/S2, no murmers, gallops, or rubs\nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles\nABDOMEN: soft, obese, nondistended, +BS, nontender\nEXTREMITIES: moving all extremities well, trace edema, small \nabrasion over L knee; full ROM of knees bilaterally with no pain \non passive ROM\nPULSES: 2+ DP pulses bilaterally \nNEURO: ___ strength in UE and ___ bilaterally\nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes', 'diagnoses': [{'icd_code': '5641', 'desc': 'Irritable bowel syndrome'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '99811', 'desc': 'Hemorrhage complicating a procedure'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '7876', 'desc': 'Incontinence of feces'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '2113', 'desc': 'Benign neoplasm of colon'}, {'icd_code': '4659', 'desc': 'Acute upper respiratory infections of unspecified site'}, {'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': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4414', 'desc': 'Abdominal aneurysm without mention of rupture'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}], 'summary': 'Admission Labs:\n\n___ 09:30AM GLUCOSE-118* UREA N-13 CREAT-1.1 SODIUM-139 \nPOTASSIUM-3.1* CHLORIDE-104 TOTAL CO2-25 ANION GAP-13\n___ 09:30AM CALCIUM-8.6 PHOSPHATE-2.6* MAGNESIUM-1.6\n___ 09:30AM WBC-13.5*# RBC-2.46* HGB-7.1* HCT-22.0* \nMCV-90 MCH-28.8 MCHC-32.2 RDW-17.9*\n___ 09:30AM NEUTS-62 BANDS-10* LYMPHS-15* MONOS-3 EOS-0 \nBASOS-1 ___ METAS-6* MYELOS-3* NUC RBCS-2*\n___ 09:30AM HYPOCHROM-2+ ANISOCYT-1+ POIKILOCY-1+ \nMACROCYT-1+ MICROCYT-1+ POLYCHROM-NORMAL OVALOCYT-1+ TEARDROP-1+\n___ 09:30AM PLT SMR-VERY LOW PLT COUNT-71*\n\n___ 07:00AM BLOOD WBC-14.2* RBC-3.30* Hgb-9.6* Hct-28.8* \nMCV-87 MCH-29.2 MCHC-33.4 RDW-18.2* Plt Ct-63*\n___ 07:00AM BLOOD Glucose-93 UreaN-18 Creat-1.2* Na-138 \nK-3.5 Cl-102 HCO3-23 ___ CXR IMPRESSION: \n1. Right perihilar rounded opacity appears new and may \nrepresent \nlymphadenopathy. An osseous or lung lesion cannot be excluded. \nNon-emergent \nchest CT may be obtained for further evaluation. \n2. Patchy left humerus head demineralization, compatible with \nmetastatic \ndisease seen on prior PET-CT. \n \nThe study and the report were reviewed by the staff radiologist. \n\n\n___ XRay Knee:\nIMPRESSION: No fracture or dislocation. Bilateral mild to \nmoderate \ndegenerative changes.\nHOSPITAL COURSE:\n___ with neuroendocrine small cell cancer of the cervix (stage \nIIIB, limited) diagnosed ___ with diffuse metastatic disease \non C1D19 of taxol presenting after fall from knee weakness. In \nhospital found to be have normocytic, normochromic anemia to \n7.1, which was likely from recent chemotherapy. Was transfused 2 \nunits PRBC and HgB responded appropriately to 9.4. Pt was also \nnoted to have leukocytosis with a differential highly suggestive \nof Neulasta effect from ___. She had no other signs of \ninfection. ___ found impairments consistent with deconditioning and felt that she would benefit from short term rehab to improve \nfunctional status. She was discharged on hospital day 2 to rehab \nat ___ with followup with ___ MD in ___ on \n___.'}}
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{'final_diagnoses': ['Acute on chronic anemia', 'Metastatic cervical cancer'], 'procedures': ['None'], 'visit_summary': 'HOSPITAL COURSE:\n___ with neuroendocrine small cell cancer of the cervix (stage \nIIIB, limited) diagnosed ___ with diffuse metastatic disease \non C1D19 of taxol presenting after fall from knee weakness. In \nhospital found to be have normocytic, normochromic anemia to \n7.1, which was likely from recent chemotherapy. Was transfused 2 \nunits PRBC and HgB responded appropriately to 9.4. Pt was also \nnoted to have leukocytosis with a differential highly suggestive \nof Neulasta effect from ___. She had no other signs of \ninfection. ___ found impairments consistent with deconditioning and felt that she would benefit from short term rehab to improve \nfunctional status. She was discharged on hospital day 2 to rehab \nat ___ with followup with ___ MD in ___ on \n___.', 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN pain \n2. Amlodipine 5 mg PO DAILY \n3. Cyanocobalamin 1000 mcg PO DAILY \n4. Dexamethasone 1 mg PO DAILY \n5. Docusate Sodium 100 mg PO BID \n6. LeVETiracetam 500 mg PO BID \n7. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN Pain \n8. Senna 1 TAB PO BID:PRN constipation \n9. Ondansetron ___ mg PO Q8H:PRN Nausea \n10. Prochlorperazine ___ mg PO Q6H:PRN Nausea \n11. TraMADOL (Ultram) 50 mg PO Q8H:PRN pain \n12. Allopurinol ___ mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 48, 'gender': 'M', 'symptoms': 'scheduled admission for chemotherapy and cardiac monitoring \ngiven uderlyin Brugada syndrome', 'medical_history': ['right breast ductal carcinoma in situ, status post partial\nmastectomy with adjuvant radiation therapy, with tamoxifen', 'Brugada syndrome which can cause congenital ventricular \ntachycardia', 'endometriosis'], 'family_history': "The patient's brother was diagnosed with Brugada syndrome and \nhad ICD placed. Possible that her father also had heart \narrhythmia.", 'present_illness': "Ms. ___ is a ___ with history of Brugada syndrome initially \ndiagnosed in ___, DCIS s/p lumpectomy and 6 weeks of radiation, \nand recently diagnosed with L breast cnacer (ER/PR +, Her2+) \nwith + LN s/p L masectomy and axillary LN dissection who is a \nscheduled admission for doxorubicin and cyclophoshamide. \n\nGiven the patient's Brugada syndrome there was a concern \nregarding initation of adriamycin, as it is associated with a \nrisk of arrythmia. After discussion with Dr. ___ \ncardiologist, it was decided that she should be admitted and \nmonitored on tele for 48 hours while adriamycin is being \nadministered. As per Dr. ___ patient has a mild form \nof Brugada and should be able to tolerated adriamycin without \nany trouble. \n\nThe patient was diagnosed with Brugada syndrome in ___ after \nher brother was diagnosed with it. Of note, her brother has an \nICD, but it was thought that the patient has a mild form. She \nwas diagnosed s/p flecainide challenge in ___, which \nprecipitated Brugada type 1 pattern. In ___, the patient had an \nepisode of palpitations and presyncope, after which a EP study \nwas done, which was negative. However, after this episode she \nwas started on a daily beta blocker.\n\nOn ROS, the patient reports feeling well. Denies any shortness \nof breath, chest pain, or palpitations. No recent fevers or \nchills. No abdominal pain, or changes in bowel movements. She \ndoes reports some residual L arm soreness and decreased L arm \nrange of motion since her recent masectomy and axillary lymph \nnode dissection.", 'medications': [{'medication': 'Magnesium Sulfate', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Phosphorus', '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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', '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': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', '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': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins W/minerals', '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': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', '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}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Guaifenesin-Dextromethorphan', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aminocaproic Acid', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Neutra-Phos', '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': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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', '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': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', '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', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', '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/NG', 'frequency': 'BID: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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', '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': 'Oxyme', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Nadolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H: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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Octreotide Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'EPINEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 127.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '17.9', 'valuenum': 17.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47.2', 'valuenum': 47.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '800', 'valuenum': 800.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 229.0, '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': '7', 'valuenum': 7.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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 = 59 if non African-American (mL/min/1.73 m2). Estimated GFR = 72 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': 237.0, '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': '1926', 'valuenum': 1926.0, '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': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.1, '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': '___', 'valuenum': 0.4, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '0.4', 'valuenum': 0.4, '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': '19.8', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.2', 'valuenum': 32.2, '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': '8.2', 'valuenum': 8.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79.1', 'valuenum': 79.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 58.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.12', 'valuenum': 2.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.95, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 16.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'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': '___', 'valuenum': 7.24, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': '383', 'valuenum': 383.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 2.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '18.2', 'valuenum': 18.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, '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': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '32.3', 'valuenum': 32.3, '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': '___', 'valuenum': 32.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', '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': '1.02', 'valuenum': 1.02, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 15.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 7.25, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 2.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.0', 'valuenum': 34.0, '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': '___', 'valuenum': 47.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, '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': '141', 'valuenum': 141.0, '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': 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'ref_range_upper': None, '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': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '8', 'valuenum': 8.0, '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': '113', 'valuenum': 113.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '370', 'valuenum': 370.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'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': '173', 'valuenum': 173.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '___', 'valuenum': 113.0, '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': '6.7', 'valuenum': 6.7, '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': None, 'valuenum': None, 'valueuom': 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'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': '35.6', 'valuenum': 35.6, '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': '79', 'valuenum': 79.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, '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': '29', 'valuenum': 29.0, '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': '1.02', 'valuenum': 1.02, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, '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': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '111', 'valuenum': 111.0, 'valueuom': 'mm 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TITER IS BETWEEN 15 AND 100 MIU/ML. 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'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': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '40', 'valuenum': 40.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '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': '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': 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': '40', 'valuenum': 40.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.000', 'valuenum': 1.0, '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': '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': '225', 'valuenum': 225.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '127', 'valuenum': 127.0, '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': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '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': 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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '1.8', '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '96', 'valuenum': 96.0, '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': '18.3', 'valuenum': 18.3, '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': '9.8', 'valuenum': 9.8, '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': '31', 'valuenum': 31.0, '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': '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': 132.0, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, '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': '141', 'valuenum': 141.0, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.0', 'valuenum': 20.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': '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': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, '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': '91', 'valuenum': 91.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '189', 'valuenum': 189.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', '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 = 72 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': 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': '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', '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': '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': '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': '___', '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': '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': '1.3', 'valuenum': 1.3, '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': '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': '129', 'valuenum': 129.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '177', 'valuenum': 177.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, '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': '50', 'valuenum': 50.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '___', 'valuenum': 1076.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 138.0, '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': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', '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': 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': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, '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': '26.9', 'valuenum': 26.9, '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': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.5', 'valuenum': 32.5, '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': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78.0', 'valuenum': 78.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.4', 'valuenum': 20.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.72', 'valuenum': 2.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, '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': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '180', 'valuenum': 180.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.1', 'valuenum': 20.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.9', 'valuenum': 18.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '19.0', 'valuenum': 19.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '7.8', 'valuenum': 7.8, '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': 10.3, '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': 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': '366', 'valuenum': 366.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': 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': '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': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.001', 'valuenum': 1.001, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', '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': '135', 'valuenum': 135.0, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.5', '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': '139', 'valuenum': 139.0, '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': '27.0', 'valuenum': 27.0, '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': '32.6', 'valuenum': 32.6, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '32.2', 'valuenum': 32.2, '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': '244', 'valuenum': 244.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.9', 'valuenum': 19.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.12', 'valuenum': 3.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '6.4', 'valuenum': 6.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '135', 'valuenum': 135.0, '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': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, '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': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.9', 'valuenum': 19.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.73', 'valuenum': 2.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '169', 'valuenum': 169.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.9', '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': '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Admission PE:\nVS: 97.7 101/70 58 18 100RA\nGeneral: pleasant, well appearing woman, NAD, sitting up \ncomfortably in bed\nneck: supple\nCV: RRR, S1, S2 no murmurs, rubs, gallops appreciated\nL axilla: 10 cm healing scar in the L axilla, slight tenderness \nto palpation, but wound is well healed with no drainage\nlungs: clear to auscultation b/l, no wheezes, crackles, rhonchi \nappreciated\nabdomen: soft, nontender, nondistended, +BS\nextremities: warm, well perfused, no ___ edema, 2+ DP pulses\nNeuro: muscle strength and sensation grossly intact \n\nDischarge PE:\nVS: 98 100/70 (96-112/40-70) 69 (62-77) 16 98RA\nGeneral: pleasant, well appearing woman, NAD, laying in bed \nsleeping\nneck: supple\nCV: RRR, S1, S2 no murmurs, rubs, gallops appreciated\nL axilla: 10 cm healing scar in the L axilla, slight tenderness \nto palpation, but wound is well healed with no drainage\nlungs: clear to auscultation b/l, no wheezes, crackles, rhonchi \nappreciated\nabdomen: soft, nontender, nondistended, +BS\nextremities: warm, well perfused, no ___ edema, 2+ DP pulses\nNeuro: muscle strength and sensation grossly intact ', 'diagnoses': [{'icd_code': '5712', 'desc': 'Alcoholic cirrhosis of liver'}, {'icd_code': '45620', 'desc': 'Esophageal varices in diseases classified elsewhere, with bleeding'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '34982', 'desc': 'Toxic encephalopathy'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '78559', 'desc': 'Other shock without mention of trauma'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '99881', 'desc': 'Emphysema (subcutaneous) (surgical) resulting from procedure'}, {'icd_code': '27661', 'desc': 'Transfusion associated circulatory overload'}, {'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'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': 'E8497', 'desc': 'Accidents occurring in residential institution'}], 'summary': "Admission labs: none\n\nDischarge labs:\n\n___ 06:15AM BLOOD WBC-7.7# RBC-3.85* Hgb-11.5* Hct-34.9* \nMCV-91 MCH-29.8 MCHC-32.8 RDW-13.1 Plt ___\n___ 07:42AM BLOOD WBC-22.7*# RBC-3.71* Hgb-11.2* Hct-33.9* \nMCV-92 MCH-30.2 MCHC-33.0 RDW-13.4 Plt ___\n___ 07:42AM BLOOD Neuts-90.6* Lymphs-5.7* Monos-3.6 Eos-0.1 \nBaso-0.1\n___ 07:42AM BLOOD Glucose-73 UreaN-18 Creat-0.7 Na-144 \nK-3.9 Cl-108 HCO3-28 AnGap-12\n___ 06:15AM BLOOD ALT-18 AST-21 LD(LDH)-152 AlkPhos-52 \nTotBili-0.3\n___ 07:42AM BLOOD Calcium-9.0 Phos-2.9 Mg-2.2\nMs. ___ is a ___ with history of Brugada syndrome initially \ndiagnosed in ___, DCIS s/p lumpectomy and 6 weeks of radiation, \nand recently diagnosed with L breast cnacer (ER/PR +, Her2+) \nwith + LN s/p L masectomy and axillary LN dissection who is a \nscheduled admission for doxorubicin and cyclophoshamide.\n \n# breast cancer: Given doxorubicin's ability to induce \narrhythmia and the patient's underlying Brugada, the patient was \nadmitted for cardiac monitoring while initially getting this \nchemotherapy. A baseline EKG was obtained and the patient was \nmonitored on telemetry. EKGs were checked every four hours. \nShe tolerated the cheomtherapy well. The patient was given \nDecadron for nausea control. Upon discharge, she was adivsed to \nuse ativan and compazine for nausea control. She was also given \na prescription for Zofran, but she was cautioned about the \npotential for all anti-emetics to have QT prolonging effects. \nThe patient was given Neulasta prior to being discharged. \n\n# Brugada syndrome: The patient has a history of mild Brugada \nsyndrome. She was monitored on telemetry as described above and \nshe had q4h EKG checks. She was also continued on her home \nnadolol 20 mg daily."}}
|
{'final_diagnoses': ['breast cancer', 'Brugada syndrome'], 'procedures': ['none.'], 'visit_summary': "Ms. ___ is a ___ with history of Brugada syndrome initially \ndiagnosed in ___, DCIS s/p lumpectomy and 6 weeks of radiation, \nand recently diagnosed with L breast cnacer (ER/PR +, Her2+) \nwith + LN s/p L masectomy and axillary LN dissection who is a \nscheduled admission for doxorubicin and cyclophoshamide.\n \n# breast cancer: Given doxorubicin's ability to induce \narrhythmia and the patient's underlying Brugada, the patient was \nadmitted for cardiac monitoring while initially getting this \nchemotherapy. A baseline EKG was obtained and the patient was \nmonitored on telemetry. EKGs were checked every four hours. \nShe tolerated the cheomtherapy well. The patient was given \nDecadron for nausea control. Upon discharge, she was adivsed to \nuse ativan and compazine for nausea control. She was also given \na prescription for Zofran, but she was cautioned about the \npotential for all anti-emetics to have QT prolonging effects. \nThe patient was given Neulasta prior to being discharged. \n\n# Brugada syndrome: The patient has a history of mild Brugada \nsyndrome. She was monitored on telemetry as described above and \nshe had q4h EKG checks. She was also continued on her home \nnadolol 20 mg daily.", 'medications_prescribed': ['1. nadolol 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '2. dexamethasone 4 mg Tablet Sig: One (1) Tablet PO twice a day \nfor 3 doses.\nDisp:*3 Tablet(s)* Refills:*0*', '3. Ativan 0.5 mg Tablet Sig: ___ Tablets PO every ___ hours as \nneeded for nausea.\nDisp:*40 Tablet(s)* Refills:*0*', '4. prochlorperazine maleate 5 mg Tablet Sig: One (1) Tablet PO \nevery eight (8) hours as needed for nausea: please try ativan \nfirst.\nDisp:*60 Tablet(s)* Refills:*0*', '5. Zofran 4 mg Tablet Sig: One (1) Tablet PO every eight (8) \nhours as needed for nausea: please try ativan first.\nDisp:*60 Tablet(s)* Refills:*0*']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'lower back and leg pains', 'medical_history': ['gastritis', 'R THR ___'], 'family_history': 'non-contributory', 'present_illness': '___ y.o M with longstanding back and leg pains not amenable to \nconservative treatment presents for elective lumbar surgery. MRI \nnoted for severe L4/5 spinal stenosis.', 'medications': [{'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', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', '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': '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: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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '14', 'valuenum': 14.0, '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': '0.7', 'valuenum': 0.7, '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': 10.2, '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': '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': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '4.1', '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': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '32.5', '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': '193', 'valuenum': 193.0, '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': '3.42', 'valuenum': 3.42, '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': 'units', 'ref_range_lower': 0.0, 'ref_range_upper': 19.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE <20, BORDERLINE 20-30, POSITIVE >30. METHOD IS ___ (IGA ANTI-HUMAN TTG). IN IGA DEFICIENCY, MAY BE FALSELY NEGATIVE.'}, {'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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, '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': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, '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': 'RANDOM.'}, {'value': '___', 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '33.5', 'valuenum': 33.5, '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': '31.1', 'valuenum': 31.1, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '218', 'valuenum': 218.0, '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': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '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': '82', 'valuenum': 82.0, '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': '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': 3.3, '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': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'The patient sits upright in discomfort, in no acute distress, in \ngood spirits, and is alert and oriented X3. Patient is afebrile. \nHeart rate is 68 and regular in rhythm, the respiratory rate is \n12 and is in good general health. \n\nHead and Neck: Centered without misalignment (y).\nPalpation results in pain: (n)\nROM is ___ on F/Ext/R rotation/L rotation, R lat \nbend/L lat bend with mild discomfort. \nThe neck is stable and the muscle strength and tone are within \nnormal limits. Skin is intact. \n\nSpine/Pelvis: Spine is asymmetric with right lumbar prominence. \nPain on palpation: (n) .\nActive Forward Flexion 40, Pain (n) .\nActive Extension ___, Pain (n) .\nFacet loading: R (n), L (n) .\nThe muscle strength and tone are within normal limits. \nStraight leg raises: R (n), L (n). ___ test: R (y), L (y). \nSkin is intact. \n\nLower Extremities: Palpation on palpation: (n) .\nROM of hips, knees, and ankles is full and painless. Hip \nimpingement signs are negative on the right and positive on the \nleft; knee is stable to manipulation. Lower extremity motor \nstrength is ___ and symmetric at IP, Q, H, TA, ___, FHL, and GC. \nPatellar and ankle jerks are 2+/2+ and 2+/2+ on R/L \nrespectively. Skin is intact bilaterally. Heel-to-shin and rapid \nfinger movement tests are within normal limits.\n\nSensation is intact to light touch bilaterally in the upper and \nlower extremities. Distal pulses are intact with good distal \ncapillary refill. There is no lymphadenopathy on palpation of \nneck, axillae, or groin.\n\nGait: Left antalgic. Difficulty with Toe Walk (n) or Heel Walk \n(n).', 'diagnoses': [{'icd_code': '78901', 'desc': 'Abdominal pain, right upper quadrant'}, {'icd_code': '78906', 'desc': 'Abdominal pain, epigastric'}, {'icd_code': '28989', 'desc': 'Other specified diseases of blood and blood-forming organs'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}], 'summary': "___ 06:35AM BLOOD WBC-10.8# RBC-4.12* Hgb-13.4* Hct-38.4* \nMCV-93 MCH-32.5* MCHC-34.8 RDW-12.7 Plt ___\n___ 10:53AM BLOOD WBC-5.2 RBC-3.99* Hgb-13.7* Hct-37.9* \nMCV-95 MCH-34.3* MCHC-36.1* RDW-13.0 Plt ___\n___ 10:53AM BLOOD Glucose-119* UreaN-14 Creat-0.8 Na-139 \nK-4.6 Cl-105 HCO3-23 AnGap-16\nPt taken to the OR for elective L4/5 laminectomy/fusion with \ninstrumentation on ___ secondary to longstanding back and \nleg pains. surgery went without incident. See Op note for \nfurther details. Kefzol for abx, Foley/Epidural/HV placed \nintraoperatively\nPOD 1- AVSS, AO x 3, Epidural d/c'd, Pt continued PCA, then \ntransitioned to PO pain meds without issue. Foley d/c'd. ___ \nevaluation requested. \nPOD 2- AVSS, Dressing changed, no erythema noted, HV d/c'd. Pt \nmedically stable and ambulating with a walker. \nPOD 3- AVSS, Pt cleared for d/c to home by ___. Pain well \ncontrolled on Dilaudid."}}
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{'final_diagnoses': ['L4/5 central stenosis'], 'procedures': ['s/p L4/5 lami/fusion ___'], 'visit_summary': "Pt taken to the OR for elective L4/5 laminectomy/fusion with \ninstrumentation on ___ secondary to longstanding back and \nleg pains. surgery went without incident. See Op note for \nfurther details. Kefzol for abx, Foley/Epidural/HV placed \nintraoperatively\nPOD 1- AVSS, AO x 3, Epidural d/c'd, Pt continued PCA, then \ntransitioned to PO pain meds without issue. Foley d/c'd. ___ \nevaluation requested. \nPOD 2- AVSS, Dressing changed, no erythema noted, HV d/c'd. Pt \nmedically stable and ambulating with a walker. \nPOD 3- AVSS, Pt cleared for d/c to home by ___. Pain well \ncontrolled on Dilaudid.", 'medications_prescribed': ['Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', 'Hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q4H (every 4 \nhours) as needed.\nDisp:*80 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 23, 'gender': 'M', 'symptoms': 'Abdominal Pain', 'medical_history': ['PMH: hypercholesterolemia not on meds secondary to side\neffects/reactions', 'PSH: ___ hysterectomy, appendectomy'], 'family_history': 'Non-contributory', 'present_illness': "Ms. ___ is a healthy ___ who presents with her second\nepisode of diverticulitis. She says she began to have vague\nlower abdominal pain 2 weeks ago and that last night this pain\ntransitioned to a sharp pain in the left lower quadrant greater\nthan right. This morning the pain continued to progress so she\nwent to ___. She endorses some nausea that began this\nmorning, but denies vomiting, fevers, chills, BRBPR, melena. \nShe\ncontinues to pass flatus and had her last BM 3 days ago (which \nis\nnot unusual for her). There she was found to have a WBC of 16.___emonstrating acute diverticulitis with abscess. Per\npatient's report her last colonoscopy was approximately ___ years\nago and all they found was diverticulosis.", 'medications': [{'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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', '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': 'Potassium Chloride', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', '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': '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': 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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '43.5', 'valuenum': 43.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '34.5', 'valuenum': 34.5, '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': '208', 'valuenum': 208.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.97', 'valuenum': 4.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '18', 'valuenum': 18.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', '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': '10', 'valuenum': 10.0, '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': '1.0', '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': '28.4', 'valuenum': 28.4, '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': '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': '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'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': '0', 'valuenum': 0.0, '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': 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}, {'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': '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': '8.8', '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': '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': 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': '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': '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': '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': '10', 'valuenum': 10.0, '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': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', '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': '30.2', 'valuenum': 30.2, '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': '88', 'valuenum': 88.0, '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': '12.7', 'valuenum': 12.7, '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': 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': '41.1', 'valuenum': 41.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical exam:\n97.7 82 138/62 20 100RA\nGen: NAD\nCV: RRR\nResp: easy work of breathing\nAbd: softly distended, TTP LLQ>RLQ>upper quadrants, intermittent\nguarding\nExt: no edema\n\nDischarge Physical exam:', 'diagnoses': [{'icd_code': 'S02610A', 'desc': 'Fracture of condylar process of mandible, unspecified side, initial encounter for closed fracture'}, {'icd_code': 'S02641A', 'desc': 'Fracture of ramus of right mandible, initial encounter for closed fracture'}, {'icd_code': 'Y92413', 'desc': 'State road as the place of occurrence of the external cause'}, {'icd_code': 'V4949XA', 'desc': 'Driver injured in collision with other motor vehicles in traffic accident, initial encounter'}], 'summary': '___ 06:25AM BLOOD WBC-14.3* RBC-3.35* Hgb-10.0* Hct-30.9* \nMCV-92 MCH-29.9 MCHC-32.4 RDW-13.3 RDWSD-43.1 Plt ___\n___ 06:48AM BLOOD WBC-14.3* RBC-3.29* Hgb-10.1* Hct-30.6* \nMCV-93 MCH-30.7 MCHC-33.0 RDW-13.2 RDWSD-44.1 Plt ___\n___ 07:20AM BLOOD WBC-13.3* RBC-3.30* Hgb-10.0* Hct-30.7* \nMCV-93 MCH-30.3 MCHC-32.6 RDW-13.1 RDWSD-43.9 Plt ___\n___ 03:40AM BLOOD WBC-13.8* RBC-3.72* Hgb-11.3 Hct-34.2 \nMCV-92 MCH-30.4 MCHC-33.0 RDW-12.4 RDWSD-42.0 Plt ___\n___ 06:47AM BLOOD Neuts-74.4* Lymphs-15.4* Monos-7.7 \nEos-0.7* Baso-0.2 Im ___ AbsNeut-13.22* AbsLymp-2.73 \nAbsMono-1.36* AbsEos-0.13 AbsBaso-0.04\n___ 06:25AM BLOOD Plt ___\n___ 12:15PM BLOOD ___\n___ 06:25AM BLOOD Glucose-95 UreaN-21* Creat-0.5 Na-135 \nK-5.4 Cl-95* HCO3-26 AnGap-14\n___ 06:48AM BLOOD Glucose-106* UreaN-17 Creat-0.5 Na-134* \nK-5.2 Cl-95* HCO3-25 AnGap-14\n___ 06:25AM BLOOD Calcium-9.3 Phos-4.6* Mg-2.3\n\n___: ___ drainage:\n\nSuccessful CT-guided placement of an ___ pigtail catheter \ninto the left anterior pelvic abscess. Samples were sent for \nmicrobiology evaluation. \n\n___: CT abd and pelvis:\n\n1. Near resolution of the previously seen intramural abscess \nwithin the \nsigmoid colon, with trace residual fluid, status post \npercutaneous drainage. However the pigtail portion of the \ncatheter now appears to be within the colonic lumen and \nsurrounded by stool. The pigtail catheter should remain in \nplace or an additional 2 days to allow for healing, and then \nremoved given that output has been scant. \n2. Wall thickening of the sigmoid colon more proximally as it \ncourses anterior to the catheter site, which could be reactive. \nNo new abscess. \n3. Small bilateral pleural effusions, new from prior. Trace \npericardial \neffusion. \n\n___: fistulogram:\n\nThere is contrast filling of the sigmoid colon as expected. No \nevidence of contrast leak.\n\n___: ct abd. and pelvis:\n\n1. Persistent extraluminal collection with catheter in place. \nRelatively dry collection mostly filled with a stool ball, as \nseen previously. Patent tract to the sigmoid demonstrated. \n \n2. New pleural effusions. \n\n___ 11:06 am ABSCESS Source: pelvic abscess. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 2+ ___ per 1000X FIELD): GRAM POSITIVE COCCI IN PAIRS \nAND\n CHAINS. \n 2+ ___ per 1000X FIELD): GRAM NEGATIVE ROD(S). \n 2+ ___ per 1000X FIELD): GRAM POSITIVE ROD(S). \n\n FLUID CULTURE (Final ___: \n MIXED BACTERIAL FLORA. \n This culture contains mixed bacterial types (>=3) so an\n abbreviated workup is performed. Any growth of \nP.aeruginosa,\n S.aureus and beta hemolytic streptococci will be \nreported. IF\n THESE BACTERIA ARE NOT REPORTED, THEY ARE NOT PRESENT \nin this\n culture. \n\n ANAEROBIC CULTURE (Final ___: \n MIXED BACTERIAL FLORA. \n Mixed bacteria are present, which may include anaerobes \nand/or\n facultative anaerobes. The presence of B.fragilis, \nC.perfringens,\n and C.septicum is being ruled out. \n BACTEROIDES FRAGILIS GROUP. SPARSE GROWTH. \n BETA LACTAMASE POSITIVE. \n BACTEROIDES FRAGILIS GROUP. RARE GROWTH. ___ \nMORPHOLOGY. \n BETA LACTAMASE POSITIVE.\nMs. ___ is a ___ year old female who presented to the \nEmergency department on ___ with abomdinal pain, nausea, \nand vomiting. She had a CT scan that showed a gas containing \ncollection in the anterior pelvis. Her white blood cell count \nwas elevated at 13.8. She was given broad spectrum IV \nantibiotics, made NPO, and Interventional radiology was \nconsulted for drainage of the abscess. On ___ \ninterventional radiology placed a pigtain drain and samples were \nsent for microbiology.\n\nShe initially slowly improved clinically and her abdominal pain \ndecreased. She was tolerating minimal clear liquid diet. Her \nwhite blood cell count remained elevated despite antibiotics \nwith appropriate coverage and her abdominal pain never \ncompletely subsided and she continued to have episodes of cramp \nlike pain. On ___ informed consent was obtained and she was \ntaken to the operating room for laparoscopic sigmoid colectomy \nwith loop ileostomy. Please see operative report. Acute Pain \nservice was consulted pre-operatively and placed an epidural for \npain control. She was extubated upon completion of the case and \nrecovered in the PACU. Please see below for remainder of post \noperative course:\n\nOn POD1 she had adequate pain control with epidural. She had \nbowel function in the ileostomy and her diet was advanced to \nclears with good tolerability. The epidural catheter was removed \non POD #3. The patient was converted to oral analgesia and her \ndiet was advanced to a regular diet. The foley catheter was \nremoved and she was voiding without difficulty. She was \nreported to have increased ileostomy output and was started on \nimmodium and psyllium to decrease the output.\n\nThe patient was discharged home with ___ services on POD #9. \nHer vital signs were stable and she was afebrile. Her appetite \nwas slowly improving. She was voiding without difficulty and \nher ileostomy output had decreased. A follow-up appointment was \nmade in the acute care clinic. Discharge instructions were \nreviewed and questions answered.'}}
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{'final_diagnoses': ['Complicated diverticulitis'], 'procedures': ['___: ___ drainage', '___ laparoscopic hand assisted sigmoidectomy + loop \nileostomy'], 'visit_summary': 'Ms. ___ is a ___ year old female who presented to the \nEmergency department on ___ with abomdinal pain, nausea, \nand vomiting. She had a CT scan that showed a gas containing \ncollection in the anterior pelvis. Her white blood cell count \nwas elevated at 13.8. She was given broad spectrum IV \nantibiotics, made NPO, and Interventional radiology was \nconsulted for drainage of the abscess. On ___ \ninterventional radiology placed a pigtain drain and samples were \nsent for microbiology.\n\nShe initially slowly improved clinically and her abdominal pain \ndecreased. She was tolerating minimal clear liquid diet. Her \nwhite blood cell count remained elevated despite antibiotics \nwith appropriate coverage and her abdominal pain never \ncompletely subsided and she continued to have episodes of cramp \nlike pain. On ___ informed consent was obtained and she was \ntaken to the operating room for laparoscopic sigmoid colectomy \nwith loop ileostomy. Please see operative report. Acute Pain \nservice was consulted pre-operatively and placed an epidural for \npain control. She was extubated upon completion of the case and \nrecovered in the PACU. Please see below for remainder of post \noperative course:\n\nOn POD1 she had adequate pain control with epidural. She had \nbowel function in the ileostomy and her diet was advanced to \nclears with good tolerability. The epidural catheter was removed \non POD #3. The patient was converted to oral analgesia and her \ndiet was advanced to a regular diet. The foley catheter was \nremoved and she was voiding without difficulty. She was \nreported to have increased ileostomy output and was started on \nimmodium and psyllium to decrease the output.\n\nThe patient was discharged home with ___ services on POD #9. \nHer vital signs were stable and she was afebrile. Her appetite \nwas slowly improving. She was voiding without difficulty and \nher ileostomy output had decreased. A follow-up appointment was \nmade in the acute care clinic. Discharge instructions were \nreviewed and questions answered.', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q6H:PRN Pain - Mild ', '2. LOPERamide 2 mg PO BID \nRX *loperamide 2 mg 1 tablet by mouth twice a day Disp #*14 \nCapsule Refills:*2 ', '3. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*15 Tablet Refills:*0 ', '4. Psyllium Wafer 2 WAF PO BID \nRX *psyllium 2 wafers by mouth twice a day Disp #*12 Wafer \nRefills:*1 ', '5. Sarna Lotion 1 Appl TP QID:PRN itching']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'F', 'symptoms': 'Transfer for cardiac cath.', 'medical_history': ['- htn.', '- copd, ', '- pulm htn, ', '- chf (?) - by notes, patient denies, no h/o prior MI.', '- colon cancer, s/p resection in ___ in ___. Had received \nchemo in past - patient unsure of cycles/duration.', '- recent pneumonia - treated with moxifloxacin.'], 'family_history': 'non-contributory', 'present_illness': '___ year old female with hx of HTN, COPD, pulm htn presented to \nER at ___ this am with SOB x for several days with acute \nworsening last 48 hours. In ED found to have STE in I, AVL, \nV4-V6. Was admitted to ___ last week with pneumonia. EKG \nchanges new compared to EKG from 10 days ago. Has small Q waves \nin I, AVL. Troponin 3.79, ck mb 28.6, CK 101. Given ASA, nitro, \nplavix 600 heparin gtt and transferred to ___ for emergent \ncatheterization.\n.\nOn arrival to ___, RR 35-40. bilateral lower extremity \nswelling and chest pain free. treated with a combivent neb \nenroute to hospital\nDenies chest pain.\n.\nOn review of systems, no additional complaints.', 'medications': [{'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'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': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H: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': 'Alteplase', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Alteplase', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BIDWM', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Acetaminophen IV', '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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR1', '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': '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': '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}]}, 'clinical_findings': {'labs': [{'value': '78.3', 'valuenum': 78.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '28.4', 'valuenum': 28.4, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '210', 'valuenum': 210.0, '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': '4.13', 'valuenum': 4.13, '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': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '27.7', 'valuenum': 27.7, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '208', 'valuenum': 208.0, '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': '4.25', 'valuenum': 4.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': '%', 'ref_range_lower': 80.0, 'ref_range_upper': 130.0, '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': '87', 'valuenum': 87.0, 'valueuom': '%', 'ref_range_lower': 70.0, 'ref_range_upper': 170.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 150.0, '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': '60.0', 'valuenum': 60.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '79.4', 'valuenum': 79.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', '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': 'ROUTINE', 'comments': 'RANDOM.'}, {'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': '1.010', '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'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': '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': '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': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.5, 'ref_range_upper': 2.2, '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '217', 'valuenum': 217.0, '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': '4.34', 'valuenum': 4.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '61.8', 'valuenum': 61.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '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': '28.4', 'valuenum': 28.4, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, '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': '3.95', 'valuenum': 3.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, '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': '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': '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': 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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.5, 'ref_range_upper': 2.2, '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '11.0', 'valuenum': 11.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: T:97 (ax), BP: 110/77, HR:109, RR:32, O2:95 % on RA\nGen: Elderly woman 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, unable to assess JVP immediately post-cath. \nCV: PMI located in ___ intercostal space, midclavicular line. \nRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nChest: bilateral rales anteriorly at bases, occasional wheeze, \notherwise clear \nAbd: Soft, NTND. No HSM or tenderness. \nGroin: 2+ femoral pulses. No bruits, no hematoma, no oozing at \ngroin site.\nExt: WWP. No c/c. 2+ non-pitting edema ___ bilaterally. ___ \ncold b/l diminished symmetric pulses in ___ bilaterally.\nSkin: No stasis dermatitis, ulcers, scars', 'diagnoses': [{'icd_code': '45385', 'desc': 'Acute venous embolism and thrombosis of subclavian veins'}, {'icd_code': '7041', 'desc': 'Hirsutism'}], 'summary': "OSH Lab Results\nLabs: wbc 25.5 (on prednisone), hb 18.1, hct 54.6, plt 353, na \n134, k 4.2, cl 87, co2 37, bun 24, creat 1.1 inr 1.1\ngluc 169\n.\nTrop I 3.79, ck mb 28.6\n.\n___ Results:\n\n___ 07:00AM BLOOD WBC-20.2* RBC-4.08* Hgb-13.8 Hct-41.8 \nMCV-102* MCH-33.8* MCHC-33.0 RDW-17.1* Plt ___\n___ 09:45AM BLOOD WBC-17.7* RBC-3.36* Hgb-11.4* Hct-34.6* \nMCV-103* MCH-34.0* MCHC-33.0 RDW-16.8* Plt ___\n___ 07:45AM BLOOD WBC-14.8* RBC-3.39* Hgb-11.5* Hct-35.4* \nMCV-105* MCH-34.0* MCHC-32.5 RDW-17.6* Plt ___\n___ 07:00AM BLOOD Glucose-84 UreaN-35* Creat-1.0 Na-135 \nK-4.0 Cl-91* HCO3-32 AnGap-16\n___ 09:45AM BLOOD Glucose-159* UreaN-33* Creat-1.2* Na-135 \nK-3.9 Cl-94* HCO3-31 AnGap-14\n___ 07:45AM BLOOD Glucose-79 UreaN-25* Creat-1.1 Na-135 \nK-4.4 Cl-96 HCO3-32 AnGap-11\n___ 07:45AM BLOOD ___ PTT-24.5 ___\n___ 07:00AM BLOOD CK-MB-NotDone cTropnT-0.46*\n___ 09:45AM BLOOD cTropnT-0.23*\n___ 07:00AM BLOOD Calcium-8.5 Phos-3.2 Mg-2.0 Cholest-148\n___ 07:45AM BLOOD Calcium-8.6 Phos-3.3 Mg-2.4\n___ 09:45AM BLOOD VitB12-466 Folate-5.7\n___ 07:00AM BLOOD Triglyc-274* HDL-43 CHOL/HD-3.4 \nLDLcalc-50\n___ 04:47PM BLOOD Type-ART pO2-132* pCO2-45 pH-7.47* \ncalTCO2-34* Base XS-8\n___ 04:47PM BLOOD Hgb-15.9 calcHCT-48\n.\nCardiac Cath ___\nCOMMENTS: \n1. Selective coronary angiography of this right dominant system \nrevealed \nsingle vessel coronary artery disease. The LMCA and LAD had no \nangiographically apparent flow-limiting disease. The LCX had a \nnotable \nthrombus and ulcerated 80% lesion in OM1. The RCA had no \nangiographically apparent obstructive disease. \n2. Limited resting hemodynamics revealed normal systemic \narterial blood \npressure of 99/65 mm Hg. \n3. Successful stenting of the OM branch with a 2.5 X 8 mm and a \n2.0 X 12 \nmm Vision bare metal stents in an overlapping fashion (see ___ \ncomments \nfor detail). \n.\nEcho: The left atrium is normal in size. No atrial septal defect \nis seen by 2D or color Doppler. Left ventricular wall \nthicknesses are normal. The left ventricular cavity is unusually \nsmall. There is moderate to severe regional left ventricular \nsystolic dysfunction with mid to distal anterior, septal and \napical akinesis. The basal segments are hyperdynamic. No masses \nor thrombi are seen in the left ventricle. There is a moderate \nresting left ventricular outflow tract obstruction. There is no \nventricular septal defect. Right ventricular chamber size and \nfree wall motion are normal. The aortic valve leaflets (3) are \nmildly thickened but aortic stenosis is not present. Mild (1+) \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. There is systolic anterior motion of the \nmitral valve leaflets. An eccentric, posteriorly directed jet of \nmild to moderate (___) mitral regurgitation is seen. The left \nventricular inflow pattern suggests impaired relaxation. The \ntricuspid valve leaflets are mildly thickened. Moderate [2+] \ntricuspid regurgitation is seen. There is moderate pulmonary \nartery systolic hypertension. There is a trivial/physiologic \npericardial effusion.\nIMPRESSION: Severe regional LV systolic dysfunction c/w \nCAD/myocardial infarction. Small LV cavity with mitral valvular \n___ and moderate LVOT obstruction at rest. Electronically \nsigned by ___, MD, Interpreting physician ___ \n___ 09:21\n.\nSinus rhythm \nAtrial premature complex \nAnterior ST elevation - acute myocardial infarction \nNo previous tracing available for comparison \n \n \nRead by: ___. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n94 126 90 356/415 82 59 55 \n \n.\nSinus rhythm \nAcute anterior infarct \nPossible left ventricular hypertrophy \nNonspecific inferior T changes \nSince previous tracing of ___, evolving myocardial \ninfarction seen, sinus \ntachycardia and atrial premature complexes absent \n \n \nRead by: ___. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n92 126 86 380/436 77 1 -131 \n.\nSinus tachycardia. Inferolateral ST-T wave changes suggest \nmyocardial \nischemia or evolving myocardial infarction. Poor R wave \nprogression. \nProbable left ventricular hypertrophy. Compared to the previous \ntracing \nof ___ the anterolateral ST segment elevation is less \npronunced. \nT wave inversion is more prominent. \n \n \nRead by: ___. \n \n Intervals Axes \nRate PR QRS QT/QTc P QRS T \n100 120 76 370/440 83 29 -148 \n.\nCXR:\nFINDINGS: Both lungs are hyperinflated. The asymmetry of \nopacification between the right and left lung is most likely \nsecondary to the left breast being projected over the left \nhemithorax while the right breast which appears smaller is out \nof view. No focal areas of infiltration or masses are seen in \nthe lungs. No pleural effusion is noted. The heart size is \nwithin normal limits.\n\nIMPRESSION:\n1. Hyperinflated lungs that could either represent emphysema \nversus small airway disease.\n2. No focal pneumonia detected.\nPatient was taken for emergent cardiac catheterization. Cath \nresults as above - bare metal stent placed into OM1.\n.\n#CAD: STEMI. Post-cath management with aggrastat, aspirin, \nplavix, metoprolol, lipitor. Course complicated by mild \nhypotension with SBP in 90's limiting administration of \nbeta-blocker and ACE. Patient was generally asymptomatic with \nher BP and hold parameters reduced to SBP 90 allowing low dose \nACE and beta-blocker to be continued. Echo demonstrated \nmoderate to severe systolic dysfunciton with an EF of ___. \nEnzymes peaked prior to presentation suggesting late \npresentation of STEMI. EKG changes also persisted through \nhospital day 1 (s/p revascularization) also correlating with \npoor prognosis. Patient's cardiac stay was otherwise \nuneventful. She had limited ectopy on telemetry, and was \nworking well with ___ prior to discharge. Patient was given \nsmoking cessation counselling and started on buproprion prior to \nDC home.\n.\n#Anxiety: Patient was requesting ativan q6 hrs on hospital day 1 \nas she had been taking it at home. This was felt to be limiting \nadministration of her CAD meds due to hypotension. Ativan was \nscaled back to q8 to BID without difficulty. Patient was \noffered smoking cessation counselling, and started on buproprion \nfor treatment of her smoking cravings, anxiety, and depression. \nShe was not suicidal at any point during her stay but did report \nsome symptoms of depression.\n.\n#htn: Hypotensive during hospitalization limiting administration \nof ACE/Beta-blocker post-MI.\n.\n#COPD: Stable w/o O2 requirement. Continue low dose prednisone \nfor COPD despite relative contraindication in MI given long-term \nuse.\n.\n#Pneumonia: completed course of antibiotics in house. CXR \nshowed no infiltrate. Antibiotics discontinued.\n."}}
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{'final_diagnoses': ['Acute ST Elevation Myocardial Infarction', 'Acute Systolic Heart Failure', 'Coronary Artery Disease', 'COPD', 'Pulmonary Hypertension', 'Pneumonia', 'Hypertension'], 'procedures': ['Cardiac Catheterization'], 'visit_summary': "Patient was taken for emergent cardiac catheterization. Cath \nresults as above - bare metal stent placed into OM1.\n.\n#CAD: STEMI. Post-cath management with aggrastat, aspirin, \nplavix, metoprolol, lipitor. Course complicated by mild \nhypotension with SBP in 90's limiting administration of \nbeta-blocker and ACE. Patient was generally asymptomatic with \nher BP and hold parameters reduced to SBP 90 allowing low dose \nACE and beta-blocker to be continued. Echo demonstrated \nmoderate to severe systolic dysfunciton with an EF of ___. \nEnzymes peaked prior to presentation suggesting late \npresentation of STEMI. EKG changes also persisted through \nhospital day 1 (s/p revascularization) also correlating with \npoor prognosis. Patient's cardiac stay was otherwise \nuneventful. She had limited ectopy on telemetry, and was \nworking well with ___ prior to discharge. Patient was given \nsmoking cessation counselling and started on buproprion prior to \nDC home.\n.\n#Anxiety: Patient was requesting ativan q6 hrs on hospital day 1 \nas she had been taking it at home. This was felt to be limiting \nadministration of her CAD meds due to hypotension. Ativan was \nscaled back to q8 to BID without difficulty. Patient was \noffered smoking cessation counselling, and started on buproprion \nfor treatment of her smoking cravings, anxiety, and depression. \nShe was not suicidal at any point during her stay but did report \nsome symptoms of depression.\n.\n#htn: Hypotensive during hospitalization limiting administration \nof ACE/Beta-blocker post-MI.\n.\n#COPD: Stable w/o O2 requirement. Continue low dose prednisone \nfor COPD despite relative contraindication in MI given long-term \nuse.\n.\n#Pneumonia: completed course of antibiotics in house. CXR \nshowed no infiltrate. Antibiotics discontinued.\n.", 'medications_prescribed': ['1. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', '2. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '3. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day). ', '4. Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: \nOne (1) Cap Inhalation DAILY (Daily). ', '5. Atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '6. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) \nfor 2 days.\nDisp:*2 Tablet(s)* Refills:*0*', '7. Lisinopril 5 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '8. Metoprolol Tartrate 25 mg Tablet Sig: 0.5 Tablet PO BID (2 \ntimes a day).\nDisp:*30 Tablet(s)* Refills:*2*', '9. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO Q12H (every 12 \nhours) as needed for anxiety.\nDisp:*30 Tablet(s)* Refills:*0*', '10. Bupropion 150 mg Tablet Sustained Release Sig: One (1) \nTablet Sustained Release PO twice a day: Please take 1 tablet \nper day for 3 days, and then change to twice per day thereafter.\nDisp:*60 Tablet Sustained Release(s)* Refills:*2*', '11. Lasix 20 mg Tablet Sig: One (1) Tablet PO once a day: \ndiscuss with primary doctor before restarting. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 89, 'gender': 'M', 'symptoms': 'Bright red blood per rectum', 'medical_history': ['Right TKA ___ with subsequent DVT (___)', 'Type 2 diabetes mellitus', 'hypertension', 'Hyperlipidemia', 'GERD', 'Diverticulosis', 'recurrent LGIB ___, \n___: earlier attributed to diverticulosis, ___ unclear \nsource, ?splenic flexure bleed (on tagged RBC scan)', 'Degenerative joint disease (hip/knee)'], 'family_history': "Diverticulosis in all three children, son (___) and daughter \n(___) have had colectomies for LGIBs. Father may have had an MI.\n\nNo family history of colitis, Crohn's, ulcerative colitis. No \nbleeding disorders or family history of malignancies.", 'present_illness': 'Mrs. ___ is a ___ female with HTN, DM type II,\ndiverticulosis, and a long history of lower GI bleeding possibly\n___ diverticular bleeds who presented to the ED with bright red\nblood per rectum.\n\nThis morning she woke up before 8am and went to the bathroom to\nhave a bowel movement. The bowel movement was brown with pink\nblood mixed in to the water and stool. There were no blood \nclots.\nThere was also some pink blood on the toilet paper when she\nwiped. Given her history of GI bleed, she came right to the ED.\nShe has not had a bowel movement since. \n\nOther than the BRBPR, she has been feeling in her normal state \nof\nhealth and has no complaints. She has no abdominal pain. No\nnausea/vomiting. No fevers/chills. No lightheadedness. No\nheadache or visual changes. No dysphagia. Her GERD has been well\ncontrolled on omeprazole. She has no dysuria, increased\nfrequency, or change in appearance/odor of her urine.\n\nShe has not had a bowel movement since this morning. Typically\nshe has two or three brown bowel movements daily. \n\nThe first time she had a significant GI bleed was ___. She was\nmost recently hospitalized in ___ for lower GI bleed. During\nthe most recent hospital stay, she was admitted to the ICU for\ntransient hypotension and active passage of blood clots in the\nED. She received 1 unit pRBCs. CTA was negative for a localized\nsource, but it was thought to likely be due to a diverticular\nbleed given her history. Her bleeding stopped spontaneously and\nshe did not have a colonoscopy because of her stability. The \nidea\nof prophylactic colectomy was discussed with the patient but she\ndecided against this. However, she was willing to continue to\ndiscussion with surgery as an outpatient. Of note, she had\ncapsule endoscopy in ___, which showed tiny vascular ectasias.\nHowever the GI team following her at the time did not believe\nthis to be the source of her recurrent bleeds. Tagged RBC scan \nin\n___ showed bleeding at the splenic flexure.', 'medications': [{'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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID: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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '77', 'valuenum': 77.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '394', 'valuenum': 394.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '110', 'valuenum': 110.0, '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': '13.1', 'valuenum': 13.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '185', 'valuenum': 185.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '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': '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}, {'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': '16.8', 'valuenum': 16.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '10.7', 'valuenum': 10.7, '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': '32.0', 'valuenum': 32.0, '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': '290', 'valuenum': 290.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '64', 'valuenum': 64.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '358', 'valuenum': 358.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '12.1', 'valuenum': 12.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, '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': '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '265', 'valuenum': 265.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED, CHECKED FOR NRBCS.'}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '383', 'valuenum': 383.0, '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': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '391', 'valuenum': 391.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '71', 'valuenum': 71.0, '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': '10.3', 'valuenum': 10.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '348', 'valuenum': 348.0, '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': '83', 'valuenum': 83.0, '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': '10.3', 'valuenum': 10.3, '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': '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': '___', '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': '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': '2.8', 'valuenum': 2.8, '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, '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': '31.8', 'valuenum': 31.8, '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': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, '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': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '313', 'valuenum': 313.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, '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}], 'exams': 'Admission Exam: \nVITALS: T 98.4, HR 73, BP 133/71, RR 16, SpO2 98% on 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: Heart regular, no murmur, no S3, no S4. No JVD.\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. No HSM\nGU: No suprapubic fullness or tenderness to palpation\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:\nT 98.4, HR 64, BP 151/80, RR 18, SpO2 99% on RA\nGENERAL: NAD, appears well\nEYES: PERRL\nENT: OP clear, MMM\nCV: Heart regular, no m/r/g\nRESP: CTAB\nGI: Abdomen soft, non-distended, non-tender to palpation. Bowel\nsounds present. \nMSK: 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\nPSYCH: normal affect', 'diagnoses': [{'icd_code': '5779', 'desc': 'Unspecified disease of pancreas'}, {'icd_code': '5762', 'desc': 'Obstruction of bile duct'}, {'icd_code': '2639', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': '2867', 'desc': 'Acquired coagulation factor deficiency'}, {'icd_code': '185', 'desc': 'Malignant neoplasm of prostate'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': 'E9478', 'desc': 'Other drugs and medicinal substances causing adverse effects in therapeutic use'}, {'icd_code': 'V153'}, {'icd_code': 'V8741', 'desc': 'Personal history of antineoplastic chemotherapy'}], 'summary': 'Admission Labs:\n___ normal\nH/H ___ (from 9.6/30.7 on ___. Baseline Hgb appears to \nbe\nin the mid-9s.\nNa 144, K 4.4, Cl 106, Hco3 25, BUN 37, Cr 1.3 (from baseline\n~1.2)\nLactate 1.8\nINR 1\n\n___ 09:15AM BLOOD WBC-6.3 RBC-3.10* Hgb-9.0* Hct-29.4* \nMCV-95 MCH-29.0 MCHC-30.6* RDW-12.6 RDWSD-43.7 Plt ___\n\nDischarge Labs:\nLab review:\n___ wnl\nHgb 9.5 -> 9 -> 8.7 -> 7.9 -> 8.7\nPlt wnl\nCr improved 1.4 -> 1.2\n\nMICRO:\n URINE CULTURE (Final ___: \n MIXED BACTERIAL FLORA ( >= 3 COLONY TYPES), CONSISTENT \nWITH SKIN\n AND/OR GENITAL CONTAMINATION. \n\nIMAGING: none\nReviewed imaging and procedure notes from prior \nhospitalizations.\n\nLast colonoscopy was in ___, which showed "multiple\nmedium-sized internal hemorrhoids seen. One was engorged and\noozed blood after retroflexion in the rectum. Diverticulosis of\nthe sigmoid, descending, transverse, ascending colon Otherwise\nnormal colonoscopy to cecum."\nMs. ___ is a ___ female with HTN, DM type II,\ndiverticulosis, and a long history of lower GI bleeding possibly\n___ diverticular bleeds who presented to the ED with bright red\nblood per rectum.\n\nACUTE/ACTIVE PROBLEMS:\n# BRBPR\n# History of LGIB\n# Diverticulosis\n# Acute blood loss anemia\nThe etiology of her BRBPR is still unclear but she has a history\nof diverticular as well as hemorrhoidal bleeding. GI was\nconsulted. Given her stability and lack of ongoing bleeding, \nthey\nrecommended continued observation. She had no further bloody \noutput after 48 hours of observation and she was discharged \nhome. She was instructed to return to the ED if she had bright \nred bloody output. In that case, it may be possible to localize \na bleeding source which may be amenable to elective surgical \nintervention. However, in the past she has not been interested \nin discussing surgical options.\n\n# HTN\nHer home chlorthalidone, atenolol, and losartan were continued \nin-house. Her home spironolactone was held and can be resumed as \nan outpatient.\n\nCHRONIC/STABLE PROBLEMS:\n\n# DM type II\nHer home metformin and glipizide were held during this hospital \nstay and resumed on discharge. She was maintained on sliding \nscale insulin while in-house.\n\n# CKD III\nCr was 1.3 on admission from baseline 1.2.\n\n# HLD - continued home simvastatin 20 mg qhs\n\n# GERD - continued omeprazole 20 mg daily\n\n# Right TKA ___ with subsequent DVT (___)\n# S/p IVC filter'}}
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{'final_diagnoses': ['Lower gastrointestinal bleeding'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ female with HTN, DM type II,\ndiverticulosis, and a long history of lower GI bleeding possibly\n___ diverticular bleeds who presented to the ED with bright red\nblood per rectum.\n\nACUTE/ACTIVE PROBLEMS:\n# BRBPR\n# History of LGIB\n# Diverticulosis\n# Acute blood loss anemia\nThe etiology of her BRBPR is still unclear but she has a history\nof diverticular as well as hemorrhoidal bleeding. GI was\nconsulted. Given her stability and lack of ongoing bleeding, \nthey\nrecommended continued observation. She had no further bloody \noutput after 48 hours of observation and she was discharged \nhome. She was instructed to return to the ED if she had bright \nred bloody output. In that case, it may be possible to localize \na bleeding source which may be amenable to elective surgical \nintervention. However, in the past she has not been interested \nin discussing surgical options.\n\n# HTN\nHer home chlorthalidone, atenolol, and losartan were continued \nin-house. Her home spironolactone was held and can be resumed as \nan outpatient.\n\nCHRONIC/STABLE PROBLEMS:\n\n# DM type II\nHer home metformin and glipizide were held during this hospital \nstay and resumed on discharge. She was maintained on sliding \nscale insulin while in-house.\n\n# CKD III\nCr was 1.3 on admission from baseline 1.2.\n\n# HLD - continued home simvastatin 20 mg qhs\n\n# GERD - continued omeprazole 20 mg daily\n\n# Right TKA ___ with subsequent DVT (___)\n# S/p IVC filter', 'medications_prescribed': ['amLODIPine 10 mg PO DAILY', 'Atenolol 100 mg PO DAILY', 'Calcium Carbonate 500 mg PO BID', 'Chlorthalidone 25 mg PO DAILY', 'Clobetasol Propionate 0.05% Ointment 1 Appl TP TWICE A WEEK', 'Ferrous Sulfate 325 mg PO DAILY', 'Fluticasone Propionate NASAL 2 SPRY NU DAILY', 'GlipiZIDE XL 2.5 mg PO DAILY', 'Losartan Potassium 100 mg PO QHS', 'MetFORMIN (Glucophage) 500 mg PO BID', 'Multivitamins 1 TAB PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Psyllium Powder 1 PKT PO DAILY', 'Simvastatin 20 mg PO QPM', 'Spironolactone 25 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Abdominal pain', 'medical_history': ['Congenital deafness secondary to Varicella ', 'Multiple sclerosis (presented with headache, falls and leg\nnumbness in ___: most recent MRI performed in ___ \ndemonstrated\n3 new enhancing punctate lesions: R frontal, R temporal and R\nfrontal periventricular', 'Diabetes ___', 'Asthma', 'Hyperlipidemia', 'Seizure disorder'], 'family_history': 'Significant for throat cancer in maternal grandmother, diabetes \n___ in her father, asthma and hypertension in her mother. \nHer maternal grandmother also has "heart problems" and has worn \na holter monitor. She has one sister who is healthy and has two \nchildren who are healthy. ', 'present_illness': 'The patient is a ___ year old female with medical history \nsignificant for congenital deafness, multiple sclerosis, and \nseizure disorder who presented with epigastric abdominal pain \nsince the prior night. According to the patient, she was in her \nusual state of health until shortly after dinner when she \ndeveloped acute-onset of epigastric pain which was gnawing/sharp \nand persistent in nature. The pain did not radiate anywhere, and \nwas not associated with\nfever or chills. She did however have some nausea without \nemesis. The pain continued through-out the night, and she \nfinally presented to the ED for further evaluation when it \nfailed to improve. She stated she had never experienced anything \nlike this before.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'amLODIPine', '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': 'LORazepam', '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': 'Q8H: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': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '___', 'valuenum': 11.0, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 128.0, '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': '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': '___', 'valuenum': 4.4, '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': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '43.4', 'valuenum': 43.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '428', 'valuenum': 428.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.59', 'valuenum': 4.59, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '57.1', 'valuenum': 57.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Upon Discharge:\nVitals: 98.2 96 104/65 16 98%RA\nGeneral: awake, alert, oriented x 3\nHEENT: NCAT, EOMI, anicteric\nHeart: RRR, NMRG\nLungs: CTAB, normal excursion, no respiratory distress\nChest: non-tender, no deformities\nBack: no vertebral tenderness, no CVAT\nAbdomen: soft, mildly and appropriately tender near incisions, \nnondistended, incisions clean/dry/intact with no \nerythema/drainage/induration\nExtremities: WWP, no CCE, no tenderness', 'diagnoses': [{'icd_code': 'D320', 'desc': 'Benign neoplasm of cerebral meninges'}, {'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': '___ 06:25AM BLOOD WBC-7.3 RBC-4.29 Hgb-12.0 Hct-34.5* \nMCV-80* MCH-27.9 MCHC-34.7 RDW-12.7 Plt ___\n___ 07:00AM BLOOD Neuts-75.9* Lymphs-12.8* Monos-5.5 \nEos-5.5* Baso-0.3\n___ 07:00AM BLOOD Glucose-157* UreaN-7 Creat-0.5 Na-135 \nK-3.9 Cl-101 HCO3-24 AnGap-14\n___ 06:25AM BLOOD ALT-8 AST-11 AlkPhos-75 TotBili-0.3\n\nCT Abdomen/Pelvis ___\n1. Cholelithiasis. \n2. 2.2 cm cyst within the posterior interpolar region of the \nleft kidney, with internal density values slightly higher than \nexpected for a simple cyst. Further assessment with renal \nultrasound on an nonemergent basis is suggested. \n3. No acute abnormality otherwise identified within the abdomen \nor pelvis. \n\nRUQ Ultrasound ___\nIMPRESSION: Cholelithiasis without evidence of cholecystitis.\nMs. ___ was admitted to ___ surgical service where she \nunderwent a laparoscopic cholecystectomy on ___. The reader \nis referred to the Operative Note for further details.\n\nThereafter, she was admitted to the surgical floor for further \ncare. She was given a clear liquid diet to be advanced to \nregular diet as tolerated. She was given oral pain medications \nfor pain control. She was restarted on her essential home \nmedications. She was encouraged to ambulate early and \nfrequently.\n\nShe tolerated all these steps well. By POD#1, she reported \nfeeling prepared to complete her recovery at home. She was \ntolerating a regular diet, had good pain control on oral \nmedications, was taking all her usual home medications, was \nvoiding, and was able to ambulate independently and without \ndifficulty. She will plan to follow-up in ___ clinic as \ninstructed. She was explained and expressed agreement with the \ndischarge plan with an ___ Sign Language interpreter, and \nwas discharged home in good condition.'}}
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{'final_diagnoses': ['Cholecystitis'], 'procedures': ['___ - Laparoscopic cholecystectomy'], 'visit_summary': 'Ms. ___ was admitted to ___ surgical service where she \nunderwent a laparoscopic cholecystectomy on ___. The reader \nis referred to the Operative Note for further details.\n\nThereafter, she was admitted to the surgical floor for further \ncare. She was given a clear liquid diet to be advanced to \nregular diet as tolerated. She was given oral pain medications \nfor pain control. She was restarted on her essential home \nmedications. She was encouraged to ambulate early and \nfrequently.\n\nShe tolerated all these steps well. By POD#1, she reported \nfeeling prepared to complete her recovery at home. She was \ntolerating a regular diet, had good pain control on oral \nmedications, was taking all her usual home medications, was \nvoiding, and was able to ambulate independently and without \ndifficulty. She will plan to follow-up in ___ clinic as \ninstructed. She was explained and expressed agreement with the \ndischarge plan with an ___ Sign Language interpreter, and \nwas discharged home in good condition.', 'medications_prescribed': ['LeVETiracetam 1000 mg PO BID ', 'Avonex *NF* (interferon beta-1a) 30 mcg Injection weekly ', 'Ferrous Sulfate 325 mg PO DAILY ', 'MetFORMIN (Glucophage) 500 mg PO BID ', 'Simvastatin 10 mg PO DAILY ', 'Acetaminophen 325-650 mg PO Q6H:PRN pain ', 'OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nDisp #*40 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 69, 'gender': 'F', 'symptoms': 'Recurrent falls, aortic valve mass', 'medical_history': ['1. CARDIAC RISK FACTORS: \n - Hypertension', '2. CARDIAC HISTORY: \n - Syncope,', '- ? bicuspid aortic valve', '- High grade second degree AV block/Mobitz type I', '- CAD s/p CABG', '3. OTHER PAST MEDICAL HISTORY: \n - Gait abnormality', '- Mild cognitive impairment \x96 able to consent for self', '- ESRD; HD ___ Dialysis ___', '- Left arm fistula', '- h/o Prostate cancer s/p prostatectomy', "- ___'s macroglobulinemia", '- Chronic anemia/transfusion dependent', '- Severe spinal stenosis', '- Lyme disease', '- Large right complex renal cyst c/f renal cell carcinoma, \nmonitored by urology/oncology', '- Colon adenoma', '- Seizure disorder (3 seizures about ___ years ago)', '- Hyperparathyroidism', '- Thoracic aortic aneurysm s/p reapir ___'], 'family_history': 'Unknown', 'present_illness': '___ M with history of recurrent falls for ___ years, second \ndegree AV block with sinus node exit block, Waldenstrom\'s \nmacroglobulinemia, ESRD (HD ___, chronic anemia requiring \nmonthly blood transfusions transferring from OSH for workup of \naortic valve "mass vs vegetation" prior to consideration for \npacemaker. \n Over the past ___ years, the patient has been falling with \nincreasing frequency. These episodes are associated with \nintermittent baseline dizziness. Patient has fallen while \nseated, standing and moving. He has had 2 syncopal episodes in \nthe past month, with known Mobitz type 1 heart block. Most \nrecently, on ___, patient suffered unwitnessed fall with ?LOC, \nfor which he was admitted to ___. There he had CT head, \nC-spine, and hip x-rays all negative at OSH. He was also \nevaluated for possible BiV pacer implantation with plans to \ntransfer directly to EP lab at ___. \n On ___, echocardiogram at ___ showed an aortic valve with \n\x93mass vs. vegetation\x94. He was transferred to ___ for work-up \nof this lesion prior to potential pacing device implant. Prior \nto transfer he had HD on ___ (took off 1 liter) and received 2 \nunits PRBC (usually gets approximately 1 unit per month). No \nsigns of active bleeding. At time of transfer Tele showed \nsinus/sinus Brady 50-60s rare VEA. Negative orthostatics. \n On the floor, initial vitals were 97.8, 138/46, 82, 16, 98% RA. \nPatient had no significant complaints except for residual pain \nfrom falls of lateral L chest wall and R hip.', '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': 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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron ODT', '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', 'doses_per_24_hrs': 4.0}, {'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': 'Citalopram', '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 via patient discharge', 'route': 'SC', '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': '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '0.6', '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': '___', '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': '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': '3.2', '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': '___', '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': '13', 'valuenum': 13.0, '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': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.8', 'valuenum': 36.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '2.66', 'valuenum': 2.66, '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': '74.4', 'valuenum': 74.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSIONS PHYSICAL:\n--------------------\nVitals: 97.8, 138/46, 82, 16, 98% RA \nGeneral: Well-appearing, tall gentleman in NAD. Makes poor eye \nand speaks slowly but thoughtfully. \nNeck: Brisk arterial upstroke in carotids. No JVD. \nCV: II/VI early decrescendo diastolic murmur heard most clearly \nat L upper sternal border. Loud S2. Regularly irregular. \nLungs: Clear to auscultation bilaterally, crackles at bases L>R \n\nAbdomen: Soft, non-tender, non-distended. No hepatomegaly. \nExtr: +2 pedal pulses bilaterally. Trace edema. \nNeuro: Alert and oriented x3. No focal deficits appreciated \ngrossly. Attention intact. \nSkin: Abrasions and hematomas on face above L eye, chin, left \nforearm, right flank.\n\nDISCHARGE PHYSICAL:\n-------------------\nVitals: 97.8, 104/61, 78, 16, 98% RA\nWt: 69.4 kg/69.4kg 1 day prior\nI/O: NR\nGeneral: Well-appearing, tall gentleman in NAD. Makes poor eye \nand speaks slowly but thoughtfully. \nNeck: Brisk arterial upstroke in carotids. No JVD. \nCV: II/VI early decrescendo diastolic murmur heard most clearly \nat L upper sternal border. Loud S2. Regularly irregular. \nLungs: Clear to auscultation bilaterally\nAbdomen: Soft, non-tender, non-distended. No hepatomegaly. \nExtr: +2 pedal pulses bilaterally. RUE in sling following PPM.\nNeuro: Alert and oriented x3. No focal deficits appreciated \ngrossly. Attention intact. \nSkin: Abrasions and hematomas on face above L eye, chin, left \nforearm, right flank. R anterior chest with ppm site dressing \nc/d/I. Left flank hematoma extending to back, large, firm, \npalpable, ~25cm in diameter', 'diagnoses': [{'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}, {'icd_code': 'J910', 'desc': 'Malignant pleural effusion'}, {'icd_code': 'C7951', 'desc': 'Secondary malignant neoplasm of bone'}, {'icd_code': 'Z8543', 'desc': 'Personal history of malignant neoplasm of ovary'}, {'icd_code': 'Z85820', 'desc': 'Personal history of malignant melanoma of skin'}, {'icd_code': 'Z96642', 'desc': 'Presence of left artificial hip joint'}, {'icd_code': 'Z90710', 'desc': 'Acquired absence of both cervix and uterus'}, {'icd_code': 'Z9221', 'desc': 'Personal history of antineoplastic chemotherapy'}], 'summary': 'ADMISSIONS PHYSICAL:\n--------------------\n___ 07:10PM BLOOD WBC-3.1* RBC-2.37* Hgb-7.5* Hct-23.0* \nMCV-97 MCH-31.6 MCHC-32.6 RDW-21.7* RDWSD-73.5* Plt ___\n___ 07:10PM BLOOD ___ PTT-31.8 ___\n___ 07:10PM BLOOD Plt ___\n___ 07:10PM BLOOD Glucose-121* UreaN-32* Creat-3.6* Na-138 \nK-4.8 Cl-100 HCO3-23 AnGap-20\n___ 07:10PM BLOOD Calcium-8.2* Phos-3.0 Mg-2.0\n\nIMAGING AND OTHER STUDIES:\nCXR ___: There has been placement of a new right-sided dual \nlead pacemaker with the distal lead tips in the right atrium and \nright ventricle. Mediastinal wires are seen. Cardiomediastinal \nsilhouette is within normal limits. There are no focal \nconsolidations, pleural effusion, or pulmonary edema. There are \nno pneumothoraces. \n\nTEE ___: No spontaneous echo contrast or thrombus is seen \nin the body of the left atrium/left atrial appendage or the body \nof the right atrium/right atrial appendage. No atrial septal \ndefect is seen by 2D or color Doppler. Overall left ventricular \nsystolic function is normal (LVEF>55%). Right ventricular \nchamber size and free wall motion are normal. There are simple \natheroma in the aortic arch. There are simple atheroma in the \ndescending thoracic aorta to 45 cm from the incisors.The aortic \nvalve leaflets are mildly thickened. The aortic valve is \nfunctionally bicuspid secondary to fusion of the raphe between \nthe right and left coronary cusps. The non-coronary leaflet is \nredundant and has a very small echodense to hyperechoic \nstructure attached to the leaflet tip, which moves with the \nvalve during systole and diastole. This may represent \ncalcification, though cannot rule out thrombus or vegetation in \nthe appropriate clinical context. Trace aortic regurgitation is \nseen. The mitral valve appears structurally normal with trivial \nmitral regurgitation. No mass or vegetation is seen on the \nmitral valve. The pulmonary artery systolic pressure could not \nbe determined. There is no pericardial effusion. \n\nIMPRESSION: Functionally bicuspid aortic valve with fusion of \nthe right and left coronary cusps. Redundant non-coronary \nleaflet with a very small echodensity attached to the leaflet \ntip that may represent calcification with thrombus or vegetation \nbeing less likely\n\nOTHER IMPORTANT LABS:\n___ Blood cultures: pending, NGTD\n___ Blood cultures: pending, NGTD\n\nDISCHARGE PHYSICAL:\n-------------------\n___ 07:10AM BLOOD WBC-2.7* RBC-2.78* Hgb-8.6* Hct-27.8* \nMCV-100* MCH-30.9 MCHC-30.9* RDW-19.2* RDWSD-71.1* Plt ___\n___ 07:10AM BLOOD ___ PTT-32.2 ___\n___ 07:53AM BLOOD Glucose-88 UreaN-19 Creat-2.7*# Na-139 \nK-4.0 Cl-101 HCO3-25 AnGap-17\n___ 07:53AM BLOOD Calcium-8.8 Phos-2.9 Mg-1.9\n___ 11:30AM BLOOD Vanco-10.9\n___ 11:30AM BLOOD Vanco-10.\n___ M with history of recurrent falls for ___, second degree \nAV block with sinus node exit block, Waldenstrom\'s \nmacroglobulinemia, ESRD (HD ___, chronic anemia requiring \nmonthly blood transfusions transferred from OSH for workup of \naortic valve "mass vs vegetation" prior to consideration for \npacemaker. He underwent TEE showing likely functional bicuspid \nvalve with calcification without evidence of infection and \nsubsequently PPM on ___. \n\nACUTE PROBLEMS: \n--------------- \n# Cardiogenic Syncope/heart block: Patient was admitted \nrecurrent falls and syncope most likely in association with \nunderlying arrhythmia and cardiogenic syncope and known \nunderlying arrhythmia with unclear characterization. Per review \nof his prior EKG\'s and telemetry tracings, patient had \nunderlying 1st degree AV delay with intermittent sinus exit \nblock and 2nd degree Mobitz Type 1 heart block. For this, he \nunderwent successful AV PPM on ___ with 3 days of \npost-procedure abx prophylaxis (Vancomycin ___ as per \nroutine. He was monitored on telemetry and had his pacer \ninterrogated prior to discharge.\n\n# Aortic valve mass: On outside hospital TTE, prior to \nadmission, patient was noted to have aortic valve mass most \nconcerning for endocarditis. His PPM was deferred at that time \nand he was transferred to ___ for TEE on ___, which \nshowed most likely a benign calcification of the aortic valve \nwith functional fusion of valve leaflets, requiring no further \nwork-up.\n\n# Chronic anemia/Waldenstrom\'s Macroglobulinemia: Patient was \nadmitted with chronic anemia ___ his Waldenstrom\'s \nMacroglobulinemia and ESRD. He does require regular transfusions \nfor multifactorial anemia and is followed as an outpatient by \nDr. ___. During this hospital course, he received 2u pRBC\'s \nprior to transfer to ___ at the OSH and while at ___, he \nreceived and additional 1 u pRBC with dialysis on ___. His Hgb \nremained stable around his baseline of 8 for the rest of his \nhospitalization.\n\n# End-Stage Renal Dialysis on Hemodialysis: Patient has ESRD \nlikely ___ his Waldenstrom\'s Macroglobulinemia and is on a \nschedule of ___. He received HD during \nthis hospitalization per this home schedule.\n\n# Nausea/vomiting: During this hospitalization, the patient \nexperienced 1 episode of nausea and vomiting, likely due to a \nvagal reaction to trying to sit up from his bed. Per his wife, \nthe patient, at baseline, reports similar episodes of nausea and \nvomiting usually in the mornings, associated with physical \nexertion. She also added that he has been thoroughly worked up \nas outpatient per her without satisfactory explanation. During \nthis episode, he was hemodynamically stable and conscious and \nhis pacer was interrogated, without any concerning abnormalities \nnoted. He was treated symptomatically with IV Zofran and \nmonitored on telemetry as above without further episodes.\n\n# Right Flank Hematoma: Per patient, he suffered fall during \nepisode of syncope prior to admission to OSH, with subsequent \ndevelopment of R flank pain. On exam here at ___, he was noted \nto have a large, firm, tender hematoma (~25cm in size) along his \nR flank. His pain was managed with acetaminophen PRN and his \nexam was not concerning for any decreased strength, decreased \nsensation, parasthesias, decreased pulses in his lower \nextremities. His H&H also remained stable following initial \ntransfusion early during this hospital course and his vitals \nwere normal during this hospitalization. As a result, he did not \nundergo any further imaging and this flank hematoma was \nmonitored clinically.\n\nCHRONIC/RESOLVED PROBLEMS: \n# Seizure disorder: For his history of seizure disorder, he was \nmaintained on his home Oxcarbazepine 600MG BID PO.\n\n# Depression/anxiety: Patient normally takes home dose of \nZaleplon ___ mg oral QHS, although medication was not on \nformulary at ___. He was treated with Zolpidem instead. He was \nalso maintained on home Sertraline 100mg PO daily per home \nregimen. On discharge, he was resumed on his home medication.'}}
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{'final_diagnoses': ['PRIMARY DIAGNOSIS/ES: \n-Symptomatic Heart Block: 2nd degree AV block with sinus exit \nblock', "SECONDARY DIAGNOSIS/ES: \n-End Stage Renal Disease \n-Waldenstrom's Macroglobulinemia \n-Anemia \n-Seizure Disorder \n-Depression/Anxiety"], 'procedures': ['___: Transesophageal Echocardiogram', '___: Pacemaker Placement'], 'visit_summary': '___ M with history of recurrent falls for ___, second degree \nAV block with sinus node exit block, Waldenstrom\'s \nmacroglobulinemia, ESRD (HD ___, chronic anemia requiring \nmonthly blood transfusions transferred from OSH for workup of \naortic valve "mass vs vegetation" prior to consideration for \npacemaker. He underwent TEE showing likely functional bicuspid \nvalve with calcification without evidence of infection and \nsubsequently PPM on ___. \n\nACUTE PROBLEMS: \n--------------- \n# Cardiogenic Syncope/heart block: Patient was admitted \nrecurrent falls and syncope most likely in association with \nunderlying arrhythmia and cardiogenic syncope and known \nunderlying arrhythmia with unclear characterization. Per review \nof his prior EKG\'s and telemetry tracings, patient had \nunderlying 1st degree AV delay with intermittent sinus exit \nblock and 2nd degree Mobitz Type 1 heart block. For this, he \nunderwent successful AV PPM on ___ with 3 days of \npost-procedure abx prophylaxis (Vancomycin ___ as per \nroutine. He was monitored on telemetry and had his pacer \ninterrogated prior to discharge.\n\n# Aortic valve mass: On outside hospital TTE, prior to \nadmission, patient was noted to have aortic valve mass most \nconcerning for endocarditis. His PPM was deferred at that time \nand he was transferred to ___ for TEE on ___, which \nshowed most likely a benign calcification of the aortic valve \nwith functional fusion of valve leaflets, requiring no further \nwork-up.\n\n# Chronic anemia/Waldenstrom\'s Macroglobulinemia: Patient was \nadmitted with chronic anemia ___ his Waldenstrom\'s \nMacroglobulinemia and ESRD. He does require regular transfusions \nfor multifactorial anemia and is followed as an outpatient by \nDr. ___. During this hospital course, he received 2u pRBC\'s \nprior to transfer to ___ at the OSH and while at ___, he \nreceived and additional 1 u pRBC with dialysis on ___. His Hgb \nremained stable around his baseline of 8 for the rest of his \nhospitalization.\n\n# End-Stage Renal Dialysis on Hemodialysis: Patient has ESRD \nlikely ___ his Waldenstrom\'s Macroglobulinemia and is on a \nschedule of ___. He received HD during \nthis hospitalization per this home schedule.\n\n# Nausea/vomiting: During this hospitalization, the patient \nexperienced 1 episode of nausea and vomiting, likely due to a \nvagal reaction to trying to sit up from his bed. Per his wife, \nthe patient, at baseline, reports similar episodes of nausea and \nvomiting usually in the mornings, associated with physical \nexertion. She also added that he has been thoroughly worked up \nas outpatient per her without satisfactory explanation. During \nthis episode, he was hemodynamically stable and conscious and \nhis pacer was interrogated, without any concerning abnormalities \nnoted. He was treated symptomatically with IV Zofran and \nmonitored on telemetry as above without further episodes.\n\n# Right Flank Hematoma: Per patient, he suffered fall during \nepisode of syncope prior to admission to OSH, with subsequent \ndevelopment of R flank pain. On exam here at ___, he was noted \nto have a large, firm, tender hematoma (~25cm in size) along his \nR flank. His pain was managed with acetaminophen PRN and his \nexam was not concerning for any decreased strength, decreased \nsensation, parasthesias, decreased pulses in his lower \nextremities. His H&H also remained stable following initial \ntransfusion early during this hospital course and his vitals \nwere normal during this hospitalization. As a result, he did not \nundergo any further imaging and this flank hematoma was \nmonitored clinically.\n\nCHRONIC/RESOLVED PROBLEMS: \n# Seizure disorder: For his history of seizure disorder, he was \nmaintained on his home Oxcarbazepine 600MG BID PO.\n\n# Depression/anxiety: Patient normally takes home dose of \nZaleplon ___ mg oral QHS, although medication was not on \nformulary at ___. He was treated with Zolpidem instead. He was \nalso maintained on home Sertraline 100mg PO daily per home \nregimen. On discharge, he was resumed on his home medication.', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO ASDIR', '2. Oxcarbazepine 600 mg PO BID', '3. Sertraline 100 mg PO DAILY', '4. Calcitriol 0.125 mcg PO 3X/WEEK (___)', '5. Docusate Sodium 100 mg PO BID', '6. Bisacodyl 10 mg PO/PR DAILY:PRN constipation', '7. Polyethylene Glycol 17 g PO BID', '8. Senna 8.6 mg PO BID', '9. Sonata (zaleplon) ___ mg oral QHS']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'requesting detox', 'medical_history': ['*recent diagnosis of hepatitis B', '*History of alcohol and substance abuse', '*Borderline personality disorder', '*IDDM since ___ with a history of diabetic ketoacidosis in the \npast', '*Prior suicidal behavior', '*Schizo-affective disorder', '*History of depression and paranoia', '*Questionable history of seizure disorder, no seizures in ___ \nyears', '*History of microcytic anemia'], 'family_history': 'Remarkable for DM. No bleeding diathesis or early CAD.', 'present_illness': '___ yo male with PMH significant for borderline personality \ndisorder,\nalcohol abuse, schizo-affective disorder, and IDDM who presented \nto the ED intoxicated after being brought in by EMS requesting \ndetox. The pt reports that he is unable to recall the exact \ndetails of how EMS care was initiated.\n\nIn the ED, initial vitals were 98.0, 105, 20, 138/88 and 94% RA. \nThe pt was failry combative and required several doses of Ativan \nand Haldol for sedation. A serum EtOH level was found to be 291. \nThe pt complained on nausea and was reported to have \napproximately 500 cc of bright red hematemasis; he was then \ngiven Zofran for nausea. A right subclavian line was placed as \nthe pt has difficult access. Lab testing was remarkable for an \nelevated serum blood sugar and AG acidosis.\n\nThe pt report that he had been in his usual state of health \nuntil the end of last week. Approximately four days PTA the pt \nstepped off a curb when he slipped and fell, injuring his left \nfoot (denies hitting his head). The following day he stopped \ntaking his insulin, which he reports he does intermittently. He \ndenies significant NSAID use.\n\nAt present, the pt reports he is comfortable but thirsty. He \ndenies pain, fever, chills or persistent nausea. No CP, \npalpitations or diaphoresis. No cough, but the pt does report \nhis breathing has felt "shallow" a few times in the last several \ndays; he noted this while at rest. No abd pain. The pt reports \nhe has noted some BRB streaking his stools over the last few \ndays which is new for him; he denies melena or blood mixed \nwithin the stool. MSK complaints only as above. Denies weakness, \nchange in sensation or balance.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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', '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', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Succinylcholine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H: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': '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 via patient discharge', 'route': 'IV', 'frequency': 'Q1H: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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', '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': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vecuronium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE MR2', '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': 'Hyoscyamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 24 HRS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '37.6', 'valuenum': 37.6, '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': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '86', 'valuenum': 86.0, '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': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, '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': '22', 'valuenum': 22.0, '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': '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': 129.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '1.18', 'valuenum': 1.18, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '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': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, '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': '7.53', 'valuenum': 7.53, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '540', 'valuenum': 540.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '18/.', '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': '-1', 'valuenum': -1.0, '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': '1.24', 'valuenum': 1.24, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '1.00', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, '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': '30', 'valuenum': 30.0, '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/17.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'SPONTANEOUS.', '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': '10', 'valuenum': 10.0, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, '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': '34.8', 'valuenum': 34.8, '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': '205', 'valuenum': 205.0, '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': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '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': 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': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT.'}, {'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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, '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': '1.8', 'valuenum': 1.8, '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': '140', 'valuenum': 140.0, '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': '38.6', 'valuenum': 38.6, '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': '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': '252', 'valuenum': 252.0, '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': '4.27', 'valuenum': 4.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '1.22', 'valuenum': 1.22, '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': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '219', 'valuenum': 219.0, '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': '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', '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': '27', 'valuenum': 27.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, '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': '71', 'valuenum': 71.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MANY.'}, {'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', 'valuenum': 0.0, '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': 'SM', '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': '5.5', 'valuenum': 5.5, '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': '42', 'valuenum': 42.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '>1.030', 'valuenum': None, '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': 'Yellow', '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': 'RARE.'}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '>182*.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Gen: Chronically ill appearing adult male, no acute distress.\nHEENT: PERRL, EOMI. Dry MM. Conjunctiva well pigmented. \nNeck: Supple, without adenopathy or JVD. No tenderness with \npalpation.\nChest: CTAB anterior and posterior.\nCor: Normal S1, S2. Mildly tachycardic, regular rhythm. No \nmurmurs appreciated.\nAbdomen: Soft, non-tender and non-distended. +BS, no HSM. \nExtremity: Warm, without edema. Tenderness and swelling noted at \nleft foot. 2+ DP pulses bilat.\nNeuro: Alert; initially oriented to self only. CN ___ intact. \nMotor strength intact in all extremities. Sensation intact \ngrossly. Cerebellar function intact. Gait not assessed.', 'diagnoses': [{'icd_code': '430', 'desc': 'Subarachnoid hemorrhage'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '34280', 'desc': 'Other specified hemiplegia and hemiparesis affecting unspecified side'}, {'icd_code': '4321', 'desc': 'Subdural hemorrhage'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': 'V667'}, {'icd_code': 'V4976', 'desc': 'Above knee amputation status'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}], 'summary': '___ 09:40PM WBC-10.0 RBC-3.99* HGB-11.0* HCT-32.7* MCV-82 \nMCH-27.6 MCHC-33.8 RDW-14.7\n___ 09:40PM NEUTS-85.1* LYMPHS-11.5* MONOS-2.4 EOS-0.7 \nBASOS-0.2\n___ 09:40PM GLUCOSE-403* UREA N-9 CREAT-0.9 SODIUM-139 \nPOTASSIUM-4.0 CHLORIDE-96 TOTAL CO2-19* ANION GAP-28*\n.\nAdmission CXR:\nBibasilar atelectasis. No free air under the diaphragms or \nevidence of pneumomediastinum. Mild gaseous distention of \ncolonic loops of bowel in the left upper quadrant.\n___ yo male with borderline personality disorder, alcohol abuse, \nschizo-affective disorder and IDDM admitted with DKA and and an \nepisode of hematemesis.\n\n#DKA: Pt reports not taking his insulin; this, in conjunction \nwith EtOH intake, appears to be the cause of his DKA. Currently \nno evidence of infection or myocardial ischemia. Found to have \nelevated serum glucose, glucose and ketones in urine and AG \nacidosis. Clinical picture is c/w DKA; HONK also in differential \nalthough less likely.\n-continue insulin gtt with hourly FBSB until controlled and AG \nclosed\n-q4 hour lytes with aggressive repletion of Mg and K\n-continue aggressive fluid repletion\n\n#Hematemesis: Pt with episode of hematemasis in ED. HCT appears \napproximately five points below prior baseline; pt currently HD \nstable. No prior h/o GI bleeding or varicies. Pt is not \ncoagulopathic.\n-PPI gtt\n-GI aware; probable EGD in AM\n-serial HCTs\n-type and cross\n-central access; attempt to also place PIV\n-hold home ASA for now\n\n#Elevated LFTs: Pt with elevated LFTs at admission, greater than \nin past. Denies abd sxs. Recent dx as above of hepatitis B. Ddx \nwould include EtOH abuse, stone disease, ___. \n-consider U/S\n-trend LFTs\n\n#Foot injury: Pt is s/p fall in which he injured foot. Will \ncheck x-ray.\n\n#EtOH abuse: Pt reports drinking one quart of alcohol daily.\n-continue home thiamine, folate and MVI\n-CIWA protocol\n\n#left foot injury: Pt is s/p fall. Will check x-ray to eval for \nfracture.\n\n#question history of seizures: Continue Depakote once able to \nclarify dose.\n\n#Psych: Pt currently reports treatment with Celexa and \nthorazine, however doses unclear. Plan to clarify these in AM. \nWould consider psych consult once improved. SW consult now.\n\n#Anemia: Normocytic with normal RDW. Difficult to interpret in \nsetting of possible acute GI bleeding. Will need additional \nworkup once stable.\n\n#HTN: Hold antihypertensives in setting of possible GIB.\n\n#Hyperlipidemia: Would consider continuation of statin once dose \ncan be clarified.\n\n#FEN: NS for volume repletion as above. Aggressive electrolyte \nrepletion. NPO for now.\n\n#Code: Full\n\n#Prophy: Pneumoboots given possible bleeding. PPI infusion for \nhematemasis as above.\n\nOn the morning after admission the patient was adamant to leave \nthe hospital. He was able to clearly state the risks of this \nchoice including death. Pysch had seen him the night prior and \nfelt he did have capacity. He signed AMA paperwork and left the \nhospital with instructions for follow up '}}
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{'final_diagnoses': ['UGIB', 'DKA'], 'procedures': ['EGD'], 'visit_summary': '___ yo male with borderline personality disorder, alcohol abuse, \nschizo-affective disorder and IDDM admitted with DKA and and an \nepisode of hematemesis.\n\n#DKA: Pt reports not taking his insulin; this, in conjunction \nwith EtOH intake, appears to be the cause of his DKA. Currently \nno evidence of infection or myocardial ischemia. Found to have \nelevated serum glucose, glucose and ketones in urine and AG \nacidosis. Clinical picture is c/w DKA; HONK also in differential \nalthough less likely.\n-continue insulin gtt with hourly FBSB until controlled and AG \nclosed\n-q4 hour lytes with aggressive repletion of Mg and K\n-continue aggressive fluid repletion\n\n#Hematemesis: Pt with episode of hematemasis in ED. HCT appears \napproximately five points below prior baseline; pt currently HD \nstable. No prior h/o GI bleeding or varicies. Pt is not \ncoagulopathic.\n-PPI gtt\n-GI aware; probable EGD in AM\n-serial HCTs\n-type and cross\n-central access; attempt to also place PIV\n-hold home ASA for now\n\n#Elevated LFTs: Pt with elevated LFTs at admission, greater than \nin past. Denies abd sxs. Recent dx as above of hepatitis B. Ddx \nwould include EtOH abuse, stone disease, ___. \n-consider U/S\n-trend LFTs\n\n#Foot injury: Pt is s/p fall in which he injured foot. Will \ncheck x-ray.\n\n#EtOH abuse: Pt reports drinking one quart of alcohol daily.\n-continue home thiamine, folate and MVI\n-CIWA protocol\n\n#left foot injury: Pt is s/p fall. Will check x-ray to eval for \nfracture.\n\n#question history of seizures: Continue Depakote once able to \nclarify dose.\n\n#Psych: Pt currently reports treatment with Celexa and \nthorazine, however doses unclear. Plan to clarify these in AM. \nWould consider psych consult once improved. SW consult now.\n\n#Anemia: Normocytic with normal RDW. Difficult to interpret in \nsetting of possible acute GI bleeding. Will need additional \nworkup once stable.\n\n#HTN: Hold antihypertensives in setting of possible GIB.\n\n#Hyperlipidemia: Would consider continuation of statin once dose \ncan be clarified.\n\n#FEN: NS for volume repletion as above. Aggressive electrolyte \nrepletion. NPO for now.\n\n#Code: Full\n\n#Prophy: Pneumoboots given possible bleeding. PPI infusion for \nhematemasis as above.\n\nOn the morning after admission the patient was adamant to leave \nthe hospital. He was able to clearly state the risks of this \nchoice including death. Pysch had seen him the night prior and \nfelt he did have capacity. He signed AMA paperwork and left the \nhospital with instructions for follow up ', 'medications_prescribed': ['left ama']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 80, 'gender': 'F', 'symptoms': 'Right hip drainage', 'medical_history': ['Right hip PJI', 'dyslipidemia', 'mild AR/MR', 'history DVT', 'hypertension', 'ischemic heart disease with history CABG', 'history CVA', 'GERD', 'BPH', 'history UTI'], 'family_history': 'Reviewed and found to be not relevant to this illness/reason for \nhospitalization.', 'present_illness': '___ s/p conversion abx spacer to right THA ___, now with \ndirect admit for eval of ?infected R THA. Plan for I&D versus \nhead/liner exchange.', 'medications': [{'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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Famotidine', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Docusate Sodium', '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', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'NiCARdipine', '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': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', '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': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Labetalol', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H: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': 'HOLD.'}, {'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': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': 'STAT', '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': '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, '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': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LDL(calc) invalid if Non- Fasting sample..'}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 76.0, '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': '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': 0.4, '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': '23', 'valuenum': 23.0, 'valueuom': 'IU/L', 'ref_range_lower': 5.0, 'ref_range_upper': 36.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 116.0, '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': '12', 'valuenum': 12.0, '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': '237', 'valuenum': 237.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, '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': '5.5', 'valuenum': 5.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '14', 'valuenum': 14.0, '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': '39.9', 'valuenum': 39.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '95', 'valuenum': 95.0, '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': 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': '4.22', 'valuenum': 4.22, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.0', 'valuenum': 42.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '10.3', 'valuenum': 10.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.2, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 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{'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': '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': '77', 'valuenum': 77.0, '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': '287', 'valuenum': 287.0, 'valueuom': 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'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': 148.0, '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': '21', 'valuenum': 21.0, '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': '289', 'valuenum': 289.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '___', 'valuenum': 3.8, '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': 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': '17', 'valuenum': 17.0, '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, 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'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', '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': '22.6', 'valuenum': 22.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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{'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': '290', 'valuenum': 290.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '___', 'valuenum': 3.8, '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': 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': '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}, {'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': '___', 'valuenum': 23.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 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'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, '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': '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': '2.0', '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': '___', 'valuenum': 3.8, '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': 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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '___', 'valuenum': 4.2, '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': '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': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 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'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, '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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'MOD*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'POS*.'}, {'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': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': 'OCC*.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, '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': '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* Aquacel dressing with scant serosanguinous drainage \n* Thigh full but soft \n* No calf tenderness \n* ___ strength \n* SILT, NVI distally \n* Toes warm', 'diagnoses': [{'icd_code': 'I63541', 'desc': 'Cerebral infarction due to unspecified occlusion or stenosis of right cerebellar artery'}, {'icd_code': 'I614', 'desc': 'Nontraumatic intracerebral hemorrhage in cerebellum'}, {'icd_code': 'G936', 'desc': 'Cerebral edema'}, {'icd_code': 'G911', 'desc': 'Obstructive hydrocephalus'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I69398', 'desc': 'Other sequelae of cerebral infarction'}, {'icd_code': 'G40909', 'desc': 'Epilepsy, unspecified, not intractable, without status epilepticus'}, {'icd_code': 'R1312', 'desc': 'Dysphagia, oropharyngeal phase'}, {'icd_code': 'R739', 'desc': 'Hyperglycemia, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'R0689', 'desc': 'Other abnormalities of breathing'}, {'icd_code': 'R29704', 'desc': 'NIHSS score 4'}, {'icd_code': 'Z781', 'desc': 'Physical restraint status'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}], 'summary': "___ 06:40AM BLOOD WBC-6.0 RBC-2.61* Hgb-8.3* Hct-25.9* \nMCV-99* MCH-31.8 MCHC-32.0 RDW-16.3* RDWSD-59.9* Plt ___\n___ 05:35AM BLOOD WBC-4.5 RBC-2.54* Hgb-8.1* Hct-25.1* \nMCV-99* ___-31.9 MCHC-32.3 RDW-16.0* RDWSD-57.5* Plt ___\n___ 05:31AM BLOOD WBC-4.2 RBC-2.33* Hgb-7.4* Hct-22.8* \nMCV-98 MCH-31.8 MCHC-32.5 RDW-16.0* RDWSD-57.7* Plt ___\n___ 01:00PM BLOOD WBC-5.2 RBC-2.49* Hgb-8.0* Hct-24.5* \nMCV-98 MCH-32.1* MCHC-32.7 RDW-16.1* RDWSD-58.6* Plt ___\n___ 05:31AM BLOOD WBC-4.8 RBC-2.54* Hgb-8.1* Hct-25.1* \nMCV-99* MCH-31.9 MCHC-32.3 RDW-16.2* RDWSD-59.2* Plt ___\n___ 05:08AM BLOOD WBC-6.6 RBC-2.61* Hgb-8.4* Hct-25.2* \nMCV-97 MCH-32.2* MCHC-33.3 RDW-15.9* RDWSD-57.1* Plt ___\n___ 11:00AM BLOOD WBC-4.5 RBC-3.11* Hgb-9.9* Hct-30.3* \nMCV-97 MCH-31.8 MCHC-32.7 RDW-15.9* RDWSD-57.1* Plt ___\n___ 06:49AM BLOOD WBC-3.6* RBC-3.03* Hgb-9.8* Hct-29.9* \nMCV-99* MCH-32.3* MCHC-32.8 RDW-16.0* RDWSD-58.1* Plt ___\n___ 06:05AM BLOOD WBC-4.0 RBC-2.90* Hgb-9.3* Hct-28.6* \nMCV-99* MCH-32.1* MCHC-32.5 RDW-16.3* RDWSD-58.6* Plt ___\n___ 05:35AM BLOOD Neuts-62.2 ___ Monos-6.6 \nEos-10.8* Baso-0.2 Im ___ AbsNeut-2.81 AbsLymp-0.88* \nAbsMono-0.30 AbsEos-0.49 AbsBaso-0.01\n___ 05:31AM BLOOD Neuts-56.0 ___ Monos-9.2 \nEos-11.0* Baso-0.2 Im ___ AbsNeut-2.24 AbsLymp-0.94* \nAbsMono-0.37 AbsEos-0.44 AbsBaso-0.01\n___ 01:00PM BLOOD Neuts-68.7 Lymphs-15.9* Monos-7.1 \nEos-7.5* Baso-0.2 Im ___ AbsNeut-3.58 AbsLymp-0.83* \nAbsMono-0.37 AbsEos-0.39 AbsBaso-0.01\n___ 06:40AM BLOOD Plt ___\n___ 06:40AM BLOOD ___\n___ 05:35AM BLOOD Plt ___\n___ 05:35AM BLOOD ___\n___ 05:31AM BLOOD Plt ___\n___ 05:31AM BLOOD ___\n___ 01:00PM BLOOD Plt ___\n___ 05:31AM BLOOD Plt ___\n___ 05:31AM BLOOD ___\n___ 05:08AM BLOOD Plt ___\n___ 05:08AM BLOOD ___\n___ 11:00AM BLOOD Plt ___\n___ 06:49AM BLOOD ___\n___ 06:05AM BLOOD Plt ___\n___ 06:05AM BLOOD ___ PTT-40.1* ___\n___ 06:40AM BLOOD UreaN-20 Creat-0.7\n___ 05:35AM BLOOD UreaN-20 Creat-0.6\n___ 01:15PM BLOOD UreaN-20 Creat-0.7\n___ 01:00PM BLOOD UreaN-17 Creat-0.7\n___ 05:08AM BLOOD Glucose-121* UreaN-17 Creat-0.8 Na-137 \nK-4.8 Cl-101 HCO3-23 AnGap-13\n___ 11:00AM BLOOD Glucose-88 UreaN-18 Creat-0.7 Na-139 \nK-4.6 Cl-104 HCO3-23 AnGap-12\n___ 06:49AM BLOOD Glucose-97 UreaN-23* Creat-0.8 Na-142 \nK-4.2 Cl-106 HCO3-23 AnGap-13\n___ 06:05AM BLOOD Glucose-93 UreaN-26* Creat-0.8 Na-140 \nK-4.4 Cl-103 HCO3-25 AnGap-12\n___ 06:40AM BLOOD estGFR-Using this\n___ 06:05AM BLOOD estGFR-Using this\n___ 01:00PM BLOOD ALT-6 AST-13 CK(CPK)-29*\n___ 05:08AM BLOOD Calcium-8.7 Phos-3.3 Mg-1.7\n___ 11:00AM BLOOD Calcium-9.1 Phos-3.6 Mg-1.8\n___ 06:49AM BLOOD Calcium-9.1 Phos-3.4 Mg-2.1\n___ 06:05AM BLOOD Calcium-9.1 Phos-3.3 Mg-1.9\n___:00PM BLOOD CRP-55.0*\n___ 06:05AM BLOOD CRP-12.2*\n___ 01:00PM BLOOD Vanco-23.3*\n___ 05:31AM BLOOD RedHold-HOLD\n___ 06:40AM BLOOD\n___ 05:35AM BLOOD\n___ 01:15PM BLOOD\n___ 01:00PM BLOOD\n___ 05:08AM BLOOD\n___ 11:00AM BLOOD\n___ 06:49AM BLOOD\n___ 06:05AM BLOOD\n___ 06:05AM BLOOD SED RATE-Test \n___ 10:23AM URINE Color-Straw Appear-Clear Sp ___\n___ 09:02PM URINE Color-Yellow Appear-Hazy* Sp ___\n___ 10:23AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-SM*\n___ 09:02PM URINE Blood-NEG Nitrite-NEG Protein-TR* \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-LG*\n___ 10:23AM URINE RBC-1 WBC-9* Bacteri-NONE Yeast-NONE \nEpi-0\n___ 09:02PM URINE RBC-5* WBC->182* Bacteri-FEW* Yeast-NONE \nEpi-1\n___ 09:02PM URINE Mucous-RARE*\n___ 10:23AM URINE\n___ 09:02PM URINE\n___ 09:02PM URINE Hours-RANDOM\n___ 09:02PM URINE Uhold-HOLD\nURINE CULTURE (Final ___: < 10,000 CFU/mL\nURINE CULTURE (Final ___: NO GROWTH.\n___ 3:50 pm TISSUE RIGHT HIP ACETABULAR TISSUE. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n TISSUE (Final ___: \n STAPH AUREUS COAG +. RARE GROWTH. \n Susceptibility testing performed on culture # ___\n___. \n STAPH AUREUS COAG +. RARE GROWTH. \n Susceptibility testing performed on culture # ___\n___. \n SECOND MORPHOLOGY. \n\n ANAEROBIC CULTURE (Final ___: NO ANAEROBES ISOLATED. \n\n\n ACID FAST SMEAR (Final ___: \n NO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \n\n ACID FAST CULTURE (Preliminary): \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:\nPOD #1, Infectious Disease was consulted for antibiotic \nmanagement pending OR cultures. They recommended continuing IV \nAncef and Vancomycin pending OR cultures, CBC/diff, CPK, CRP, \nAST/ALT, Bun/Cr, blood cultures. Minimal output noted on Prevena \nvac dressing.\nPOD #2, OR cultures showed +staph aureus and ID recommended \ndiscontinuation of IV Ancef and continuing IV Vancomycin pending \nsensitivities. Vanco trough was 23.3 and dose was decreased to \n750mg Q12.\nPOD #3, ID recommended discontinuation of IV Vancomycin and \nstarting IV Daptomycin 450mg Q24. Prevena continued to show no \noutput. Final urine cultures showed no growth.\nPOD #4, blood cultures showed no growth to date x 48 hours and \npatient was consented for PICC line placement. Prevena vac \ndressing was removed and Aquacel dressing was applied. Patient \ncontinued to report burning sensation with urination and a \nrepeat urinalysis was obtained. The result of the urinalysis and \nurine culture were negative. He continued to receive \nintermittent straight cathing which he also does at home. \nOn POD#5, his PICC line was placed successfully. \n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Coumadin daily for DVT \nprophylaxis starting on POD #0. The Aquacel dressing remained \nclean and intact without erythema or abnormal \ndrainage/saturation. The patient was seen daily by physical \ntherapy. Labs were checked throughout the hospital course and \nrepleted accordingly. At the time of discharge, the patient was \ntolerating a regular diet and feeling well. The patient was \nafebrile with stable vital signs. The patient's hematocrit was \nacceptable and pain was adequately controlled on an oral \nregimen. The operative extremity was neurovascularly intact.\n \nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity. Please use walker or 2 \ncrutches for as long as you need. The physical therapist will \nhelp guide you until you are safe to wean from assistive \ndevices.\n \nMr. ___ is discharged to home with services in stable \ncondition."}}
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{'final_diagnoses': ['Superficial infection right THA'], 'procedures': ['Right hip I&D, head/liner exchange'], '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:\nPOD #1, Infectious Disease was consulted for antibiotic \nmanagement pending OR cultures. They recommended continuing IV \nAncef and Vancomycin pending OR cultures, CBC/diff, CPK, CRP, \nAST/ALT, Bun/Cr, blood cultures. Minimal output noted on Prevena \nvac dressing.\nPOD #2, OR cultures showed +staph aureus and ID recommended \ndiscontinuation of IV Ancef and continuing IV Vancomycin pending \nsensitivities. Vanco trough was 23.3 and dose was decreased to \n750mg Q12.\nPOD #3, ID recommended discontinuation of IV Vancomycin and \nstarting IV Daptomycin 450mg Q24. Prevena continued to show no \noutput. Final urine cultures showed no growth.\nPOD #4, blood cultures showed no growth to date x 48 hours and \npatient was consented for PICC line placement. Prevena vac \ndressing was removed and Aquacel dressing was applied. Patient \ncontinued to report burning sensation with urination and a \nrepeat urinalysis was obtained. The result of the urinalysis and \nurine culture were negative. He continued to receive \nintermittent straight cathing which he also does at home. \nOn POD#5, his PICC line was placed successfully. \n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Coumadin daily for DVT \nprophylaxis starting on POD #0. The Aquacel dressing remained \nclean and intact without erythema or abnormal \ndrainage/saturation. The patient was seen daily by physical \ntherapy. Labs were checked throughout the hospital course and \nrepleted accordingly. At the time of discharge, the patient was \ntolerating a regular diet and feeling well. The patient was \nafebrile with stable vital signs. The patient's hematocrit was \nacceptable and pain was adequately controlled on an oral \nregimen. The operative extremity was neurovascularly intact.\n \nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity. Please use walker or 2 \ncrutches for as long as you need. The physical therapist will \nhelp guide you until you are safe to wean from assistive \ndevices.\n \nMr. ___ is discharged to home with services in stable \ncondition.", 'medications_prescribed': ['Acetaminophen 1000 mg PO Q8H', 'Daptomycin 450 mg IV Q24H \nRX *daptomycin 500 mg 450 mg IV Q24H Disp #*42 Vial Refills:*0', 'Senna 8.6 mg PO BID', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN \nBREAKTHROUGH PAIN', '___ MD to order daily dose PO ONCE Duration: 1 Dose', 'Ascorbic Acid ___ mg PO DAILY', 'Aspirin EC 81 mg PO DAILY', 'Docusate Sodium 100 mg PO TID', 'Finasteride 5 mg PO DAILY', 'Multivitamins 1 TAB PO DAILY', 'pitavastatin calcium 2 mg oral QHS', 'Tamsulosin 0.4 mg PO BID', 'HELD- Fish Oil (Omega 3) 1000 mg PO BID This medication was \nheld. Do not restart Fish Oil (Omega 3) until 4 weeks post-op', 'HELD- Vitamin E 400 UNIT PO DAILY This medication was held. \nDo not restart Vitamin E until 4 weeks post-op']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 54, 'gender': 'M', 'symptoms': 'shortness of breath', 'medical_history': ['1)ESRD secondary to RPGN: baseline Cr ___', '-s/p 3 renal transplants: two failed renal transplants - LRRT \n___ (from her brother), s/p DCD in ___ and another DCD in \n___ with what appears to be chronic allograft nephropathy (bx \n___.', '2)Hypertension', '3)GERD', '4)Anemia', '5)S/p gastric bypass few yrs ago - had DM-II for ___ prior to \nthat, but surgery "cured DM"', '6)Hepatitis C secondary to blood transfusion', '7)Bradycardia', '8)s/p Parathyroidectomy', '9)L knee chronic pain following injury; s/p lumbar sympathetic\nblock to limit pain on ___ at ___ clinic', '10)Neuropathic foot pain, uncertain etiology', '11)Spina bifida occulta', '12)Tension headaches/chronic headaches', '13)Fecal/urinary incontinence', '14)Recurrent UTIs', '15)Osteopenia', '16)s/p ventral hernia repair in ___'], 'family_history': 'Maternal grandmother with history of liver cancer, CVA. Mother \nwas killed at age ___. Father died of lung cancer, was former \n___. Has 7 living siblings, one with HTN and ESRD on \nHD, one with DM. One died of MI, one has thyroid disease. ', 'present_illness': "Ms. ___ is ___ year old woman with an extensive PMH \nincluding Hepatitis C, ESRD s/p 3 kidney transplants (last in \n___, not on HD), HTN (recently discharged on ___ p/w chest \nheaviness and shortness of breath since this morning. The \npatient reports that she was watching television last night when \nshe felt a heaviness in her chest. She said that she had the \nsensation that she could not get enough air and felt tingly all \nover her body. She sat up, but it did not improve her feeling of \nchest heaviness or air hunger. She denies any chest pain, \npalpitations, fever, chills, diaphoresis, nausea, vomiting. She \nalso reports another episode a few days prior to admission when \nshe was in bed. During this episode, she states that she was \nfalling asleep and suddenly felt that she could not breathe. She \nendorses heart palpitations and anxiety during this episode and \nestimates that it resolved after about 10 minutes.\n.\nIn the ED, initial vs were: T 97 P 84 BP 118/73 R 28 O2 sat \n100%RA. Patient was given supplemental O2 in the ED that \nresolved her symptoms. She had a prolonged ED course while \nwaiting for a hospital bed, so she was placed on Heparin gtt out \nof concern for PE and received a CXR and V/Q scan that were both \nnegative. She ruled out for MI with ___ negative sets of CE's. \nIn the ED, the patient also complained of periumbilical pain, so \nSurgery was consulted and she received a non-contrast \nabdominopelvic CT and renal ultrasound that demonstrated a \ndiffusely dilated small bowel to the ileum, but no obstruction.\n.\nOn the floor, the patient reported feeling well, without \ncomplaints. She was passing flatus and had a bowel movement.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'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': 'Valsartan', '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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', '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': '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-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': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'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': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', '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': 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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Terbinafine 1% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', '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': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Ondansetron', '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': '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'GlyBURIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', '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': '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', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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}]}, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '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': 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 1.7,. Estimated GFR = 42 if non African-American (mL/min/1.73 m2). Estimated GFR = 51 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': '211', 'valuenum': 211.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, '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': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '261', 'valuenum': 261.0, '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': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9.7, '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': '11', 'valuenum': 11.0, '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '237', 'valuenum': 237.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, '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': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '261', 'valuenum': 261.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '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': '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': '___', 'valuenum': 13.4, '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': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.94', 'valuenum': 3.94, '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': '13', 'valuenum': 13.0, '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': 10.2, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, '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': '3.4', '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '145', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '29.0', 'valuenum': 29.0, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '357', 'valuenum': 357.0, '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': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, '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': '222', 'valuenum': 222.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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0.0, 'ref_range_upper': 0.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '428', 'valuenum': 428.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '580', 'valuenum': 580.0, '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': 'POSITIVE RARE EOS.'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', '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': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.1', 'valuenum': 22.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '5.8', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '61.1', 'valuenum': 61.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '379', 'valuenum': 379.0, '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': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, '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': '106', 'valuenum': 106.0, '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': 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 2.3,. Estimated GFR = 30 if non African-American (mL/min/1.73 m2). Estimated GFR = 36 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': '299', 'valuenum': 299.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '243', 'valuenum': 243.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', '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': '53', 'valuenum': 53.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, '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': '28.6', 'valuenum': 28.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, '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': '354', 'valuenum': 354.0, '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': '3.64', 'valuenum': 3.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, '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': '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': '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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T: 98 BP: 151/92 P: 71 R: 18 O2: 96 RA\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNeck: supple, JVP not elevated, no LAD\nLungs: Portocath, clear to auscultation bilaterally, no wheezes, \nrales, rhonchi\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\nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema', 'diagnoses': [{'icd_code': '25062', 'desc': 'Diabetes with neurological manifestations, type II or unspecified type, uncontrolled'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '70714', 'desc': 'Ulcer of heel and midfoot'}, {'icd_code': '7135', 'desc': 'Arthropathy associated with neurological disorders'}, {'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': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}], 'summary': "___ 12:08AM BLOOD WBC-8.7 RBC-3.71* Hgb-10.4* Hct-31.0* \nMCV-84 MCH-27.9 MCHC-33.4 RDW-15.0 Plt ___\n___ 02:00PM BLOOD ___ PTT->150* ___\n___ 12:08AM BLOOD Glucose-85 UreaN-40* Creat-2.8* Na-140 \nK-3.6 Cl-106 HCO3-20* AnGap-18\n___ 08:15AM BLOOD CK(CPK)-50\n___ 12:08AM BLOOD CK(CPK)-67\n___ 08:15AM BLOOD cTropnT-<0.01\n___ 12:08AM BLOOD cTropnT-<0.01\n___ 12:08AM BLOOD CK-MB-NotDone proBNP-787*\n___ 02:59AM URINE Blood-NEG Nitrite-NEG Protein-25 \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.0 Leuks-SM\n___ 02:59AM URINE ___ Bacteri-NONE Yeast-NONE \n___ year old woman with complicated PMH and multiple recent \nhospitalizations for numerous complaints admitted for chest \nheaviness & shortness of breath concerning for panic attacks.\n.\n# Chest heaviness/SOB: Patient reported 2 episodes of \npalpitations, chest heaviness, and shortness of breath that \nresolved within minutes. Given the time course, resolution of \nsymptoms without intervention, and description of the events, \nthere was some concern for panic attacks. The patient ruled out \nfor MI and a V/Q scan was negative. She was able to breathe \ncomfortably on room air throughout her stay and had no further \nepisodes of these symptoms as an inpatient. There was also some \nconcern that this could be ___ her known GERD, so she was \nadvised to take Maalox PRN for these episodes. The team explored \nthe possibility of panic attacks with the patient, who, with \nfurther discussion, admitted recurring fears of death and dying \nand her own belief that these episodes may be anxiety related. \nShe was not interested in starting an SSRI at this time, but \nstated that she would discuss this with her PCP if she had \nadditional episodes.\n.\n# ESRD secondary to RPGN: Patient with a baseline Cr of 2.4. On \nadmission, her Cr was 2.8 and she received IVF's in the ED. She \nrefused AM labs to re-evaluate her Cr function the following \nday. Otherwise, there were no acute issues during this admission \nand she was continued on her home Calcitriol 0.5 mcg daily, \nCalcium Carbonate 500mg twice daily, Sirolimus 3mg daily, \nPrednisone 5mg daily, Ferrous Sulfate 325 mg Daily, and Sodium \nBicarbonate 650 mg PO twice a day.\n.\n#. Hypertension: Patient not hypertensive on admission, but with \nelevated bp's (sbp's 150's) on arrival to the floor as she did \nnot receive her home medications in the ED overnight. Her bp's \nreturned to normal on her home Nifedipine 60mg XR daily\n& Metoprolol Tartrate 100 mg Tablet BID.\n.\n#. GERD: Continued patient's home Ranitidine 75mg twice daily &\nPantoprazole 40 mg Tablet q12H.\n.\n# Anemia: Chronic issue, Hct on admission consistent with prior. \nContinued on home Ferrous Sulfate 325mg daily.\n.\n#. Hepatitis C secondary to blood transfusion: Not an active \nissue on this admission, not currently on medication.\n.\n#. L knee chronic pain: Patient denies any pain on admission. \nShe was continued on her home Lidocaine HCl 5 % Ointment, \nOxycontin 20 mg BID, and Oxycodone 5mg q4H:PRN pain.\n.\n# Migraine Headaches: Patient with low-grade HA in the ED, not \nconsistent with migraines that resolved with Tylenol. She \ncontinued her home Nortriptyline 50mg qHS.\n.\nCode: Patient remained FULL CODE throughout this \nhospitalization."}}
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{'final_diagnoses': ['Dyspnea on exertion', 'Panic attack', 'ESRD'], 'procedures': ['none'], 'visit_summary': "___ year old woman with complicated PMH and multiple recent \nhospitalizations for numerous complaints admitted for chest \nheaviness & shortness of breath concerning for panic attacks.\n.\n# Chest heaviness/SOB: Patient reported 2 episodes of \npalpitations, chest heaviness, and shortness of breath that \nresolved within minutes. Given the time course, resolution of \nsymptoms without intervention, and description of the events, \nthere was some concern for panic attacks. The patient ruled out \nfor MI and a V/Q scan was negative. She was able to breathe \ncomfortably on room air throughout her stay and had no further \nepisodes of these symptoms as an inpatient. There was also some \nconcern that this could be ___ her known GERD, so she was \nadvised to take Maalox PRN for these episodes. The team explored \nthe possibility of panic attacks with the patient, who, with \nfurther discussion, admitted recurring fears of death and dying \nand her own belief that these episodes may be anxiety related. \nShe was not interested in starting an SSRI at this time, but \nstated that she would discuss this with her PCP if she had \nadditional episodes.\n.\n# ESRD secondary to RPGN: Patient with a baseline Cr of 2.4. On \nadmission, her Cr was 2.8 and she received IVF's in the ED. She \nrefused AM labs to re-evaluate her Cr function the following \nday. Otherwise, there were no acute issues during this admission \nand she was continued on her home Calcitriol 0.5 mcg daily, \nCalcium Carbonate 500mg twice daily, Sirolimus 3mg daily, \nPrednisone 5mg daily, Ferrous Sulfate 325 mg Daily, and Sodium \nBicarbonate 650 mg PO twice a day.\n.\n#. Hypertension: Patient not hypertensive on admission, but with \nelevated bp's (sbp's 150's) on arrival to the floor as she did \nnot receive her home medications in the ED overnight. Her bp's \nreturned to normal on her home Nifedipine 60mg XR daily\n& Metoprolol Tartrate 100 mg Tablet BID.\n.\n#. GERD: Continued patient's home Ranitidine 75mg twice daily &\nPantoprazole 40 mg Tablet q12H.\n.\n# Anemia: Chronic issue, Hct on admission consistent with prior. \nContinued on home Ferrous Sulfate 325mg daily.\n.\n#. Hepatitis C secondary to blood transfusion: Not an active \nissue on this admission, not currently on medication.\n.\n#. L knee chronic pain: Patient denies any pain on admission. \nShe was continued on her home Lidocaine HCl 5 % Ointment, \nOxycontin 20 mg BID, and Oxycodone 5mg q4H:PRN pain.\n.\n# Migraine Headaches: Patient with low-grade HA in the ED, not \nconsistent with migraines that resolved with Tylenol. She \ncontinued her home Nortriptyline 50mg qHS.\n.\nCode: Patient remained FULL CODE throughout this \nhospitalization.", 'medications_prescribed': ['1. Calcitriol 0.5 mcg Capsule Sig: One (1) Capsule PO DAILY \n(Daily). ', '2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO BID (2 times a day). ', '3. Nifedipine 60 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO DAILY (Daily). ', '4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '5. Oxycodone 20 mg Tablet Sustained Release 12 hr Sig: One (1) \nTablet Sustained Release 12 hr PO Q12H (every 12 hours). ', '6. Ranitidine HCl 15 mg/mL Syrup Sig: One (1) PO BID (2 times a \nday). ', '7. Sirolimus 1 mg Tablet Sig: Three (3) Tablet PO DAILY (Daily). ', '8. Prednisone 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '9. Clonazepam 0.5 mg Tablet Sig: ___ Tablets PO QHS (once a day \n(at bedtime)) as needed for insomnia. ', '10. Diphenoxylate-Atropine 2.5-0.025 mg Tablet Sig: One (1) \nTablet PO Q6H (every 6 hours) as needed for diarrhea. ', '11. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '12. Lidocaine HCl 5 % Ointment Sig: One (1) Appl Topical TID (3 \ntimes a day) as needed for pain. ', '13. Metoprolol Tartrate 100 mg Tablet Sig: One (1) Tablet PO \ntwice a day. ', '14. Nortriptyline 50 mg Capsule Sig: One (1) Capsule PO at \nbedtime. ', '15. Oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain. ', '16. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q12H (every 12 hours). ', '17. Loperamide 2 mg Capsule Sig: One (1) Capsule PO BID (2 times \na day) as needed for diarrhea. ', '18. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '19. Sumatriptan Succinate 25 mg Tablet Sig: One (1) Tablet PO \nPRN (as needed) as needed for headache. ', '20. Sodium Bicarbonate 650 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day). ', '21. Hydroxyzine HCl 25 mg Tablet Sig: Two (2) Tablet PO PRN (as \nneeded) as needed for before pain medication. ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'dizziness', 'medical_history': ['- recent admission for sepsis with MSSA bacteremia, s/p 4 weeks \ncefazolin - just finished ___. Unable to r/o endocarditis at \nthat time due to co-morbid conditions', '- CKD Stage 3', '- dCHF - volume overloaded during last admission requiring \ndialysis, currently on torsemide and spironolactone', '- Anemia - multifactorial', '- GI bleed ___ EGD found no evidence of active bleeding or \nulceration)', '- Alcoholic hepatitis/cirrhosis (followed as out-patient) c/b \nhepatic encephalopathy (___)', '- Splenomegaly (outside u/s ___', '- OSA; written for CPAP, but noncompliant', '- GERD', '- EtOH abuse; has been abstinent since ___', '- Obesity', '- folate deficiency', '- migraine', '- multiple ventral hernias', '- history of epididymitis', 'PSH:\n- Cholecystectomy', '- Gastric bipass', '- Tonsillectomy'], 'family_history': 'Grandmother - d. breast cancer in ___\nMother - CAD, DM\nFather - DM', 'present_illness': 'Mr. ___ is a ___ gentleman with a history of EtOH \ncirrhosis, CKD, dCHF, morbid obesity and anemia who presents \nwith dizziness. \nPatient reports acute onset of dizziness yesterday. He had been \nin his usual state of health until yesterday when he started \nfeeling weakness, unsteady and dizzy. He denies room spinning. \nNO SOB, CP, headache or palpitations. He reports these symptoms \nare similar to when he has been anemic in the past and required \ntransfusions. He reports an episode of prolonged epistaxis the \nday before. \nThe patient was recently admitted in ___ for sepsis with \nMSSA bacteremia. He just finished a 4 week course of cefazolin \non ___. He was never fully evaluated for endocarditis at that \ntime ___ his other co-morbidities. His hospital course was \ncomplicated by worsening renal function and significant volume \noverload requiring dialysis for volume removal.Since discharge, \nhe has continued to lose volume with diuretics. He has also lost \na significant amount of weight with diet and exercise. \nHe denies fever, chills. No N/V/diarrhea. No dysuria. No change \nin po intake. \nIn the ED intial vitals were: 98.5 94 129/50 16 100% ra \nOrthostatics were positive \nlying: 114/43, 97 \nsitting: 130/59, 129 \nstanding: 122/63, 134 \n- Labs were significant for Cr 3.0, BUN 78 \n- Patient was started on 1L IVF \nVitals prior to transfer were: 97.8 97 114/43 14 100% RA', 'medications': [{'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': '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 Gluconate', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H: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}, {'medication': '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': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H: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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H: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': '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', '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': 'Expired', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '41.4', 'valuenum': 41.4, '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': '29.4', 'valuenum': 29.4, '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': '183', 'valuenum': 183.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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}, {'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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '1.1', 'valuenum': 1.1, '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': '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': '4.1', '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': '16', 'valuenum': 16.0, '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': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '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': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, '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': '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '35.3', 'valuenum': 35.3, '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': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.40', 'valuenum': 4.4, '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': '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': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.9', '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, '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': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, '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': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.55', 'valuenum': 4.55, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, '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': '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': '107', 'valuenum': 107.0, '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': '3.4', 'valuenum': 3.4, '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '29.2', 'valuenum': 29.2, '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': '86', 'valuenum': 86.0, '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': 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': '4.88', 'valuenum': 4.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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}], 'exams': 'ON ADMISSION:\n============\nVS: 98.1 122/70 107 20 99% on RA \nGeneral- Obese but considerable weight loss since last \nadmission, NAD, resting comfortably \nHEENT- Sclera mild icterus, MMM, oropharynx with cracked lips \nthat are oozing blood \nNeck- supple \nLungs- Clear to auscultation bilaterally, no w/r/r \nCV- Regular rate and rhythm, II/VI SEM at LUSB, normal S1 + S2, \nno m/r/g \nAbdomen- Obese. soft, non-tender, non-distended, bowel sounds \npresent, no rebound tenderness or guarding, well healed midline \nscar present. \nExt- chronic venous stasis changes and lyphedema bilateral lower \n \nextremities, no pitting edema, 2+ peripheral pulses \nNeuro- A&Ox3, CNs2-12 intact\n\nON DISCHARGE:\n===========\nVS: 97.5, 82, 100/50, 100% on RA \nGeneral- NAD, resting comfortably \nHEENT- Sclera mild icterus, MMM, anicteric sclera \nNeck- supple, thick neck \nLungs- Clear to auscultation bilaterally, no w/r/r \nCV- Regular rate and rhythm, II/VI SEM at LUSB\nAbdomen- Obese. soft, non-tender, non-distended, bowel sounds \npresent, no rebound tenderness or guarding \nExt- chronic venous stasis changes and lyphedema bilateral lower \n \nextremities, no pitting edema, 2+ peripheral pulses\nSkin: excess loose skin especially in arms after weight loss \nNeuro- A&Ox3, +asterixis', 'diagnoses': [{'icd_code': '99859', 'desc': 'Other postoperative infection'}, {'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '99591', 'desc': 'Sepsis'}, {'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': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '79093', 'desc': 'Elevated prostate specific antigen [PSA]'}, {'icd_code': '7850', 'desc': 'Tachycardia, unspecified'}], 'summary': "ON ADMISSSION:\n============\n\n___ 01:40AM BLOOD WBC-8.1 RBC-2.80* Hgb-7.5* Hct-23.9* \nMCV-86 MCH-26.9* MCHC-31.5 RDW-17.2* Plt ___\n___ 01:40AM BLOOD Neuts-70 Bands-0 ___ Monos-5 Eos-6* \nBaso-0 ___ Myelos-0\n___ 01:40AM BLOOD Hypochr-2+ Anisocy-OCCASIONAL \nPoiklo-OCCASIONAL Macrocy-OCCASIONAL Microcy-NORMAL \nPolychr-NORMAL Ovalocy-OCCASIONAL MacroOv-OCCASIONAL\n___ 01:40AM BLOOD ___ PTT-38.3* ___\n___ 01:40AM BLOOD Glucose-86 UreaN-78* Creat-3.0* Na-134 \nK-4.8 Cl-96 HCO3-24 AnGap-19\n___ 01:40AM BLOOD ALT-19 AST-80* AlkPhos-160* TotBili-2.2*\n___ 01:40AM BLOOD Albumin-3.4* Calcium-9.0 Phos-5.5*# \nMg-2.4\n___ 01:40AM BLOOD TSH-3.9\n___ 02:40AM URINE Color-Yellow Appear-Clear Sp ___\n___ 02:40AM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-2* pH-6.0 Leuks-NEG\n___ 02:40AM URINE Hours-RANDOM UreaN-347 Creat-58 Na-69 \nK-18 Cl-55\n___ 02:40AM URINE Osmolal-325\n\nMICRO:\n=====\n___: BLOOD CX-PND\n\nIMAGING:\n========\nNONE\n\nDISCHARGE LABS:\n============\n\n___ 08:00AM BLOOD WBC-4.9 RBC-2.49* Hgb-6.5* Hct-21.4* \nMCV-86 MCH-26.2* MCHC-30.6* RDW-17.2* Plt Ct-82*\n___ 08:00AM BLOOD Glucose-91 UreaN-76* Creat-2.3* Na-135 \nK-4.2 Cl-101 HCO3-24 AnGap-14\nMr. ___ is a ___ gentleman with a history of EtOH \ncirrhosis, CKD, dCHF, morbid obesity and anemia who presented \nwith dizziness.\n\nACTIVE MEDICAL ISSUES: \n#Dizziness - Most likely secondary to dehydration from \noverdiuresis. Pt found to have positive orthostatics in ED and \ndizziness resolved with holding diuretics and 1.5 L fluids. \nOrthostatics negative on ___ and pt no longer tachycardiac. ___ \nalso be component of pt's chronic anemia (see below). Less \nlikely infectious as pt afebrile, normal wbc ct, and no \nlocalizing signs of infection. \n\n# acute on chronic kidney disease: Prior to admission patient's \nmost recent Cr 2.1, which may be his new baseline. His Cr was \nnow increased to 3.0 on admission, most likely pre-renal in \nsetting of heavy diuretic use. Cr improving with fluids which \nsupports pre-renal etiology. On discharge, his Cr was 2.3 which \nwas close to baseline, 2.3. His torsemide was restarted at a \nlower dose (60 mg) and spironolactone (100 mg, admission dose) \nwas restarted. Pt has appointment to follow up with PCP for labs \nto monitor Cr and titrate diuretics as needed.\n\nCHRONIC MEDICAL ISSUES:\n#alcoholic cirrhosis: Pt has hx of hepatic encephalopathy. No \nevidence of ascites in past and none on exam this admission \nalthough difficult given pt's body habitus. No abdominal pain or \nperitonitis on exam to suggest SBP. INR downtrended to 1.3 since \nlast admission, LFTs stable. During this admission he was AOx3 \nbut was noted to have asterixis on exam. Pt been on rifaxamin at \ndischarge but states this medicine has been stopped by his PCP. \nGiven his asterixis, pt was restarted on rifaxamin and lactulose \ntitrate to no more than ___ BM per day (given his recent \ndehydration)\n\n# morbid obesity - Pt has lost close to 100lbs in the last ___ \nweeks. Most of that large component of fluid loss as well as \ncomponent of diet changes and increased exercise activity. Pt \ndenies fevers, nightsweats or other concerning symptoms to \nsuggest malignancy. \n \n# Anemia - Pt with chronic anemia that has been worked up in the \npast and thought to be multifactorial. He had slight downtrend \nin hgb 6.8-> 6.5 in setting of epistaxis (although more oozing \nblood from nose rather than large bleed) . Pt was continued on \niron. Given that pt was no longer symptomatic on discharge and \nnot actively bleeding, he was not transfused. He was a follow up \nappointment in ___ clinic next week. Hgb on discharge 6.5.\n \n# dCHF - Pt with previously issues with volume overload \nrequiring ICU stay and dialysis for volume removal. Last echo in \n___ showed severe pulmonary artery systolic hypertension \n(previously mild), mild mitral regurgitation, preserved EF. His \ntorsemide was restarted at a lower dose (60 mg) and \nspironolactone (100 mg, admission dose) was restarted. He was \ntold to weight himself daily and call his doctor if his weight \nincreased by ___ lb per day.\n\n# hypothyroidism: Pt's TSH was checked and found to be 3.9. He \nwas continued on his home synthroid dose."}}
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{'final_diagnoses': ['dehydration', '___ on CKD'], 'procedures': ['none'], 'visit_summary': "Mr. ___ is a ___ gentleman with a history of EtOH \ncirrhosis, CKD, dCHF, morbid obesity and anemia who presented \nwith dizziness.\n\nACTIVE MEDICAL ISSUES: \n#Dizziness - Most likely secondary to dehydration from \noverdiuresis. Pt found to have positive orthostatics in ED and \ndizziness resolved with holding diuretics and 1.5 L fluids. \nOrthostatics negative on ___ and pt no longer tachycardiac. ___ \nalso be component of pt's chronic anemia (see below). Less \nlikely infectious as pt afebrile, normal wbc ct, and no \nlocalizing signs of infection. \n\n# acute on chronic kidney disease: Prior to admission patient's \nmost recent Cr 2.1, which may be his new baseline. His Cr was \nnow increased to 3.0 on admission, most likely pre-renal in \nsetting of heavy diuretic use. Cr improving with fluids which \nsupports pre-renal etiology. On discharge, his Cr was 2.3 which \nwas close to baseline, 2.3. His torsemide was restarted at a \nlower dose (60 mg) and spironolactone (100 mg, admission dose) \nwas restarted. Pt has appointment to follow up with PCP for labs \nto monitor Cr and titrate diuretics as needed.\n\nCHRONIC MEDICAL ISSUES:\n#alcoholic cirrhosis: Pt has hx of hepatic encephalopathy. No \nevidence of ascites in past and none on exam this admission \nalthough difficult given pt's body habitus. No abdominal pain or \nperitonitis on exam to suggest SBP. INR downtrended to 1.3 since \nlast admission, LFTs stable. During this admission he was AOx3 \nbut was noted to have asterixis on exam. Pt been on rifaxamin at \ndischarge but states this medicine has been stopped by his PCP. \nGiven his asterixis, pt was restarted on rifaxamin and lactulose \ntitrate to no more than ___ BM per day (given his recent \ndehydration)\n\n# morbid obesity - Pt has lost close to 100lbs in the last ___ \nweeks. Most of that large component of fluid loss as well as \ncomponent of diet changes and increased exercise activity. Pt \ndenies fevers, nightsweats or other concerning symptoms to \nsuggest malignancy. \n \n# Anemia - Pt with chronic anemia that has been worked up in the \npast and thought to be multifactorial. He had slight downtrend \nin hgb 6.8-> 6.5 in setting of epistaxis (although more oozing \nblood from nose rather than large bleed) . Pt was continued on \niron. Given that pt was no longer symptomatic on discharge and \nnot actively bleeding, he was not transfused. He was a follow up \nappointment in ___ clinic next week. Hgb on discharge 6.5.\n \n# dCHF - Pt with previously issues with volume overload \nrequiring ICU stay and dialysis for volume removal. Last echo in \n___ showed severe pulmonary artery systolic hypertension \n(previously mild), mild mitral regurgitation, preserved EF. His \ntorsemide was restarted at a lower dose (60 mg) and \nspironolactone (100 mg, admission dose) was restarted. He was \ntold to weight himself daily and call his doctor if his weight \nincreased by ___ lb per day.\n\n# hypothyroidism: Pt's TSH was checked and found to be 3.9. He \nwas continued on his home synthroid dose.", 'medications_prescribed': ['1. Ferrous GLUCONATE 240 mg PO BID', '2. FoLIC Acid 1 mg PO DAILY', '3. Levothyroxine Sodium 75 mcg PO DAILY', '4. Multivitamins 1 TAB PO DAILY', '5. Pantoprazole 40 mg PO Q24H', '6. Spironolactone 100 mg PO DAILY \nHold this medication if you feel dizzy or if your weight \ndecreased ___ lb per day', '7. Torsemide 60 mg PO DAILY \nHold this medication if you feel dizzy or if your weight \ndecreased ___ lb per day \nRX *torsemide 20 mg 3 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', '8. Lactulose 30 mL PO TID \nRX *lactulose 10 gram/15 mL (15 mL) 30 cc by mouth three times a \nday Disp #*1 Bottle Refills:*0', '9. Rifaximin 550 mg PO BID \nRX *rifaximin [Xifaxan] 550 mg 1 tablet(s) by mouth twice a day \nDisp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'M', 'symptoms': 'Abdominal pain', 'medical_history': ['Essential Thrombocythemia with V617F mutation', 'Myelofibrosis', 'Epistaxis requiring multiple transfusions ___', 'Cryptococcus neoformans pneumonia', 'Aspiration pneumonia', 'Pancytopenia'], 'family_history': 'Per ___ clinic notes, brother is alive and has\ndiabetes. Mother is alive and well. Father died at age ___ of\nheart disease. He denies any family history of hematologic\ndisease or malignancy.', 'present_illness': 'Mr. ___ is a ___ year old male with end stage myelofibrosis\non ruxolitinib who presents with progressive abdominal pain.\n\nHe was recently admitted at ___ from ___ with\nrefractory epistaxis that resovled after plt transfusion and\nrhino rocket. During that hospitalization, he was noted to have \na\nQTc of 500 which was attributed to his citalopram and \nfluconazole\nfor which he takes due to a history of pulmonary Cryptococcus\nneoformans. He was subsequently started on isavuconazole. \n\nIn addition, during that hospitalization, his ruxolitinib was\ndecreased from 10mg/5mg to 5mg BID due to drug-drug interactions\nwith isavuconazole. \n\nOn the morning of presentation, the patient noticed the sudden\nonset of intense, sharp LUQ abdominal pain without radiation. It\nwas not associated with any other symptoms. The patient notes\nthat it occurred after taking his Jakafi and cresemba. He called\nhis oncologist who recommended he present to the ED for further\nevaluation.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Neomycin Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ASDIR', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': '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': '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': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', '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': 'Heparin', 'proc_type': 'IV Piggyback', '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', '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': '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': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, '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': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '266', 'valuenum': 266.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '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': '8.9', 'valuenum': 8.9, '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': '0.9', '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 = >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': 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': '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 144.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '84.8', 'valuenum': 84.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '30.0', 'valuenum': 30.0, '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '256', 'valuenum': 256.0, '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': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, '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': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': 109.0, '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': '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': '3.9', 'valuenum': 3.9, '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 104.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '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': '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': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '66.0', 'valuenum': 66.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '8.8', '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': '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': 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': '2.1', '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': '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, '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': '32.3', 'valuenum': 32.3, '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': '226', 'valuenum': 226.0, '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': '3.67', 'valuenum': 3.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74.8', 'valuenum': 74.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '82.1', 'valuenum': 82.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '65.7', 'valuenum': 65.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.9', 'valuenum': 51.9, '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': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'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': '5', 'valuenum': 5.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, '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': 'FEW.'}, {'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': '56.4', 'valuenum': 56.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '64.1', 'valuenum': 64.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': 'ROUTINE', 'comments': None}, {'value': '62.4', 'valuenum': 62.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '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': '83.0', 'valuenum': 83.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97.5', 'valuenum': 97.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': '===============\nADMISSION EXAM:\n===============\nPHYSICAL EXAM: \nVITALS: T 97.3 BP 115/72 HR 100 R 18 SpO2 99 Ra \nGENERAL: Chronically ill appearing, fatigued, NAD\nHEENT: Moist membranes without lesions. temporal wasting\nEYES: PERRL, anicteric\nNECK: supple\nRESP: CTAB, no wheezing, rhonchi or crackles. Mild splinting \ndue\nto abd pain\n___: RRR no MRG\nGI: Hard mass involving entire left hemi-abdomen. Tender to\npalpation without rebound or guarding\nEXT: warm, no edema. Noted sarcopenia\nSKIN: dry\nNEURO: CN II-XII intact\nACCESS: PIV\n\n===============\nDISCHARGE EXAM:\n===============\n98.3 110/60 90 18 96 \nGENERAL: Chronically ill appearing, fatigued, NAD\nHEENT: Moist membranes without lesions. temporal wasting\nEYES: PERRL, anicteric\nNECK: supple\nRESP: CTAB, no wheezing, rhonchi or crackles. Mild splinting \ndue\nto abd pain\n___: RRR no MRG\nGI: Hard mass involving entire left hemi-abdomen. Tender to\npalpation without rebound or guarding\nEXT: warm, no edema. Noted sarcopenia\nSKIN: dry\nNEURO: CN II-XII intact\nACCESS: PIV', 'diagnoses': [{'icd_code': '2352', 'desc': 'Neoplasm of uncertain behavior of stomach, intestines, and rectum'}, {'icd_code': '42732', 'desc': 'Atrial flutter'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '99859', 'desc': 'Other postoperative infection'}, {'icd_code': '6822', 'desc': 'Cellulitis and abscess of trunk'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'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'}], 'summary': "___ 08:30PM URINE HOURS-RANDOM CREAT-93 SODIUM-151 \nPHOSPHATE-6.6\n___ 08:30PM URINE OSMOLAL-614\n___ 08:30PM URINE UHOLD-HOLD\n___ 08:30PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 08:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-100* \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-8.5* \nLEUK-NEG\n___ 08:30PM URINE RBC-<1 WBC-5 BACTERIA-FEW* YEAST-NONE \nEPI-0\n___ 08:30PM URINE HYALINE-3*\n___ 08:30PM URINE MUCOUS-RARE*\n___ 07:48PM COMMENTS-GREEN TOP\n___ 07:48PM LACTATE-1.3\n___ 07:45PM GLUCOSE-94 UREA N-16 CREAT-1.2 SODIUM-139 \nPOTASSIUM-4.3 CHLORIDE-105 TOTAL CO2-26 ANION GAP-8*\n___ 07:45PM estGFR-Using this\n___ 07:45PM ALT(SGPT)-12 AST(SGOT)-38 ALK PHOS-139* TOT \nBILI-1.0\n___ 07:45PM LIPASE-14\n___ 07:45PM ALBUMIN-4.1 CALCIUM-8.2* PHOSPHATE-1.6* \nMAGNESIUM-2.2\n___ 07:45PM WBC-42.0* RBC-3.30* HGB-8.7* HCT-31.9* MCV-97 \nMCH-26.4 MCHC-27.3* RDW-19.9* RDWSD-66.2*\n___ 07:45PM NEUTS-86* BANDS-5 LYMPHS-0* MONOS-0* EOS-0* \n___ MYELOS-9* NUC RBCS-19.6* AbsNeut-38.22* AbsLymp-0.00* \nAbsMono-0.00* AbsEos-0.00* AbsBaso-0.00*\n___ 07:45PM POIKILOCY-2+* POLYCHROM-1+* OVALOCYT-1+* \nSTIPPLED-1+* TEARDROP-1+*\n___ 07:45PM PLT SMR-VERY LOW* PLT COUNT-34*\n___ 08:25AM UREA N-11 CREAT-1.0 SODIUM-140 POTASSIUM-4.1 \nCHLORIDE-107 TOTAL CO2-23 ANION GAP-10\n___ 08:25AM ALT(SGPT)-13 AST(SGOT)-38 LD(LDH)-1210* ALK \nPHOS-140* TOT BILI-0.9\n___ 08:25AM PHOSPHATE-1.1*\n___ 08:25AM CALCIUM-8.4 URIC ACID-4.1\n___ 08:25AM WBC-54.6* RBC-3.18* HGB-8.7* HCT-29.9* MCV-94 \nMCH-27.4 MCHC-29.1* RDW-19.5* RDWSD-64.7*\n___ 08:25AM NEUTS-71 BANDS-5 LYMPHS-1* MONOS-4* EOS-1 \nBASOS-2* METAS-4* MYELOS-11* NUC RBCS-15.4* AbsNeut-41.50* \nAbsLymp-0.55* AbsMono-2.18* AbsEos-0.55* AbsBaso-1.09*\n___ 08:25AM ANISOCYT-3+* MACROCYT-1+* MICROCYT-1+* \nPOLYCHROM-2+* RBCM-SLIDE REVI\n___ 08:25AM PLT SMR-VERY LOW* PLT COUNT-33*\n\n=============\nMICROBIOLOGY:\n=============\n__________________________________________________________\n___ 8:45 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): No growth to date. \n__________________________________________________________\n___ 8:30 pm URINE\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n__________________________________________________________\n___ 7:45 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): No growth to date. \n__________________________________________________________\n___ 9:34 pm URINE Source: ___. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n\n========\nSTUDIES:\n========\nCT Abd/pelvis ___:\n1. Worsening massive splenomegaly with multiple areas of \ninfarction, some of which appear new. Trace perisplenic \nascites. \n2. Left kidney appears increasingly malrotated since ___ \ndue to \nworsening splenomegaly with resultant new mild hydronephrosis. \n3. No definite diverticulosis or diverticulitis. \n\n===============\nDISCHARGE LABS:\n===============\n___ 06:40AM BLOOD WBC-31.6* RBC-2.53* Hgb-6.8* Hct-24.4* \nMCV-96 MCH-26.9 MCHC-27.9* RDW-19.5* RDWSD-66.0* Plt Ct-25*\n___ 06:40AM BLOOD Neuts-73* Bands-11* Lymphs-6* Monos-3* \nEos-1 Baso-1 Atyps-2* Myelos-2* Blasts-1* NRBC-25.3* \nAbsNeut-26.54* AbsLymp-2.53 AbsMono-0.95* AbsEos-0.32 \nAbsBaso-0.32*\n___ 06:40AM BLOOD Anisocy-2+* Poiklo-2+* Microcy-1+* Tear \nDr-1+* Ellipto-2+* RBC Mor-SLIDE REVI\n___ 06:40AM BLOOD Glucose-81 UreaN-19 Creat-1.0 Na-139 \nK-4.2 Cl-103 HCO3-21* AnGap-15\n___ 06:40AM BLOOD Calcium-7.7* Phos-3.0 Mg-2.3\n===\nSUMMARY STATEMENT:\n===\n___ with end stage myelofibrosis who presents with progressive\nleft sided abdominal pain found to have a splenic infarct on CT \nlikely ___ progression of disease. \n\n==============\nACTIVE ISSUES:\n==============\n#ACUTE ABODMINAL PAIN\n#SPLENOMEGALLY:\nPatient presents with sudden onset abdominal pain with CT \nimaging\ndemonstrating massive splenomegaly with infarction likely ___ \nprogression of his underlying myelofibrosis. Initially \nconsidered that his splenomegaly could have been from decreasing \nhis ruxolitinib dose during last hospitalization, but given \nhemodynamically stable and the fact that he has end stage \ndisease, this likely represents progression of his \nmyelofibrosis. He was continued on his home Jakafi (ruxolitinib) \n5mg BID as this is the proper dose given his degree of \nthrombocytopenia and due to medication interactions. For pain \nmanagement, he was continued on his home tramadol, given PO \nmorphine 7.5mg Q4H PRN moderate pain, and IV morphine 2mg Q4H \nbreakthrough pain. He was sent home with PO tramadol and \nmorphine.\n\n#END STAGE MYELOFIBROSIS\n#LEUKOCYTOSIS\n#ANEMIA\n#THROMBOCYTOPENIA: On ruxolitinib with recent dose reduction. \nNot\na transplant candidate due to functional status. Cytopenias have\nbeen managed with outpatient transfusions. Continued on \nallopurinol and acyclovir prophylaxis and ruxolitinib 5mg BID. \nHe receiving 1uPRBCs on ___ for hgb 6.8.\n\n#HYPOPHOSPHATEMIA: New since ___. No hypercalcemia to \nindicated\nelevated PTH. No history of significantly decreased oral intake\nor diarrhea to suggest poor absorption or excretion. no other\nsignificant electrolyte abnormalities or glucosuria to suggest\nFanconi syndrome and FePO4 low. Phos improved with minimal \nrepletion. \n\n===============\nCHRONIC ISSUES:\n===============\n#HISTORY OF EPISTAXIS: Currently stable. Has required\ncauterization and rhino rocket previously. Continued on home \noxymetazoline PRN and amicar.\n\n#HISTORY OF PULMONARY CRYPTOCOCCUS: Recently d/c'd fluconazole\ndue to prolonged QTc and started on isavuconazole. QTc currently\n<500.\n\n#ANXIETY: Re-started citalopram as QTc wnl (may need to stop if \nchanging antifungal). Continued on home lorazepam. \n\n#BILATERAL KNEE PAIN: Recent MRI demonstrated b/l meniscal tears \nfor which he was continued on home tramadol and gabapentin.\n\n#Goals of Care: Patient is OK with intubation for reversible\ncauses such as airway protection during epistaxis. Has thought\nabout DNR previously, but would like to be full code currently.\n\n====================\nTRANSITIONAL ISSUES:\n====================\n[] Given splenomegaly and infarction, he may behave as \nfunctionally aplenic and could benefit from daily prophylactic \nabx or emergency abx to take if develop sx prior to presenting \nto ED\n[] Re-started citalopram as QTc wnl (may need to stop if \nchanging antifungal)\n[] Started on morphine in addition to home tramadol to control \nworsening abdominal pain. Well controlled currently, but may \nneed uptitration. \n[] Patient changes his code status on various hospitalizations. \nCurrently full code.\n\nThis patient was prescribed, or continued on, an opioid pain \nmedication at the time of discharge (please see the attached \nmedication list for details). As part of our safe opioid \nprescribing process, all patients are provided with an opioid \nrisks and treatment resource education sheet and encouraged to \ndiscuss this therapy with their outpatient providers to \ndetermine if opioid pain medication is still indicated."}}
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{'final_diagnoses': ['Splenic infarct', 'Myelofibrosis', 'Leukocytosis', 'Anemia', 'Thrombocytopenia'], 'procedures': ['None'], 'visit_summary': "===\nSUMMARY STATEMENT:\n===\n___ with end stage myelofibrosis who presents with progressive\nleft sided abdominal pain found to have a splenic infarct on CT \nlikely ___ progression of disease. \n\n==============\nACTIVE ISSUES:\n==============\n#ACUTE ABODMINAL PAIN\n#SPLENOMEGALLY:\nPatient presents with sudden onset abdominal pain with CT \nimaging\ndemonstrating massive splenomegaly with infarction likely ___ \nprogression of his underlying myelofibrosis. Initially \nconsidered that his splenomegaly could have been from decreasing \nhis ruxolitinib dose during last hospitalization, but given \nhemodynamically stable and the fact that he has end stage \ndisease, this likely represents progression of his \nmyelofibrosis. He was continued on his home Jakafi (ruxolitinib) \n5mg BID as this is the proper dose given his degree of \nthrombocytopenia and due to medication interactions. For pain \nmanagement, he was continued on his home tramadol, given PO \nmorphine 7.5mg Q4H PRN moderate pain, and IV morphine 2mg Q4H \nbreakthrough pain. He was sent home with PO tramadol and \nmorphine.\n\n#END STAGE MYELOFIBROSIS\n#LEUKOCYTOSIS\n#ANEMIA\n#THROMBOCYTOPENIA: On ruxolitinib with recent dose reduction. \nNot\na transplant candidate due to functional status. Cytopenias have\nbeen managed with outpatient transfusions. Continued on \nallopurinol and acyclovir prophylaxis and ruxolitinib 5mg BID. \nHe receiving 1uPRBCs on ___ for hgb 6.8.\n\n#HYPOPHOSPHATEMIA: New since ___. No hypercalcemia to \nindicated\nelevated PTH. No history of significantly decreased oral intake\nor diarrhea to suggest poor absorption or excretion. no other\nsignificant electrolyte abnormalities or glucosuria to suggest\nFanconi syndrome and FePO4 low. Phos improved with minimal \nrepletion. \n\n===============\nCHRONIC ISSUES:\n===============\n#HISTORY OF EPISTAXIS: Currently stable. Has required\ncauterization and rhino rocket previously. Continued on home \noxymetazoline PRN and amicar.\n\n#HISTORY OF PULMONARY CRYPTOCOCCUS: Recently d/c'd fluconazole\ndue to prolonged QTc and started on isavuconazole. QTc currently\n<500.\n\n#ANXIETY: Re-started citalopram as QTc wnl (may need to stop if \nchanging antifungal). Continued on home lorazepam. \n\n#BILATERAL KNEE PAIN: Recent MRI demonstrated b/l meniscal tears \nfor which he was continued on home tramadol and gabapentin.\n\n#Goals of Care: Patient is OK with intubation for reversible\ncauses such as airway protection during epistaxis. Has thought\nabout DNR previously, but would like to be full code currently.\n\n====================\nTRANSITIONAL ISSUES:\n====================\n[] Given splenomegaly and infarction, he may behave as \nfunctionally aplenic and could benefit from daily prophylactic \nabx or emergency abx to take if develop sx prior to presenting \nto ED\n[] Re-started citalopram as QTc wnl (may need to stop if \nchanging antifungal)\n[] Started on morphine in addition to home tramadol to control \nworsening abdominal pain. Well controlled currently, but may \nneed uptitration. \n[] Patient changes his code status on various hospitalizations. \nCurrently full code.\n\nThis patient was prescribed, or continued on, an opioid pain \nmedication at the time of discharge (please see the attached \nmedication list for details). As part of our safe opioid \nprescribing process, all patients are provided with an opioid \nrisks and treatment resource education sheet and encouraged to \ndiscuss this therapy with their outpatient providers to \ndetermine if opioid pain medication is still indicated.", 'medications_prescribed': ['Morphine Sulfate ___ 7.5 mg PO Q4H:PRN Pain - Moderate \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity\nRX *morphine 15 mg 0.5 (One half) tablet(s) by mouth Every 4 \nhours Disp #*30 Tablet Refills:*0', 'Polyethylene Glycol 17 g PO DAILY:PRN Constipation - Second \nLine \nRX *polyethylene glycol 3350 17 gram 1 packet by mouth Daily \nDisp #*30 Packet Refills:*0', 'Senna 8.6 mg PO BID:PRN Constipation - First Line \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth Twice daily Disp \n#*60 Tablet Refills:*0', 'Acyclovir 400 mg PO Q8H', 'Allopurinol ___ mg PO DAILY', 'Aminocaproic Acid 2 g PO TID', 'Gabapentin 100 mg PO BID', 'Isavuconazonium Sulfate 372 mg PO DAILY', 'Jakafi 5 mg PO BID', 'LORazepam 0.5 mg PO TID:PRN anxiety', 'Oxymetazoline 5 SPRY NU Q6H:PRN nosebleed', 'TraMADol 50 mg PO Q6H:PRN Pain - Moderate']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 66, 'gender': 'F', 'symptoms': 'fever', 'medical_history': ['1. Sarcoidosis, dx skin bx: intestinal & pulmonary involvement, \nrecurrent iritis', '2. Inflammatory bowel disease; s/p ileo-hemicolectomy ___, \npath +sarcoid ', '3. GERD.', '4. Hyperlipidemia', '5 OSA on CPAP', '6. Asthma.', '7. Osteoarthritis.', '8. Fractured pelvis, ___ s/p fall.', '9. BPH, status post prostatectomy.', '10. Depression.', '11. History of ITP, status post splenectomy in ___.', '12. Hard of hearing and wears hearing aid.'], 'family_history': 'Mother: ___, cardiac disease. \nFather: diverticulosis, peptic ulcer disease, died at age ___. \nMaternal grandfather: ___ cancer. \nTwo siblings, living and healthy.', 'present_illness': "Mr ___ is a ___ with h/o stage IV Hodgkins c1d10 of ABVD, \nsystemic sarcoidosis on high dose steroids, IBD, OSA w/ CPAP, \nITP s/p splenectomy, prior SVT, who presents to FICU w/ \nneutropenic fever, SVT, hypotension. Last night, he reports \nchills and temp to 102.2F. Had a minor cough, nonproductive. No \nchest pain, shortness of breath, or palpitations at home or in \nthe ED. Denies sorethroat, rhinorrhea, or nasal congestion. No \nsick contacts but lives with grandkids who go to daycare. Recent \ndiarrhea that he has attributed to chemo. Denies dysuria or \nabdominal pain as well as oral pain/dysphagia. No lines yet- \nport to be placed on ___\n\nIn the ED, initial vitals were 99.8 119 129/51 22 99%ra. Labs \nsignificant for ANC 8, lactate 3.2, Cr 1.3 from baseline 1.1. \nGiven 2L NS and lactate normalized. Given vancomycin and \ncefepime. Discussed w/ BMT fellow and held off on tamiflu.\n\nPt triggered in the ED at 1:27 pm for tachycardia to the 140s. \nEKG revealed AVNRT. Dropped pressures to ___ systolic in this \nsetting. Resolved spontaneously, without intervention. Has h/o \nprior ___ note).Is on metoprolol at home since ___. \nThen triggered again for SVT w/ pressures to 70's, and esmolol \ngtt was started. HR did not respond to esmolol and remained in \nthe 130s, and pt dropped SBPs to ___. He was started on neo per \ncards recs. CVL (RIJ) was placed and during placement pt self \nconverted to sinus (spontaneously for ___ time). Pt received \ntotal of 4L IVF in ED. Cards said to continue pressors, nothing \nfor rate control and no ablation given immuncompromised state. \nPt's sats dropped to 93% RA and so repeat CXR done. Stress dose \nsteroids (hydrocortisone 100mg IV) was also given. \n\nOn arrival to the MICU, \nVital signs 124/67 on neosynephrin 1.5mcg/kg/min, pulse 74, 95% \nO2 sats on room air. Has no complaints.", 'medications': [{'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Aspirin', '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': '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': 'Aspirin', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ezetimibe', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', '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': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Rosuvastatin Calcium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Valsartan', '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', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranexa', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': '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': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', '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': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '8.9', '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': '21', 'valuenum': 21.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 389.0, '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': '23', 'valuenum': 23.0, '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': '237', 'valuenum': 237.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.2, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '59', 'valuenum': 59.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.7', 'valuenum': 52.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', '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': '203', 'valuenum': 203.0, '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': '3.19', 'valuenum': 3.19, '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': '43.9', 'valuenum': 43.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', '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', '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': '___', 'valuenum': 0.68, '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': '63.5', 'valuenum': 63.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.71, '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': '6', 'valuenum': 6.0, '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': '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': '69.3', 'valuenum': 69.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, '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': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '7', 'valuenum': 7.0, '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': '2.0', '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': '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '227', 'valuenum': 227.0, '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': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 305.0, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, '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': '7', 'valuenum': 7.0, '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': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\nVitals: 124/67 on neosynephrin 1.5mcg/kg/min, pulse 74, 95% O2 \nsats on room air. \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, \nronchi \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 \nNeuro- CNs2-12 intact, motor function grossly normal \n.\nDISCHARGE EXAM\nVITALS 97.7 (97.7) 113/76 76 18 98RA \nGeneral: well-appearing, in NAD \nHEENT: NCAT, sclera clear, PERRLA, OP clear w/o thrush/ulcer, no \nsinus tenderness \nNeck: supple, no tenderness with full ROM, no LAD, no \nthyromegaly \nCV: regular rate and rhythm, no m/r/g \nLungs: good airway entry b/l no crackles, no wheezes/ronchi, no \nconsolidation appreciated per egophony \nAbdomen: soft, NTND, no HSM, NABS. brusing on abd surface noted, \nno clear skin break/bleeding \nGU: no foley \nSkin: port site clean with no blood, erytehma, warm, tenderness; \nbruising noted in the ___ region \nNeuro: A&Ox3, CN II-XII intact, motor strengh symmetrical and \n___ throughout, sensory grossly intact', 'diagnoses': [{'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'T82855A', 'desc': 'Stenosis of coronary artery stent, initial encounter'}, {'icd_code': 'I25810', 'desc': 'Atherosclerosis of coronary artery bypass graft(s) without angina pectoris'}, {'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': 'I5032', 'desc': 'Chronic diastolic (congestive) heart failure'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}, {'icd_code': 'E1121', 'desc': 'Type 2 diabetes mellitus with diabetic nephropathy'}, {'icd_code': 'E11319', 'desc': 'Type 2 diabetes mellitus with unspecified diabetic retinopathy without macular edema'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'E11649', 'desc': 'Type 2 diabetes mellitus with hypoglycemia without coma'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'E7849', 'desc': 'Other hyperlipidemia'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'M2550', 'desc': 'Pain in unspecified joint'}, {'icd_code': 'Z833', 'desc': 'Family history of diabetes mellitus'}, {'icd_code': 'Z8489', 'desc': 'Family history of other specified conditions'}, {'icd_code': 'H548', 'desc': 'Legal blindness, as defined in USA'}], 'summary': "ADMISSION LABS\n___ 10:40AM BLOOD WBC-0.2* RBC-3.55* Hgb-11.0* Hct-33.0* \nMCV-93 MCH-30.9 MCHC-33.3 RDW-18.3* Plt ___\n___ 10:40AM BLOOD Neuts-4* Bands-0 Lymphs-68* Monos-0 \nEos-22* Baso-0 Atyps-6* ___ Myelos-0 NRBC-42*\n___ 03:54AM BLOOD WBC-0.2* RBC-2.60*# Hgb-7.9*# Hct-24.0*# \nMCV-92 MCH-30.5 MCHC-33.1 RDW-18.7* Plt ___\n___ 03:54AM BLOOD Neuts-3* Bands-0 Lymphs-53* Monos-4 \nEos-9* Baso-0 Atyps-1* Metas-1* Myelos-1* Promyel-2* NRBC-106* \nOther-26*\n___ 10:40AM BLOOD Glucose-104* UreaN-25* Creat-1.3* Na-134 \nK-3.9 Cl-99 HCO3-21* AnGap-18\n___ 08:00PM BLOOD Glucose-112* UreaN-18 Creat-1.1 Na-135 \nK-3.5 Cl-106 HCO3-20* AnGap-13\n___ 03:54AM BLOOD Glucose-86 UreaN-15 Creat-1.0 Na-139 \nK-3.1* Cl-110* HCO3-21* AnGap-11\n___ 08:00PM BLOOD Calcium-6.9* Phos-1.8* Mg-1.4*\n___ 03:54AM BLOOD Albumin-2.4* Calcium-7.0* Phos-2.0* \nMg-2.1\n___ 10:40AM BLOOD ALT-66* AST-29 AlkPhos-190* TotBili-0.5\n___ 03:54AM BLOOD ALT-43* AST-20 LD(LDH)-193 AlkPhos-123 \nTotBili-0.3\n___ 10:50AM BLOOD Lactate-3.2*\n___ 01:51PM BLOOD Lactate-1.5\n___ 04:50PM BLOOD Lactate-1.3\n.\nDISCHARGE LABS\n___ 07:28AM BLOOD WBC-8.0# RBC-2.72* Hgb-8.4* Hct-25.7* \nMCV-94 MCH-30.8 MCHC-32.7 RDW-21.6* Plt ___\n___ 07:28AM BLOOD Neuts-88* Bands-4 Lymphs-3* Monos-4 Eos-0 \nBaso-0 ___ Metas-1* Myelos-0 NRBC-10*\n___ 07:28AM BLOOD Glucose-73 UreaN-24* Creat-1.0 Na-138 \nK-4.2 Cl-106 HCO3-25 AnGap-11\n___ 07:28AM BLOOD Calcium-7.9* Phos-2.3* Mg-2.0\n.\nPERTINENT LABS\n___ 12:01AM BLOOD 25VitD-22*\n___ 11:42AM BLOOD IgG-543* IgA-218 IgM-10*\n___ 04:50PM BLOOD Lactate-1.3\n.\nMICROBIOLOGY\n#\n___ 2:00 pm STOOL CONSISTENCY: SOFT Source: Stool. \n\n\n MICROSPORIDIA STAIN (Final ___: NO MICROSPORIDIUM \nSEEN. \n\n CYCLOSPORA STAIN (Final ___: NO CYCLOSPORA SEEN. \n\n C. difficile DNA amplification assay (Final ___: \n Negative for toxigenic C. difficile by the Illumigene DNA\n amplification assay. \n (Reference Range-Negative). \n\n FECAL CULTURE (Final ___: NO SALMONELLA OR SHIGELLA \nFOUND. \n\n CAMPYLOBACTER CULTURE (Final ___: NO CAMPYLOBACTER \nFOUND. \n\n OVA + PARASITES (Final ___: \n NO OVA AND PARASITES SEEN. \n This test does not reliably detect Cryptosporidium, \nCyclospora or\n Microsporidium. While most cases of Giardia are detected \nby routine\n O+P, the Giardia antigen test may enhance detection when \norganisms\n are rare. \n\n VIRAL CULTURE (Preliminary): NO VIRUS ISOLATED. \n___ 2:50 pm Rapid Respiratory Viral Screen & Culture\n Source: Nasopharyngeal swab. \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 only be\n performed on specific request. Please call Virology at ___\n within 1 week if additional testing is needed. \n\n Respiratory Viral Antigen Screen (Final ___: \n Negative for Respiratory Viral Antigen. \n Specimen screened for: Adeno, Parainfluenza 1, 2, 3, \nInfluenza A, B,\n and RSV by immunofluorescence. \n Refer to respiratory viral culture for further information. \n___ 10:30 am BLOOD CULTURE X2. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n=\n=\n=\n=\n=\n=\n=\n=\n================================================================\n# ECHO ___\nThe left atrium is elongated. No atrial septal defect is seen by \n2D or color Doppler. There is mild symmetric left ventricular \nhypertrophy with normal cavity size and regional/global systolic \nfunction (LVEF>55%). There is no ventricular septal defect. \nRight ventricular chamber size and free wall motion are normal. \nThe aortic root is mildly dilated at the sinus level. The aortic \nvalve leaflets (3) are mildly thickened but aortic stenosis is \nnot present. No aortic regurgitation is seen. The mitral valve \nleaflets are mildly thickened. Posterior MVP suspected but not \nclearly seen.. An eccentric, anteriorly directed jet of moderate \n(2+) mitral regurgitation is seen. Due to the eccentric nature \nof the regurgitant jet, its severity may be significantly \nunderestimated (Coanda effect). The tricuspid valve leaflets are \nmildly thickened. The pulmonary artery systolic pressure could \nnot be determined. There is no pericardial effusion. \n\nCompared with the report of the prior study (images unavailable \nfor review) of ___, no definite change. \n=\n=\n=\n=\n=\n=\n=\n=\n================================================================\nIMAGING\n# CXR ___\nFINDINGS: Frontal and lateral views of the chest were obtained. \n Left basilar \natelectasis is seen. There is left basilar and left mid lung \natelectasis/scarring. Chain sutures are noted overlying the \nright \nupper-to-mid hemithorax. There is subtle focal patchy opacity \nprojecting over \nthe right lateral lower chest, which in the same location on the \nlateral view, \nappeared to be a linear opacity dating back to ___. \nFinding could \nrepresent atelectasis/scarring; however, on the current study, \nit appears more \namorphous and a small focus of infection is not excluded. The \ncardiac and \nmediastinal silhouettes are stable. There is no pleural \neffusion or \npneumothorax. There is persistent moderate compression of \nmultiple vertebral \nbodies including at least two mid thoracic and at least two in \nthe \nthoracolumbar region, similar to the prior chest x-ray. \n# CXR ___\nIMPRESSION: AP chest compared to ___: \n \nMultifocal pulmonary consolidation is clearing. Heart is normal \nsize. Right \nparatracheal mediastinal fullness, due in part to adenopathy is \nlongstanding. \nNo pleural effusion. Heart size normal. Right jugular line \nends in the \nregion of the superior cavoatrial junction. \n# CT CHEST W/O CONTRAST ___\nFINDINGS: \n \nAorta and pulmonary arteries are normal in diameter. The right \ncentral venous \nline tip is at the level of right atrium. No appreciable \nmediastinal \nlymphadenopathy is seen. Within the limitations of this \nnon-enhanced study, \nthere is no evidence of hilar or axial lymphadenopathy. No \npericardial or \npleural effusion. Increased density of the myocardium as \ncompared to the \nblood in the chambers of the left ventricle is consistent with \nanemia. \n \nAirways are patent till the subsegmental level bilaterally. \nRight upper lobe \nscarring is unchanged with volume loss and slight bronchial \ndistortion. Left \nupper lobe scarring is unchanged. Pulmonary nodules scattered \nthroughout the \nlungs are all stable with no new pulmonary nodules, masses or \nconsolidations \nto suggest infectious process. \n \nThere are no lytic or sclerotic lesions worrisome for infection \nor neoplasm. \nMultiple compression fractures are redemonstrated and can be \nseen at least \nback on ___ chest radiograph. No new lesions seen. \n\n \nThe imaged portion of the upper abdomen reveals no appreciable \nabnormality. \n \nIMPRESSION: \n \n1. No evidence of new pulmonary abnormalities to be attributed \nto neutropenic \nfever. \n \n2. Unchanged appearance of the chronic changes related to known \nsarcoidosis. \n \n3. Status post splenectomy. Evidence of anemia. \n \n4. Multiple compression fractures of the thoracic spine, \ngallstones, \nunchanged.\n___ male with h/o Hodgkin's lymphoma C1D17 ABVD, sarcoidosis, \nOSA on CPAP, h/o AVNRT, presented with neutropenic fever and \nSVT.\n\nMICU Course: \n============\nPt. was initially admitted to the MICU for hemodynamic \ninstability requiring pressors (levo) in the setting of presumed \nneutropenic fever and sepsis. Pt.'s hemodynamics quickly \nimproved once starting cefepime/vancomycin with fluid \nresuscitation. He was also noted to have a downtrending \nlactate. He was quickly weaned off of pressors and transferred \nto the floor.\n\nFloor Course:\n============\n# Neutropenic fever, no clear source identified: p/w T102.2 at \nhome, initially met ___ SIRS criteria. lactate 3.2 on admisison, \nresolved s/p fluid resuscitation. fever quickly resolved the day \nafter admission. vanc/cefepime d/c'd ___ and ___, respectively, \nwithout new fever. Pt finished a course of levofloxacin for \ncommunity acquired pneumonia, also w/o recurrence of fever and \nno futher pulmonary symptoms. Course notable for new \nleukocytosis with watery diarrhea, c. diff ordered, but no BM \nsince. stool culture negative, O&P negative. Leukocytosis likely \nrelated to underlying malignancy. Culture with negative \nrespiratory virus studies, negative urine culture, Blood cx \nNGTD. CT negative for pneumonia. \n\n# AVNRT: Pt presented with reported (ED EKG not recovered) \nSVT/AVNRT to 130s with decreased BP x 2, spontaneously resolved \nin the ED. Has h/o 2 AVNRT per ___ cardiology consult note. \n At that time they did not suspect cardiac sarcoid as a \ncausative agent, based on TTE/EKG. Catheter-ablation was \ndiscussed but pt declined and pt not currently a candidate given \nimmunocompromised state. Beta-blockers were advised; pt did not \nrespond to esmolol gtt in ED. Initial cardiology impression was \nthat the tachycardia may be more related to presentation of \nSIRS. Pt was noted to have another episode of AVNRT during the \nhospital stay with HR to 140. The AVNRT once again \nspontaneously resolved. Pt was restarted on home dose of \nmetoprolol in short-acting forms once pt's BP improved with no \nfurther episodes of AVNRT noted.\n\n# Port placement c/b bleed - pt received port placement ___. He \nwas noted to have oozing from dressing site post procedure day \n1. Prophylactic dosing of heparin was discontinued given \nisolated PTT elevation. His PTT normalized. Pressure dressing \nwas placed on the port site. Interventional radiology \nre-examined the port and noted small bleeding vessel underneath \nthe port, which was cauterized by ___. Pt was monitored for \n24hours afterwards with no re-bleeding. Port was ok to access \nper ___. \n\n# Hodgkin's Lymphoma: stage IV. admitted in C1 of ABVD .Most \nrecent PET CT scan on ___ showed 1) hilar, mesenteric, and \nRP LAD; 2)New scattered FDG-avid foci in the liver and pancreas. \n3) New focus of FDG-avidity in the L2 vertebral body. Received \nD1 of C1 of ABVD on ___. Immuran stopped and PSE dose \nreduced to 30mg/day from 40mg/day. ___: PSE dose reduced to \n25mg/day, but increased to 30mg/day on ___. PFT obtained, which \nshowed reduced diffusing capacity. Bleomycin was therefore held. \n ECHO was obtained with good EF and no wall motion \nabnormalities. Pt received AVD in house prior to discharge. Pt \nwas continued on Fluconazole 400 mg PO Q24H, Acyclovir 400 mg PO \nQ8H, and Sulfameth/Trimethoprim SS 1 TAB PO DAILY for \nprophylaxis.\n\n# Normocytic Anemia: Hct stable this am. No gross signs of \nbleeding on transfer to floor. decrease in hct initially may be \nrelated to dilutional effect in the setting of fluid \nresuscitation - though pt did not experience similar decrease \nhis other cell lines. Pt remains asymptomatic in regards to his \nanemia. no dizziness/light headedness or palpitation. His \nhgb/hct remained stable and did not require transfusion.\n\n# Sarcoidosis: thought to involve skin, gut, eyes and lungs, and \npresumed neurosarcoidosis in the form of headaches. Followed by \nrheumatology and pulmonary service for ___ years. In this time, \nhe has been off steroids only for ~1 month. s/p stress dose \nsteroid in the ED for possible iatrogenic adrenal suppression in \nthe settingn of hypotension. Pt was restarted on prednisone 30mg \nPO daily, and remained stable on regimen.\n\n# Depression: no SI/HI on admission. stable on home Fluoxetine \n40 mg PO DAILY \n \n# HLD: stable on Simvastatin 20 mg PO DAILY \n \n# OSA: stable on CPAP at night"}}
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{'final_diagnoses': ['Primary Diagnosis', 'Neutropenic Fever, no source identified', 'Secondary Diagnosis', "Hodgkin's Lymphoma", 'Sarcoidosis'], 'procedures': ['none'], 'visit_summary': "___ male with h/o Hodgkin's lymphoma C1D17 ABVD, sarcoidosis, \nOSA on CPAP, h/o AVNRT, presented with neutropenic fever and \nSVT.\n\nMICU Course: \n============\nPt. was initially admitted to the MICU for hemodynamic \ninstability requiring pressors (levo) in the setting of presumed \nneutropenic fever and sepsis. Pt.'s hemodynamics quickly \nimproved once starting cefepime/vancomycin with fluid \nresuscitation. He was also noted to have a downtrending \nlactate. He was quickly weaned off of pressors and transferred \nto the floor.\n\nFloor Course:\n============\n# Neutropenic fever, no clear source identified: p/w T102.2 at \nhome, initially met ___ SIRS criteria. lactate 3.2 on admisison, \nresolved s/p fluid resuscitation. fever quickly resolved the day \nafter admission. vanc/cefepime d/c'd ___ and ___, respectively, \nwithout new fever. Pt finished a course of levofloxacin for \ncommunity acquired pneumonia, also w/o recurrence of fever and \nno futher pulmonary symptoms. Course notable for new \nleukocytosis with watery diarrhea, c. diff ordered, but no BM \nsince. stool culture negative, O&P negative. Leukocytosis likely \nrelated to underlying malignancy. Culture with negative \nrespiratory virus studies, negative urine culture, Blood cx \nNGTD. CT negative for pneumonia. \n\n# AVNRT: Pt presented with reported (ED EKG not recovered) \nSVT/AVNRT to 130s with decreased BP x 2, spontaneously resolved \nin the ED. Has h/o 2 AVNRT per ___ cardiology consult note. \n At that time they did not suspect cardiac sarcoid as a \ncausative agent, based on TTE/EKG. Catheter-ablation was \ndiscussed but pt declined and pt not currently a candidate given \nimmunocompromised state. Beta-blockers were advised; pt did not \nrespond to esmolol gtt in ED. Initial cardiology impression was \nthat the tachycardia may be more related to presentation of \nSIRS. Pt was noted to have another episode of AVNRT during the \nhospital stay with HR to 140. The AVNRT once again \nspontaneously resolved. Pt was restarted on home dose of \nmetoprolol in short-acting forms once pt's BP improved with no \nfurther episodes of AVNRT noted.\n\n# Port placement c/b bleed - pt received port placement ___. He \nwas noted to have oozing from dressing site post procedure day \n1. Prophylactic dosing of heparin was discontinued given \nisolated PTT elevation. His PTT normalized. Pressure dressing \nwas placed on the port site. Interventional radiology \nre-examined the port and noted small bleeding vessel underneath \nthe port, which was cauterized by ___. Pt was monitored for \n24hours afterwards with no re-bleeding. Port was ok to access \nper ___. \n\n# Hodgkin's Lymphoma: stage IV. admitted in C1 of ABVD .Most \nrecent PET CT scan on ___ showed 1) hilar, mesenteric, and \nRP LAD; 2)New scattered FDG-avid foci in the liver and pancreas. \n3) New focus of FDG-avidity in the L2 vertebral body. Received \nD1 of C1 of ABVD on ___. Immuran stopped and PSE dose \nreduced to 30mg/day from 40mg/day. ___: PSE dose reduced to \n25mg/day, but increased to 30mg/day on ___. PFT obtained, which \nshowed reduced diffusing capacity. Bleomycin was therefore held. \n ECHO was obtained with good EF and no wall motion \nabnormalities. Pt received AVD in house prior to discharge. Pt \nwas continued on Fluconazole 400 mg PO Q24H, Acyclovir 400 mg PO \nQ8H, and Sulfameth/Trimethoprim SS 1 TAB PO DAILY for \nprophylaxis.\n\n# Normocytic Anemia: Hct stable this am. No gross signs of \nbleeding on transfer to floor. decrease in hct initially may be \nrelated to dilutional effect in the setting of fluid \nresuscitation - though pt did not experience similar decrease \nhis other cell lines. Pt remains asymptomatic in regards to his \nanemia. no dizziness/light headedness or palpitation. His \nhgb/hct remained stable and did not require transfusion.\n\n# Sarcoidosis: thought to involve skin, gut, eyes and lungs, and \npresumed neurosarcoidosis in the form of headaches. Followed by \nrheumatology and pulmonary service for ___ years. In this time, \nhe has been off steroids only for ~1 month. s/p stress dose \nsteroid in the ED for possible iatrogenic adrenal suppression in \nthe settingn of hypotension. Pt was restarted on prednisone 30mg \nPO daily, and remained stable on regimen.\n\n# Depression: no SI/HI on admission. stable on home Fluoxetine \n40 mg PO DAILY \n \n# HLD: stable on Simvastatin 20 mg PO DAILY \n \n# OSA: stable on CPAP at night", 'medications_prescribed': ['1. Acyclovir 400 mg PO Q8H', '2. Fluconazole 400 mg PO Q24H', '3. Fluoxetine 40 mg PO DAILY', '4. Fluticasone Propionate 110mcg 2 PUFF IH BID', '5. Omeprazole 40 mg PO BID', '6. Ondansetron 8 mg PO Q8H:PRN nausea', '7. PredniSONE 30 mg PO DAILY', '8. Sulfameth/Trimethoprim SS 1 TAB PO DAILY', '9. Fexofenadine 180 mg PO DAILY PRN seasonal allergies', '10. Metoprolol Succinate XL 25 mg PO DAILY', '11. Prochlorperazine 10 mg PO Q6H:PRN nausea', '12. Vitamin D 50,000 UNIT PO 1X/WEEK (WE) \nRX *ergocalciferol (vitamin D2) 50,000 unit 1 capsule(s) by \nmouth once every ___ Disp #*7 Capsule Refills:*0', '13. Filgrastim 300 mcg SC Q24H \ntake daily until ___. await clinic visit for further \ninstruction.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 51, 'gender': 'F', 'symptoms': 'Dizziness', 'medical_history': ['- HIV dx ___, last CD4 >1000', '- Syphilis', '- hx Chlamydia', '- unclear vaccination status for viral hepatitis'], 'family_history': 'no known hx liver disease', 'present_illness': '___ with h/o HIV and recently diagnosed syphilis who presents \nwith dizziness and jaundice. He was diagnosed with HIV in \n___, has a recent CD4 count in the 1000s, not on \nHAART, and has unprotected sex with other HIV positive men. He \nhad complete STI testing in late ___, and \neverything was negative. However, he did have abnormal liver \ntests according to the patient. They did further testing, which \nrevealed he had syphilis. He denies any genital, anal, or oral \nlesions. He has received 2 shots of IM PCN, one on ___, and \none on ___. He was told that the abnormal liver tests were due \nto syphilis. Then on ___, he began feeling weak, fatigued, \nand feverish. He also has felt nauseated, has not vomited, but \nhas not been able to take in as much by mouth. He indicates that \nhe first felt dizzy a couple days ago while sitting at his desk \nat work, and then again while walking to meet his sister later \nthat evening. The dizziness is a sensation of the room spinning \nbut is without any diaphoresis; he does feel like he has a loss \nof peripheral vision when he feels dizzy. Nothing in particular \nimproves or exacerbates the symptoms. He does feel dehydrated. \nHe has been taking Tylenol, up to 2grams daily, for the fevers. \n\n. \nHe also reports jaundice that began perhaps before the weakness, \nas early as two weeks ago and is associated with diffuse \npruritis, tea-colored urine, and ___ stools. He denies \nany unintentional weight loss or night sweats, but he has \nrecently noticed a metallic flavor in his mouth. He drinks about \n14 drinks per week of EtOH on weekends.', 'medications': [{'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': 'CefazoLIN', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'VS - Temp 99.7 BP 109/63 HR 86 R 20 100 RA \nGENERAL - well-appearing man in NAD \nHEENT - NC/AT, PERRLA, EOMI, sclerae icteric, dry MM \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/ND, liver edge 3cm below costal margin, TTP \nof the liver, no rebound/guarding \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs) \n\nSKIN - jaundiced \nNEURO - awake, A&Ox3, without asterixis', 'diagnoses': [{'icd_code': '1748', 'desc': 'Malignant neoplasm of other specified sites of female breast'}, {'icd_code': '4430', 'desc': "Raynaud's syndrome"}, {'icd_code': 'V173'}], 'summary': "LABS:\n___ 10:40PM BLOOD WBC-12.1* RBC-5.58 Hgb-16.4 Hct-50.5 \nMCV-91 MCH-29.5 MCHC-32.6 RDW-16.2* Plt ___\n___ 10:40PM BLOOD Neuts-62 Bands-0 ___ Monos-6 Eos-2 \nBaso-0 ___ Myelos-0\n___ 06:45AM BLOOD WBC-9.8 RBC-4.90 Hgb-14.3 Hct-45.0 MCV-92 \nMCH-29.1 MCHC-31.7 RDW-16.1* Plt ___\n___ 10:40PM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-NORMAL \nMacrocy-1+ Microcy-NORMAL Polychr-NORMAL\n___ 10:40PM BLOOD ___ PTT-38.2* ___\n___ 06:45AM BLOOD ___ PTT-38.2* ___\n___ 10:40PM BLOOD Glucose-91 UreaN-11 Creat-1.3* Na-137 \nK-4.3 Cl-100 HCO3-27 AnGap-14\n___ 06:45AM BLOOD Glucose-108* UreaN-10 Creat-1.1 Na-137 \nK-4.1 Cl-104 HCO3-27 AnGap-10\n___ 10:40PM BLOOD ALT-2206* AST-1006* AlkPhos-190* \nTotBili-10.9* DirBili-7.6* IndBili-3.3\n___ 06:45AM BLOOD ALT-1477* AST-764* AlkPhos-155* \nTotBili-8.1*\n___ 10:40PM BLOOD Albumin-4.6\n___ 06:45AM BLOOD Calcium-8.8 Phos-3.6 Mg-1.8\n___ 10:40PM BLOOD HBsAg-NEGATIVE HBsAb-POSITIVE \nHBcAb-NEGATIVE HAV Ab-POSITIVE\n___ 12:55PM BLOOD IgM HAV-NEGATIVE\n___ 10:40PM BLOOD HCV Ab-NEGATIVE\n___ 10:40PM URINE Color-Yellow Appear-Clear Sp ___\n___ 10:40PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-SM Urobiln-NEG pH-5.0 Leuks-NEG\nHCV VIRAL LOAD (Final ___: HCV-RNA NOT DETECTED\n.\nSTUDIES:\nRUQ U/S ___:\nFINDINGS: The liver is normal in echogenicity and there are no \nfocal liver lesions. There is no intrahepatic biliary duct \ndilatation. The portal vein is patent with normal hepatopetal \nflow. The gallbladder is contracted. There is a small 3-mm \nprotrusion into the gallbladder lumen that may represent a 3-mm \npolyp. The common bile duct is not dilated and measures 3 mm. \nThe pancreas is normal. The visualized right kidney is \nunremarkable.\nIMPRESSION: No intrahepatic or extrahepatic biliary duct \ndilatation. The gallbladder is contracted and no evidence of \ncholecystitis. 3 mm gallbladder polyp.\n___ with h/o HIV and recently diagnosed syphilis who presents \nwith dizziness, fevers, jaundice and found to have transaminitis \nin the 1000s.\n. \n# acute viral hepatitis: Only a few etiolgoies that cause \ntransaminitis to this degree, including viral hepaitis, \nacetaminophen, ischemia, ___, and AIH. Patient denies any \nepisodes of severe hypotension which might cause ischemia, is \nnegative for APAP. Most likely etiology was initially thought to \nbe a viral hepatitis. However, labs suggested no exposure to \nHep C, immunity to Hep B from vaccination, and immunity to Hep A \nwithout acute infection (negative IgM). The patient's PCP \nsuggested the hepatitis might be due syphilis, but it is unclear \nif syphilis can cause a transaminitis this severe. He was \ntreated with supportive care, i.e. IV fluids and hydroxyzine. \nFurther work up and management will be done by the patient's PCP \nin the outpatient setting. \n.\n# ___: Cr of 1.3 intially, and the patient has felt unwell and \ndizzy. Likely pre-renal in the setting of dehydration. Cr to 1.1 \nafter IVF overnight. Was able to tolerate POs prior to \ndischarge and understands the importance of ongoing oral fluids.\n. \n# HIV: Not currently on treatment. Patient reports his CD4 \ncount was in the 1000s most recently. \n. \n# Syphilis: Since the patient endorses having received a second \ndose of PCN on ___, he likely has late latent syphilis or \nlatent syphilis of unknown duration, which requires three doses \nof 2.4 million units IM each at one-week intervals. He will get \nthe third dose as an outpatient."}}
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{'final_diagnoses': ['acute hepatitis, possibly viral hepatitis A', 'acute kidney injury, prerenal', 'hypovolemia', 'human immunodeficiency virus', 'syphilis'], 'procedures': ['none'], 'visit_summary': "___ with h/o HIV and recently diagnosed syphilis who presents \nwith dizziness, fevers, jaundice and found to have transaminitis \nin the 1000s.\n. \n# acute viral hepatitis: Only a few etiolgoies that cause \ntransaminitis to this degree, including viral hepaitis, \nacetaminophen, ischemia, ___, and AIH. Patient denies any \nepisodes of severe hypotension which might cause ischemia, is \nnegative for APAP. Most likely etiology was initially thought to \nbe a viral hepatitis. However, labs suggested no exposure to \nHep C, immunity to Hep B from vaccination, and immunity to Hep A \nwithout acute infection (negative IgM). The patient's PCP \nsuggested the hepatitis might be due syphilis, but it is unclear \nif syphilis can cause a transaminitis this severe. He was \ntreated with supportive care, i.e. IV fluids and hydroxyzine. \nFurther work up and management will be done by the patient's PCP \nin the outpatient setting. \n.\n# ___: Cr of 1.3 intially, and the patient has felt unwell and \ndizzy. Likely pre-renal in the setting of dehydration. Cr to 1.1 \nafter IVF overnight. Was able to tolerate POs prior to \ndischarge and understands the importance of ongoing oral fluids.\n. \n# HIV: Not currently on treatment. Patient reports his CD4 \ncount was in the 1000s most recently. \n. \n# Syphilis: Since the patient endorses having received a second \ndose of PCN on ___, he likely has late latent syphilis or \nlatent syphilis of unknown duration, which requires three doses \nof 2.4 million units IM each at one-week intervals. He will get \nthe third dose as an outpatient.", 'medications_prescribed': ['Adderall *NF* (amphetamine-dextroamphetamine) 20 mg Oral \nDaily', 'HydrOXYzine ___ mg PO Q6H:PRN itching \nDO NOT drive or operate machinery while taking this medication. \nRX *hydroxyzine HCl 25 mg ___ tablet by mouth Q6H PRN Disp #*240 \nTablet Refills:*0', 'Ondansetron 4 mg PO Q8H:PRN nausea \nRX *ondansetron 4 mg 1 tablet(s) by mouth every 8 hours Disp \n#*15 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'F', 'symptoms': 'Chest pain', 'medical_history': ['Hypothyroidism diagnoised more than ___ years ago', 'Atrial fibrillation', 'Hypertension', 'Frequent UTIs', 'Osteoarthritis', 'IBS'], 'family_history': 'Non-contributory', 'present_illness': 'This is a ___ year old female with history of hypertension, \nhypothyroidism presenting with chest pain over the last week. \nThe chest pain had been intermittent until this morning of \nadmission around 10 AM while driving back from the grocery \nstore, when it became constant. She denied shortness of breath, \nnausea, vomiting, diaphoresis at the time. She presented to the \nED, vital signs were HR:46 BP:129/70 Resp:18 O(2)Sat:100% 2L NC. \nShe had an EKG that showed rate 47, atrial fibrillation, axis \nslight right axis deviation, ST elevations in II, III, AVF, V3-5 \nand reciprocal depressions in I, aVL, V1, V2 with inverted T \nwaves in I, aVL, V1, V2; ST segments resolved in precordial \nleads; ? q waves in lead V1. A right sided EKG showed signifacnt \nST elevations in V3-6. Patient was taken to the cath lab and had \na V-fib arrest for less than 1 minute. She was shocked x2 and \ngiven epi x1 and amio x1 after which she resumed her baseline \nrhythm of atrial fibrillation with slow ventricular rates. At \nthis time she was also started on levophed and dopamine for MAPs \n< 60s. She was transferred to the CCU; vitals at time of \ntransfer showed HRs of ___ in atrial fibrillation, BP of 115/70, \nintubated, but responsive to instructions.', 'medications': [{'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': 'DIALYS', 'frequency': 'ASDIR', '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': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': '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': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin (CRRT Machine Priming)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'DIALYS', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID:PRN', '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': 'Meropenem', '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', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Claritin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (1000 units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', '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': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', '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': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 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', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', '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': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Meropenem', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ambisome', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Racepinephrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin (IABP)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Pancrelipase 5000', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Micafungin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 5% (12.5g / 250mL)', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', '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': 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': 'Amiodarone', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': 0.0}, {'medication': 'Midazolam', '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', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID: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': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'PRN', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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': 'Discontinued', 'route': 'DIALYS', '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': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (5000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'DWELL', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PredniSONE', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', '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': 'Citrate Dextrose 3% (ACD-A) CRRT', 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'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': 'Inactive (Due to a change order)', 'route': 'REPLACE', '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', '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': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Vecuronium Bromide', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin (CRRT Machine Priming)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Micafungin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', '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 Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', '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': '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Phosphate', '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': 'IV', 'frequency': 'ONCE MR1', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', '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': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nystatin Oral Suspension', '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': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Alteplase 1mg/1mL ( Clearance ie. Temp TLCL )', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '2X', 'doses_per_24_hrs': 0.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Xopenex Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'AcetaZOLamide', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', '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': 'Xopenex', 'proc_type': 'Non-Formulary', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', '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': 'ONCE', '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': 1.0}, {'medication': 'Sodium Bicarbonate', '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': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Na Succ.', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Xopenex Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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}]}, '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': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.028', 'valuenum': 1.028, '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'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': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55.8', 'valuenum': 55.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.5', 'valuenum': 34.5, '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': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92.4', 'valuenum': 92.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '478', 'valuenum': 478.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, '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': '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': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': 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 = 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': '___', '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': '343', 'valuenum': 343.0, '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': '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': '3.4', '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.4, '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': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', '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': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73.1', 'valuenum': 73.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '3.0', 'valuenum': 3.0, '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': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', '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': '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': 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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '459', 'valuenum': 459.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.5', 'valuenum': 21.5, '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': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88.6', 'valuenum': 88.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '98', 'valuenum': 98.0, '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62.7', 'valuenum': 62.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '63.6', 'valuenum': 63.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.00', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.53', 'valuenum': 7.53, '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': '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': '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.4', 'valuenum': 59.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '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': '30.9', 'valuenum': 30.9, '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': '472', 'valuenum': 472.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.66', 'valuenum': 3.66, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, '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': '124', 'valuenum': 124.0, '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': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, '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': '7.51', 'valuenum': 7.51, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '404', 'valuenum': 404.0, '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': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': 'abnormal', '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '20', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': '342', 'valuenum': 342.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '138', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '316', 'valuenum': 316.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.9', 'valuenum': 5.9, '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': '2', 'valuenum': 2.0, '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': '147', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': None, 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DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '9.7', 'valuenum': 9.7, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 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'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': '107', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '-2', 'valuenum': -2.0, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, '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': '155', 'valuenum': 155.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '33.6', 'valuenum': 33.6, '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': '30.4', 'valuenum': 30.4, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '233', 'valuenum': 233.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '71', 'valuenum': 71.0, 'valueuom': '%', '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '32.8', 'valuenum': 32.8, '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': '30.3', 'valuenum': 30.3, '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': '89', 'valuenum': 89.0, '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': 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': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, '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': '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': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 362.0, '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': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', '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': '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': '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': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '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': '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': 115.0, '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': '5.3', 'valuenum': 5.3, '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': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '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': '237', 'valuenum': 237.0, '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': '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': '18.9', 'valuenum': 18.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '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': 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 1.6,. Estimated GFR = 31 if non African-American (mL/min/1.73 m2). Estimated GFR = 37 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': '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': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, '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': '44', 'valuenum': 44.0, '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': 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': '30.4', 'valuenum': 30.4, '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': '91', 'valuenum': 91.0, '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': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '15.4', 'valuenum': 15.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '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': 218.0, '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': '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '134', 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'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'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': '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': '3.5', 'valuenum': 3.5, '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': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 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{'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': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.68', 'valuenum': 3.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': 'NEG', 'valuenum': None, 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{'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '294', 'valuenum': 294.0, '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': '3.52', 'valuenum': 3.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 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'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '106', 'valuenum': 106.0, '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': '-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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.9, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, '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': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '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': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': '___', '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': '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': '3.8', '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '29.8', 'valuenum': 29.8, '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': '88', 'valuenum': 88.0, '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': '16.5', 'valuenum': 16.5, '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': '34.5', 'valuenum': 34.5, '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': 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': '41.8', 'valuenum': 41.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, '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': '78', 'valuenum': 78.0, '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': '___', 'valuenum': 0.93, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': '___'}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '30.4', 'valuenum': 30.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, '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': '126', 'valuenum': 126.0, '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': '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': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '144', 'valuenum': 144.0, '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': 3.5, 'ref_range_upper': 5.3, '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': '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': '10.5', 'valuenum': 10.5, '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': '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': 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 1.6,. Estimated GFR = 31 if non African-American (mL/min/1.73 m2). Estimated GFR = 37 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': 117.0, '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': '3.4', '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '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': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, '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': '98', 'valuenum': 98.0, '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, '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': 3.5, 'ref_range_upper': 5.3, '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': '75', 'valuenum': 75.0, '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': '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': '9.6', 'valuenum': 9.6, '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': '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': 159.0, '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': '3.5', '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '30.0', 'valuenum': 30.0, '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': '148', 'valuenum': 148.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, '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': '31.8', 'valuenum': 31.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '17.3', 'valuenum': 17.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, 'valueuom': 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{'value': '101', 'valuenum': 101.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, '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': '23.8', 'valuenum': 23.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '41.6', 'valuenum': 41.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, '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', 'valuenum': 1.0, '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': '70', 'valuenum': 70.0, 'valueuom': '%', '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 37.0, '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': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '5.4', 'valuenum': 5.4, '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': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '-1', 'valuenum': -1.0, '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': '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': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '111', 'valuenum': 111.0, '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': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, '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': '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': '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, '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': '36', 'valuenum': 36.0, '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': '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': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '120', 'valuenum': 120.0, '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': '33.1', 'valuenum': 33.1, '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': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 67.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, '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': '35.9', 'valuenum': 35.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '132', 'valuenum': 132.0, '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': '20', 'valuenum': 20.0, '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': '11.9', 'valuenum': 11.9, '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': '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': '___', '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': '3.4', 'valuenum': 3.4, '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': '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': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.31', 'valuenum': 1.31, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '35', 'valuenum': 35.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 115.0, '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': '295', 'valuenum': 295.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '2.0', 'valuenum': 2.0, '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': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, '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': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 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'ref_range_upper': 1.1, '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': '233', 'valuenum': 233.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '2.0', 'valuenum': 2.0, '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': '139', 'valuenum': 139.0, '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': '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': '1.16', 'valuenum': 1.16, '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': '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': '98', 'valuenum': 98.0, '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '121', 'valuenum': 121.0, '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': 3.5, 'ref_range_upper': 5.3, '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': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', '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': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '4', 'valuenum': 4.0, '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': '103', 'valuenum': 103.0, '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': '95', 'valuenum': 95.0, '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': '7.47', 'valuenum': 7.47, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, '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': '25.0', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.10', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '155', 'valuenum': 155.0, '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': 5.3, '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': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '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': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '130', 'valuenum': 130.0, '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': 3.5, 'ref_range_upper': 5.3, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, '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': '___', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES CK.. 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': '0.8', '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 = 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': 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': '___', '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': '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': '___', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '31.5', 'valuenum': 31.5, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69', 'valuenum': 69.0, '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': '3.44', 'valuenum': 3.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, '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': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '1.29', 'valuenum': 1.29, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '124', 'valuenum': 124.0, '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': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '118', 'valuenum': 118.0, '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': 5.3, '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': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, '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': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, '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': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 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'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': '30.6', 'valuenum': 30.6, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '116', 'valuenum': 116.0, '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': '2.91', 'valuenum': 2.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 77.0, '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': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.99, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'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': '5.0', 'valuenum': 5.0, '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': 'VEN.', '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': '___'}, {'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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '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': '49', 'valuenum': 49.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.7', 'valuenum': 25.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '33.6', 'valuenum': 33.6, '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': '105', 'valuenum': 105.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, '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': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '25.1', 'valuenum': 25.1, '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': '31.3', 'valuenum': 31.3, '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': '92', 'valuenum': 92.0, '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': 440.0, 'flag': 'abnormal', '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': '2.74', 'valuenum': 2.74, '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}, {'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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 116.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, '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': '40', 'valuenum': 40.0, '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': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, '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': '52', 'valuenum': 52.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 31.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '33.2', 'valuenum': 33.2, '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': '114', 'valuenum': 114.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '15.7', 'valuenum': 15.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '294', 'valuenum': 294.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '10.1', 'valuenum': 10.1, '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': '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': '___', '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': '223', 'valuenum': 223.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '2', 'valuenum': 2.0, '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': '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': '176', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '56', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 64.0, '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': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 35.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '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': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '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': '159', 'valuenum': 159.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '___', 'valuenum': 7.25, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '1', 'valuenum': 1.0, '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': '57', 'valuenum': 57.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '456', 'valuenum': 456.0, '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': '32.0', 'valuenum': 32.0, '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': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '12.0', 'valuenum': 12.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.04', 'valuenum': 1.04, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, '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': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': '373', 'valuenum': 373.0, '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': '18', 'valuenum': 18.0, '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': '10.7', 'valuenum': 10.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '___', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '137', 'valuenum': 137.0, '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': '30.4', 'valuenum': 30.4, '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': '32.0', 'valuenum': 32.0, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, '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': '3.35', 'valuenum': 3.35, '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': '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': '1.20', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, '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': '134', 'valuenum': 134.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '30.9', 'valuenum': 30.9, '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': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, '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': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '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': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 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'comments': None}, {'value': '1.4', 'valuenum': 1.4, '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': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '5.5', 'valuenum': 5.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, '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': '67', 'valuenum': 67.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '27', 'valuenum': 27.0, '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '114', 'valuenum': 114.0, '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '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': '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': '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': '138', 'valuenum': 138.0, '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': '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': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 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'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.16', 'valuenum': 3.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 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'valuenum': 5.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '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': '122', 'valuenum': 122.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.5', 'valuenum': 5.5, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE. TITER IS BETWEEN 15 AND 100 MIU/ML. PROTECTIVE TITERS ARE >10 MIU/ML.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, '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': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '34.2', 'valuenum': 34.2, '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': '146', 'valuenum': 146.0, 'valueuom': 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None, 'comments': '___'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, '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': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'value': '29.1', 'valuenum': 29.1, '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': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '177', 'valuenum': 177.0, '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': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'GEN: Caucasian female, intubated, off sedation able to follow \ninstructions\nNeuro: Positive for dysmetria on cerebellar testing, difficulty \nwith finger to nose\nCARDIAC: Nl s1/s2, RRR no murmurs appreciable\nRESP: Lungs clear bilaterally, no rales appreciable\nABD: Soft, nontender, nondistended, no hepatosplenomegaly, no \nmasses palpable\nExt: soft, absent pulses in right lower extremity, left lower \nextremity 1+ pulses distally', 'diagnoses': [{'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '5185', 'desc': 'Pulmonary insufficiency following trauma and surgery'}, {'icd_code': '48283', 'desc': 'Pneumonia due to other gram-negative bacteria'}, {'icd_code': '53784', 'desc': 'Dieulafoy lesion (hemorrhagic) of stomach and duodenum'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '49392', 'desc': 'Asthma, unspecified type, with (acute) exacerbation'}, {'icd_code': '1122', 'desc': 'Candidiasis of other urogenital sites'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '9971', 'desc': 'Cardiac complications, not elsewhere classified'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V4571', 'desc': 'Acquired absence of breast and nipple'}, {'icd_code': 'V103'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '78551', 'desc': 'Cardiogenic shock'}, {'icd_code': 'V707'}], 'summary': "Labs on Admission:\n___ 11:44PM SODIUM-139 POTASSIUM-3.9 CHLORIDE-104\n___ 11:44PM CK-MB-81*\n___ 11:44PM PLT COUNT-284\n___ 04:47PM TYPE-ART TEMP-37.2 PO2-92 PCO2-35 PH-7.39 \nTOTAL CO2-22 BASE XS--2\n___ 04:47PM GLUCOSE-186* LACTATE-2.1*\n___ 04:47PM O2 SAT-95\n___ 03:26PM GLUCOSE-272* UREA N-23* CREAT-0.9 SODIUM-139 \nPOTASSIUM-3.6 CHLORIDE-104 TOTAL CO2-25 ANION GAP-14\n___ 03:26PM ALT(SGPT)-282* AST(SGOT)-449* LD(LDH)-684* \nCK(CPK)-1084* ALK PHOS-86 TOT BILI-0.8\n___ 03:26PM CK-MB-87* MB INDX-8.0* cTropnT-2.68*\n___ 03:26PM ALBUMIN-3.9 CALCIUM-9.0 PHOSPHATE-3.3 \nMAGNESIUM-1.4*\n___ 03:26PM WBC-15.1* RBC-4.87 HGB-14.6 HCT-42.0 MCV-86 \nMCH-30.0 MCHC-34.8 RDW-14.6\n___ 03:26PM PLT COUNT-300\n___ 03:23PM ___ PTT-27.2 ___\n___ 12:57PM TYPE-ART TIDAL VOL-500 O2-100 PO2-387* \nPCO2-38 PH-7.32* TOTAL CO2-20* BASE XS--5 AADO2-295 REQ O2-55 \n-ASSIST/CON INTUBATED-INTUBATED\n___ 12:57PM GLUCOSE-284*\n___ 12:57PM HGB-14.6 calcHCT-44 O2 SAT-97\n___ 12:20PM TYPE-ART O2 FLOW-15 PO2-273* PCO2-72* PH-7.37 \nTOTAL CO2-43* BASE XS-13 -ASSIST/CON INTUBATED-NOT INTUBA\n___ 12:20PM LACTATE-4.9* K+-4.4 CL--104\n___ 12:20PM HGB-14.1 calcHCT-42 O2 SAT-98\n___ 11:20AM GLUCOSE-188* UREA N-22* CREAT-0.9 SODIUM-142 \nPOTASSIUM-3.6 CHLORIDE-99 TOTAL CO2-30 ANION GAP-17\n___ 11:20AM estGFR-Using this\n___ 11:20AM cTropnT-<0.01\n___ 11:20AM CALCIUM-10.1 PHOSPHATE-3.6 MAGNESIUM-1.6\n___ 11:20AM WBC-10.4 RBC-5.19 HGB-15.6 HCT-45.0 MCV-87 \nMCH-30.1 MCHC-34.7 RDW-14.8\n___ 11:20AM NEUTS-67.9 ___ MONOS-5.1 EOS-1.3 \nBASOS-0.5\n___ 11:20AM PLT COUNT-307\n___ 11:20AM ___ PTT-23.2 ___\n\nLabs on Discharge:\n___ 07:46AM BLOOD WBC-14.4* RBC-4.84 Hgb-14.1 Hct-42.1 \nMCV-87 MCH-29.2 MCHC-33.6 RDW-14.4 Plt ___\n___ 07:46AM BLOOD ___\n___ 07:46AM BLOOD Glucose-143* UreaN-24* Creat-1.0 Na-137 \nK-3.9 Cl-100 HCO3-27 AnGap-14\n___ 07:45AM BLOOD ALT-38 AST-39 LD(LDH)-392* AlkPhos-53 \nTotBili-0.6\n___ 11:37AM BLOOD CK-MB-21* MB Indx-2.6 cTropnT-4.14*\n___ 07:46AM BLOOD Phos-3.4 Mg-1.5*\n___ 07:27AM BLOOD TSH-6.7*\n___ 07:45AM BLOOD Free T4-0.92*\n___ 05:04PM BLOOD Lactate-1.5\n___ 09:19AM URINE Blood-MOD Nitrite-POS Protein-100 \nGlucose-NEG Ketone-NEG Bilirub-SM Urobiln-2* pH-6.0 Leuks-NEG\n___ 09:19AM URINE RBC-13* WBC-7* Bacteri-FEW Yeast-NONE \nEpi-0\n___ year old female s/p inferior STEMI with RV infarction and \nobserved v-fib arrest, now in slow atrial fibrillation, \nextubated, off pressors. \n\n# s/p Right ventricular/inferior STEMI + V-fib arrest: The \npatient arrived with complaints of chest pain, and was noted on \nEKG to have ST elevations in II, III, AVF, V3-5 and reciprocal \ndepressions in I, aVL, V1, V2 with inverted T waves in I, aVL, \nV1, V2. She was taken to the cath lab, where her cath report \nshowed one vessel significant coronary artery disease with RCA \nocclusion, an inferior STEMI and RV infarction, severely \nelevated left and right sided filling pressures, in addition to \nsuccessful DES of proximal and mid RCA with three overlapping \nPROMUS stents. However, her catheterization was notable for a \nV-fib arrest which lasted for less than 1 minute. She was \nshocked x2 and given epi x1 and amio x1 after which she resumed \nher baseline rhythm. She was intubated, and was started on \npressors, and was transferred to the CCU. She was started on \naspirin, plavix, and atorvastatin; her metoprolol and ACE-I were \ninitally held in the setting of bardycardia and hypotension \nrequiring pressors; however, she eventually no longer required \npressors, and was started on metoprolol and lisinpril. Her ECHO \n(for which the full report is in the results) showed mild \nsymmetric left ventricular hypertrophy, with left ventricular \nsystolic function mildly depressed (LVEF= 45 %) secondary to \nmild hypokinesis of the inferior septum and posterior wall, and \nmoderate hypokinesis of the inferior free wall. \n\n# Atrial fibrillation - The patient's known rhythm was atrial \nfibrillation, and she was on coumadin for her afib on admission \nas well. Her INRs were trended in the hospital, but her coumadin \nwas discontinued on ___ secondary to a rise in her INR to 4, \nlikely secondary to changes in her warfarin dosing in-house from \n4 days a week to daily. On the day of her discharge, she was \nstill supra-therapeutic at 3.7 (her INR had peaked around 6), \nand so she was discharged and told NOT to take her coumadin \nuntil she had had labs drawn with her PCP, who would then \ninstruct her if she should need to restart. Her coumadin was \nalso initally held on her admission secondary to concerns for \ndysmetria, with concern for possible hemmoragic stroke; when CT \nhead was negative, her coumadin was restarted.\n\n# Hypotension - The patient was initially treated in the CCU \nwith dopamine and levophed, and was subsequently able to be \nweaned off these medication. Upon her discharge, she was no \nlonger hypotense, and was tolerating her metoprolol as well as \nher lisonpril. \n\n# Dysmetria - The patient on admission was noted to have \ndifficulty with finger-to-nose on her CCU exam. A CT head was \nperformed which was normal, and the patient's dysmetria \nsubsequently resolved. There was some concern initially that her \ndysmetria might be secondary to alcohol withdrawal (the patient \nendorsing drinking ___ drinks a night) but the patient did not \nexhibit any signs of withdrawal, so her CIWA (which was order) \ndid not need to be used.\n\n# Hypothyroidism: The patient in house was treated with a \nslightly larger dose of her home levothyroxine at 137 mcg; at \nhome she had been taking 125 mcg. Her TSH in house was around 6, \nbut with a Free T4 on the low side of normal at 0.94, possibly \nconsistent with a sick euthyroid. As an outpatient, she should \nhave her TSH/Free T4 repeated to ensure that she is an \nappropriate dose of levothyroxine.\n\n# UTI: The patient has a known history of chronic UTIs. In \nhouse, she had complained of some cystitis-type pain, for which \na U/A was performed and initially did not show any signs of \ninfection. however, during her hospitalization, she continued to \nhave dysuria; a repeat U/A and culture was performed indicating \nan infection with E. Coli. She had initially been treated with \ncefpodoxime, but her culture turned out to be resistent; given \nher age and history of multiple urinary tract infections, she \nwas treated as a complicated UTI with Cipro for a 10 day course, \nstarting on ___ to end on ___. \n\n# Urinary retention: Around the same time as the patient's \ndysuria, the patient was noted to have some urinary retention as \nwell, with bladder scans showing 600 cc in her bladder at one \npoint, requiring straight catherterization. Urology was \nconsulted, and they reocmmended leaving foley for 5 days; she \nwas discharged with a foley and plans to follow-up with her PCP \nor with her ___ for Foley removal. Her retention was felt likely \nsecondary to her UTI. Urology indicated that they would \nfollow-up if the PCP so desired.\n\n# BRBPR: The patient one night noted bright red blood on the \ntoilet paper after having had a bowel movement. Hematocrits were \nmonitored and noted to be stable, and the BRBPR was felt to be \nmost consistent with hemmoroids; the patient was instructed to \ncontact her PCP if this started to bother her or if her bleeding \nworsened. \n\n# Diarrhea: In house the patient was noted to have some \ndiarrhea; C. Diff x 2 was sent off and was negative. The \npatient's diarrhea resolved with loperamide."}}
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{'final_diagnoses': ['Right Ventiricular STEMI', 'Ventricular Fibrillation Arrest', 'Atrial fibrillation on warfarin', 'Dysmetria after arrest', 'Gastroenteritis with diarrhea', 'Urinary Retention'], 'procedures': ['cardiac catheterization with drug eluting stents x3 to proximal \nright coronary artery', 'pulmonary intubation'], 'visit_summary': "___ year old female s/p inferior STEMI with RV infarction and \nobserved v-fib arrest, now in slow atrial fibrillation, \nextubated, off pressors. \n\n# s/p Right ventricular/inferior STEMI + V-fib arrest: The \npatient arrived with complaints of chest pain, and was noted on \nEKG to have ST elevations in II, III, AVF, V3-5 and reciprocal \ndepressions in I, aVL, V1, V2 with inverted T waves in I, aVL, \nV1, V2. She was taken to the cath lab, where her cath report \nshowed one vessel significant coronary artery disease with RCA \nocclusion, an inferior STEMI and RV infarction, severely \nelevated left and right sided filling pressures, in addition to \nsuccessful DES of proximal and mid RCA with three overlapping \nPROMUS stents. However, her catheterization was notable for a \nV-fib arrest which lasted for less than 1 minute. She was \nshocked x2 and given epi x1 and amio x1 after which she resumed \nher baseline rhythm. She was intubated, and was started on \npressors, and was transferred to the CCU. She was started on \naspirin, plavix, and atorvastatin; her metoprolol and ACE-I were \ninitally held in the setting of bardycardia and hypotension \nrequiring pressors; however, she eventually no longer required \npressors, and was started on metoprolol and lisinpril. Her ECHO \n(for which the full report is in the results) showed mild \nsymmetric left ventricular hypertrophy, with left ventricular \nsystolic function mildly depressed (LVEF= 45 %) secondary to \nmild hypokinesis of the inferior septum and posterior wall, and \nmoderate hypokinesis of the inferior free wall. \n\n# Atrial fibrillation - The patient's known rhythm was atrial \nfibrillation, and she was on coumadin for her afib on admission \nas well. Her INRs were trended in the hospital, but her coumadin \nwas discontinued on ___ secondary to a rise in her INR to 4, \nlikely secondary to changes in her warfarin dosing in-house from \n4 days a week to daily. On the day of her discharge, she was \nstill supra-therapeutic at 3.7 (her INR had peaked around 6), \nand so she was discharged and told NOT to take her coumadin \nuntil she had had labs drawn with her PCP, who would then \ninstruct her if she should need to restart. Her coumadin was \nalso initally held on her admission secondary to concerns for \ndysmetria, with concern for possible hemmoragic stroke; when CT \nhead was negative, her coumadin was restarted.\n\n# Hypotension - The patient was initially treated in the CCU \nwith dopamine and levophed, and was subsequently able to be \nweaned off these medication. Upon her discharge, she was no \nlonger hypotense, and was tolerating her metoprolol as well as \nher lisonpril. \n\n# Dysmetria - The patient on admission was noted to have \ndifficulty with finger-to-nose on her CCU exam. A CT head was \nperformed which was normal, and the patient's dysmetria \nsubsequently resolved. There was some concern initially that her \ndysmetria might be secondary to alcohol withdrawal (the patient \nendorsing drinking ___ drinks a night) but the patient did not \nexhibit any signs of withdrawal, so her CIWA (which was order) \ndid not need to be used.\n\n# Hypothyroidism: The patient in house was treated with a \nslightly larger dose of her home levothyroxine at 137 mcg; at \nhome she had been taking 125 mcg. Her TSH in house was around 6, \nbut with a Free T4 on the low side of normal at 0.94, possibly \nconsistent with a sick euthyroid. As an outpatient, she should \nhave her TSH/Free T4 repeated to ensure that she is an \nappropriate dose of levothyroxine.\n\n# UTI: The patient has a known history of chronic UTIs. In \nhouse, she had complained of some cystitis-type pain, for which \na U/A was performed and initially did not show any signs of \ninfection. however, during her hospitalization, she continued to \nhave dysuria; a repeat U/A and culture was performed indicating \nan infection with E. Coli. She had initially been treated with \ncefpodoxime, but her culture turned out to be resistent; given \nher age and history of multiple urinary tract infections, she \nwas treated as a complicated UTI with Cipro for a 10 day course, \nstarting on ___ to end on ___. \n\n# Urinary retention: Around the same time as the patient's \ndysuria, the patient was noted to have some urinary retention as \nwell, with bladder scans showing 600 cc in her bladder at one \npoint, requiring straight catherterization. Urology was \nconsulted, and they reocmmended leaving foley for 5 days; she \nwas discharged with a foley and plans to follow-up with her PCP \nor with her ___ for Foley removal. Her retention was felt likely \nsecondary to her UTI. Urology indicated that they would \nfollow-up if the PCP so desired.\n\n# BRBPR: The patient one night noted bright red blood on the \ntoilet paper after having had a bowel movement. Hematocrits were \nmonitored and noted to be stable, and the BRBPR was felt to be \nmost consistent with hemmoroids; the patient was instructed to \ncontact her PCP if this started to bother her or if her bleeding \nworsened. \n\n# Diarrhea: In house the patient was noted to have some \ndiarrhea; C. Diff x 2 was sent off and was negative. The \npatient's diarrhea resolved with loperamide.", 'medications_prescribed': ['1. aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily). ', '2. clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*11*', '3. atorvastatin 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '4. ciprofloxacin 250 mg Tablet Sig: One (1) Tablet PO Q12H \n(every 12 hours) for 10 days.\nDisp:*20 Tablet(s)* Refills:*0*', '5. metoprolol succinate 100 mg Tablet Extended Release 24 hr \nSig: 1.5 Tablet Extended Release 24 hrs PO DAILY (Daily).\nDisp:*45 Tablet Extended Release 24 hr(s)* Refills:*2*', '6. levothyroxine 137 mcg Capsule Sig: One (1) Capsule PO DAILY \n(Daily). ', '7. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '8. loperamide 2 mg Capsule Sig: One (1) Capsule PO QID (4 times \na day) as needed for diarrhea. ', '9. Calcium 500 500 mg (1,250 mg) Tablet Sig: One (1) Tablet PO \ntwice a day. ', '10. Vitamin D 1,000 unit Tablet Sig: One (1) Tablet PO once a \nday. ', '11. Glucosamine Chondroitin MaxStr Oral', '12. Actonel 35 mg Tablet Sig: One (1) Tablet PO once a week. ', '13. Outpatient Lab Work\nPlease check INR on ___ with results to Dr. ___ at \n___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 39, 'gender': 'F', 'symptoms': 'acute renal failure', 'medical_history': ['Mr. ___ symptoms began over the ___ when he \nnoted cramping in his hands and legs. He then developed ankle \nedema in ___, when laboratory evaluation showed \nevidence of proteinuria and a small monoclonal paraprotein. He \nwas referred to a nephrologist who had planned to do a renal \nbiopsy. However, prior to the biopsy, his INR was noted to be \nelevated and he was first referred to a hematologist. A bone \nmarrow biopsy revealed 12% lambda-restricted plasma cells in his \nbone marrow. By report, a skeletal survey was negative for lytic \nbone lesions. He then underwent a \nrenal biopsy on ___, which showed renal amyloidosis with \nmild chronic tubular, interstitial, and vascular damage. It was \nrecommended that he have an autologous stem cell transplant for \nlikely primary AL amyloidosis. For insurance reasons he was seen \nat ___, where a bone marrow biopsy was repeated on ___ and \ndemonstrated 16% plasma cells on aspirate differential count and \n20% by CD138 IHC. SPEP and UPEP showed a monoclonal IgG lambda \nwith a free kappa/lambda light chain ratio of 0.05. Thus, he was \nfelt to have a diagnosis of multiple myeloma with associated \namyloidosis.', '# Hyperlipidemia', 'History of shoulder injury', 'History of genital herpes', 'History of chest pain', '- S/p stress test ___, negative per report', 'S/p lens implantation (left) for cataracts', 'S/p discectomy'], 'family_history': "The patient's father died at age ___ from prostate cancer; his \nmother died from a pulmonary embolus and myocardial onfarction. \nHe has a brother with CLL and two first cousins with AML.", 'present_illness': 'Mr. ___ is a ___ man with multiple myeloma and \nassociated amyloidosis (see below) who is admitted today from \nthe clinic for worsening renal dysfunction. Due to significant \nperipheral edema from his nephrotic syndrome, he has been taking \nincreasing doses of furosemide and metolazone over the last ___ \nweeks, as prescribed by Dr. ___. Over the past several \ndays, after increasing the dose of his diuretics, his edema has \nnearly resolved, and he has lost 20#, returning to his baseline \nweight of 180#. At the same time he became dizzy/lightheaded, \nand his urinary volume has slowed. His appetite has been \nslightly depressed, and he has felt generally poorly. \nIn the hematologic malignancies clinic today he was noted to \nhave a significant rise in his BUN/Cr, from ___ to 57/3.5. In \naddition, vital signs taken in the ___ outpatient clinic \ndemonstrated orthostatic changes. Due to concern for prerenal \nazotemia, he was admitted for further management. \nAside from his recent lightheadedness and malaise, the patient \nhas no new symptoms or concerns at this time. He denies fevers, \nchills, sweats, recent infections, and bleeding/bruising.', 'medications': [{'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Colazal', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'Ibuprofen', '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}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', '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': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '40.6', 'valuenum': 40.6, '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': '28.4', 'valuenum': 28.4, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '375', 'valuenum': 375.0, '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': '4.58', 'valuenum': 4.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VITAL SIGNS: 98.1, 92, 124/74, 95%RA \nGENERAL APPEARANCE: The patient is a pleasant, well-appearing \nman. \nHEENT: Pupils are small, equal, round, and reactive to light. \nExtraocular muscles are intact. The oropharynx is clear without \nlesions. Mucous membranes are moist. \nNECK: Supple without lymphadenopathy. \nLUNGS: Clear bilaterally without crackles or wheezes. \nHEART: S1, S2, regular. \nABDOMEN: Soft, nontender, nondistended with no palpable \nsplenomegaly. \nEXTREMITIES: Compression stockings in place. Trace residual \nperipheral edema. \nSKIN: Tan. No bleeding, bruising, rash.', 'diagnoses': [{'icd_code': '5560', 'desc': 'Ulcerative (chronic) enterocolitis'}], 'summary': 'CBC:\n___ 02:00PM BLOOD WBC-11.3* RBC-4.61 Hgb-13.6* Hct-39.4* \nMCV-86 MCH-29.6 MCHC-34.6 RDW-15.8* Plt ___\n___ 05:40AM BLOOD WBC-15.0* RBC-3.59* Hgb-10.2* Hct-30.2* \nMCV-84 MCH-28.5 MCHC-33.8 RDW-15.7* Plt ___\n___ 12:26AM BLOOD WBC-16.2* RBC-3.84* Hgb-11.2* Hct-32.5* \nMCV-85 MCH-29.2 MCHC-34.4 RDW-15.9* Plt ___\n___ 02:00PM BLOOD Neuts-54.6 ___ Monos-7.9 Eos-1.2 \nBaso-1.0\n___ 12:00AM BLOOD Neuts-81.4* Lymphs-14.3* Monos-4.1 \nEos-0.1 Baso-0.1\n___ 02:00PM BLOOD Plt ___\n___ 06:30AM BLOOD Plt ___\n___ 06:45AM BLOOD Plt ___\n\nCoags:\n___ 03:40PM BLOOD ___ PTT-27.9 ___\n___ 12:26AM BLOOD ___ PTT-32.7 ___\n\nChemistries: (Cre 3.5 on admission to 2.1 on discharge)\n___ 02:00PM BLOOD UreaN-57* Creat-3.5*# Na-132* K-3.9 \nCl-89* HCO3-31 AnGap-16\n___ 06:30AM BLOOD Glucose-97 UreaN-59* Creat-3.6* Na-135 \nK-3.3 Cl-96 HCO3-35* AnGap-7*\n___ 06:45AM BLOOD Glucose-144* UreaN-55* Creat-3.3* Na-134 \nK-3.2* Cl-97 HCO3-28 AnGap-12\n___ 06:40AM BLOOD Glucose-152* UreaN-61* Creat-3.1* Na-135 \nK-3.2* Cl-101 HCO3-24 AnGap-13\n___ 05:40AM BLOOD Glucose-143* UreaN-58* Creat-2.9* Na-140 \nK-3.6 Cl-107 HCO3-25 AnGap-12\n___ 12:00AM BLOOD Glucose-103 UreaN-57* Creat-2.6* Na-136 \nK-3.6 Cl-104 HCO3-25 AnGap-11\n___ 12:00AM BLOOD Glucose-136* UreaN-56* Creat-2.4* Na-132* \nK-3.4 Cl-104 HCO3-24 AnGap-7*\n___ 12:00AM BLOOD Glucose-110* UreaN-48* Creat-2.4* Na-137 \nK-4.1 Cl-107 HCO3-25 AnGap-9\n___ 12:26AM BLOOD Glucose-98 UreaN-41* Creat-2.1* Na-138 \nK-3.7 Cl-106 HCO3-25 AnGap-11\n\nLFTs:\n___ 02:00PM BLOOD ALT-43* AST-43* LD(LDH)-295* AlkPhos-63 \nTotBili-0.1\n___ 12:00AM BLOOD ALT-13 AST-13 LD(LDH)-115 AlkPhos-22* \nTotBili-0.2\n\n___ 06:30AM BLOOD Calcium-7.5* Phos-5.7*# Mg-2.6\n___ 12:26AM BLOOD Calcium-7.1* Phos-3.0 Mg-1.9\n\nB2-microglobulins and Antibody Levels: \n___ 02:00PM BLOOD PEP-ABNORMAL B b2micro-10.1* IgG-660* \nIgA-140 IgM-117\n\nEKG: ___ \nBaseline artifact. Borderline P-R interval prolongation. Low \nvoltage. \nLate R wave progression. No previous tracing available for \ncomparison\n___ y.o. gentleman with multiple myeloma and associated \namyloidosis, currently undergoing evaluation for autologous stem \ncell transplantation, who is admitted with worsening renal \ndysfunction. \n \n# Acute on chronic renal failure: Likely due to overdiuresis and \npre-renal azotemia from lasix and metolazone, given his elvated \nBUN:Cre ratio, his orthostasis, hyponatremia, and markedly \ndecreased urine sodium . However, patient initially had a \ndiagnosis of amyloid kidney prior to his diagnosis of multiple \nmyeloma, with an elevated UPEP (150 mg/day up to 550 mg/day from \n___ to ___, so his renal failure may also have been due to \nworsening myeloma kidney. Diuretics were held and can be \nrestarted at the discretion of his outpatient nephrologist. \nRenal was consulted and followed him during hospitalization, \nrecommended plasmapheresis and rehydration with IVFs. Patient \nhad a pheresis ___ placed and three plasmapheresis sessions. \nFollowed by clinical pathology during his plasmapheresis \nsessions. 24 hour UPEP noted to be 280 mg daily on ___, although \nthis was collected after plasmapheresis. His orthostasis \nresolved with IVFs. Recommended leg elevation and stockings for \nlower extremity edema. His Cre was 2.1 on discharge (baseline \n1.5), and he was scheduled to follow up in outpatient ___ \nclinic 2 days after discharge for RFT check. He was also \nrecommended to follow up with his outpatient nephrologist the \nweek after discharge for renal function check. \n \n# Mutliple myeloma: Given his elevated renal function and \nconcern for progression of his myeloma in the setting of \nworsening urine UPEP, patient received Velcadeon days 1,4, and 9 \nwhile admitted and Dexamethasone on Days ___ and Days ___ (oral \non days 9 and 12, IV on days 10 and 11). He tolerated the \nchemotherapy well. He was scheduled to receive Day 11 of Velcade \nas an outpatient in the ___ prior to leaving for \n___. \n\n# Chest Discomfort: Patient had episode of non-cardiac chest \ndiscomfort, not related to exertion. EKG was unchanged compared \nto previous EKG done on ___. Likely musculoskeletal vs. GERD in \nnature. Relieved spontaneously. Discharged patient on Protonix \nwhich requires prior authorization, so gave patient script for \nomeprazole until he can be seen by his PCP oncologist in \n___. \n\n# Hyperlipidemia: ___ be related to nephrotic syndrome. \nContinued simvastatin.'}}
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{'final_diagnoses': ['Acute on Chronic Renal Failure', 'Multiple Myeloma', 'Hyperlipidemia', 'Chest Pain'], 'procedures': ['Pheresis ___ Placement and Plasmapheresis'], 'visit_summary': '___ y.o. gentleman with multiple myeloma and associated \namyloidosis, currently undergoing evaluation for autologous stem \ncell transplantation, who is admitted with worsening renal \ndysfunction. \n \n# Acute on chronic renal failure: Likely due to overdiuresis and \npre-renal azotemia from lasix and metolazone, given his elvated \nBUN:Cre ratio, his orthostasis, hyponatremia, and markedly \ndecreased urine sodium . However, patient initially had a \ndiagnosis of amyloid kidney prior to his diagnosis of multiple \nmyeloma, with an elevated UPEP (150 mg/day up to 550 mg/day from \n___ to ___, so his renal failure may also have been due to \nworsening myeloma kidney. Diuretics were held and can be \nrestarted at the discretion of his outpatient nephrologist. \nRenal was consulted and followed him during hospitalization, \nrecommended plasmapheresis and rehydration with IVFs. Patient \nhad a pheresis ___ placed and three plasmapheresis sessions. \nFollowed by clinical pathology during his plasmapheresis \nsessions. 24 hour UPEP noted to be 280 mg daily on ___, although \nthis was collected after plasmapheresis. His orthostasis \nresolved with IVFs. Recommended leg elevation and stockings for \nlower extremity edema. His Cre was 2.1 on discharge (baseline \n1.5), and he was scheduled to follow up in outpatient ___ \nclinic 2 days after discharge for RFT check. He was also \nrecommended to follow up with his outpatient nephrologist the \nweek after discharge for renal function check. \n \n# Mutliple myeloma: Given his elevated renal function and \nconcern for progression of his myeloma in the setting of \nworsening urine UPEP, patient received Velcadeon days 1,4, and 9 \nwhile admitted and Dexamethasone on Days ___ and Days ___ (oral \non days 9 and 12, IV on days 10 and 11). He tolerated the \nchemotherapy well. He was scheduled to receive Day 11 of Velcade \nas an outpatient in the ___ prior to leaving for \n___. \n\n# Chest Discomfort: Patient had episode of non-cardiac chest \ndiscomfort, not related to exertion. EKG was unchanged compared \nto previous EKG done on ___. Likely musculoskeletal vs. GERD in \nnature. Relieved spontaneously. Discharged patient on Protonix \nwhich requires prior authorization, so gave patient script for \nomeprazole until he can be seen by his PCP oncologist in \n___. \n\n# Hyperlipidemia: ___ be related to nephrotic syndrome. \nContinued simvastatin.', 'medications_prescribed': ['Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime).', 'Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Acyclovir 200 mg Capsule Sig: One (1) Capsule PO DAILY (Daily).\nDisp:*30 Capsule(s)* Refills:*2*', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One (1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2*', 'Trimethoprim-Sulfamethoxazole 80-400 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', 'Dexamethasone 4 mg Tablet Sig: Ten (10) Tablet PO once a day for 2 days: take 40 mg daily on ___ and ___ ONLY.\nDisp:*20 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'Left sided weakness', 'medical_history': ['HTN', 'HLD', 'Type 2 DM'], 'family_history': 'Non-contributory', 'present_illness': 'This is a ___ year old woman with history of HTN, HLD and\ntype 2 DM who presents with acute onset of left face, arm and \nleg\nplegia, neglect and dysarthria. History provided by family via\nphone ___ interpreter as patient cannot provide history.\n\nPer patient\'s husband and family at the bedside, patient was \nlast\nknown well at 730pm. She was sitting on the couch with her\nhusbnad when she developed acute onset of left facial droop, \nleft\narm and left leg plegia. \n\nShe was brought to ___ for further management. Initial\nvitals were notable for HR 103 (sinus tach per OSH EKG) and BP\n176/72. There, ___ stroke scale was "at least 12" but no formal\ndocumentation is available at this time including no neurology\nnote. Glucose was 173. CBC, chem 10 and coags were otherwise\nunremarkable. She received tPA at 21:14 and was transferred to\n___ for further management. Of note, while en route to ___\nthe tPA bottle fell and broke, and the patient had 25mg of 62mg\ndose remaining. \n\nOn arrival to ___, patient had exam findings consistent with\ndense right MCA syndrome. She was unable to answer questions as\nshe was somnolent and responded by saying "I\'m too tired" in\n___ to most questions. CTA H/N revealed M1 occlusion. After\nextensive discussion with family, neuro ___ team and stroke \nfellow\ndecision was made to proceed with thrombectomy. \n\nOf note, she was noted to have atrial fibrillation with RVR \nwhile\nin the thrombectomy suite. \n\nUnable to obtain ROS ___ mental status.', 'medications': [{'medication': 'Cyanocobalamin', '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 via patient discharge', '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': 'Ferrous Sulfate', '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': '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': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '___', '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '___', 'valuenum': 158.0, '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': '1', 'valuenum': 1.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'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': 'ROUTINE', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'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': 0.01, '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': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '___', 'valuenum': 208.0, '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': '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': '316', 'valuenum': 316.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, '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': '18', 'valuenum': 18.0, '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': '11', 'valuenum': 11.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', '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': 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': '0.88', 'valuenum': 0.88, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '588', 'valuenum': 588.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': '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': '___', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, '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': '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': 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': '10', 'valuenum': 10.0, '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': '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': '___', 'valuenum': 3.9, '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': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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}], 'exams': 'ADMISSION EXAM:\n============\n\nVitals: afebrile, HR 101, BP 160/74, RR 14, O2 99% RA \n\nGeneral: somnolent, in no distress \nHEENT: NCAT, no oropharyngeal lesions, neck supple\n___: warm, well perfused; regular on telemetry\nPulmonary: breathing non labored on room air\nAbdomen: Soft, NT, ND, no guarding\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental status: Somnolent, eyes open to voice. Oriented to self\nand hospital, not oriented to time or situation. When asked most\nquestions, answers in ___, "I\'m too tired." Follows one step\nmidline and appendicular commands. When asked to name objects \ncan\nname hand, calls thumb a \'finger\', and says that she cannot see\nany objects on stroke card due to poor vision and does not have\nher glasses. She has a dense left hemineglect. \n- Cranial Nerves: PERRL 3->2 brisk. Right gaze preference, does \nnot cross midline on OCR. BTT bilaterally. V1-V3 without \ndeficits to light touch bilaterally. Severe right lower facial \ndroop. Hearing intact to finger rub bilaterally. Palate \nelevation symmetric. SCM/Trapezius strength ___ bilaterally. \nTongue midline.\n- Motor: Left arm and leg plegia. Left arm no spontaneous \nmovement, extends to noxious. Left leg with no spontaneous \nmovement, withdraws vs triple flexes to noxious. Right arm and \nleg are antigravity and against resistance, unable to do \nconfrontational muscle testing due to mental status. \n- Reflexes: \n [Bic] [Tri] [___] [Quad] [Gastroc]\n L 2+ 2+ 2+ 2+ 1\n R 2+ 2+ 2+ 2+ 1 \nPlantar response extensor on left, flexor on right \n- Sensory: No deficits to light touch bilaterally. No \nextinction to DSS.\n- Coordination: No dysmetria with finger to nose testing on \nright, unable to perform on left. \n- Gait: Deferred given s/p tPA and left plegia \n\nDISCHARGE EXAM:\n==============\n\nVitals: T 99.7, HR 88, BP 130/76, RR 18, O2 91% RA \n\nGeneral: NAD, alert, pleasant\nHEENT: NCAT, no oropharyngeal lesions, neck supple\n___: warm, well perfused; regular on telemetry\nPulmonary: breathing non labored on room air\nAbdomen: Soft, NT, ND, no guarding\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental status: Somnolent, eyes open to voice. Oriented to self\nand hospital, not oriented to time or situation. When asked most\nquestions, answers in ___, "I\'m too tired." Follows one step\nmidline and appendicular commands. When asked to name objects \ncan\nname hand, calls thumb a \'finger\', and says that she cannot see\nany objects on stroke card due to poor vision and does not have\nher glasses. She has a dense left hemineglect. \n- Cranial Nerves: PERRL 3->2 brisk. Right gaze preference, does \nnot cross midline on OCR. BTT bilaterally. V1-V3 without \ndeficits to light touch bilaterally. Severe right lower facial \ndroop. Hearing intact to finger rub bilaterally. Palate \nelevation symmetric. SCM/Trapezius strength ___ bilaterally. \nTongue midline.\n- Motor: Left arm and leg plegia. Left arm no spontaneous \nmovement, extends to noxious. Left leg with no spontaneous \nmovement, withdraws vs triple flexes to noxious. Right arm and \nleg are antigravity and against resistance, unable to do \nconfrontational muscle testing due to mental status. \n- Reflexes: \n [Bic] [Tri] [___] [Quad] [Gastroc]\n L 2+ 2+ 2+ 2+ 1\n R 2+ 2+ 2+ 2+ 1 \nPlantar response extensor on left, flexor on right \n- Sensory: No deficits to light touch bilaterally. No \nextinction to DSS.\n- Coordination: No dysmetria with finger to nose testing on \nright, unable to perform on left. \n- Gait: Deferred given s/p tPA and left plegia ', 'diagnoses': [{'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'I21A1', 'desc': 'Myocardial infarction type 2'}, {'icd_code': 'D61818', 'desc': 'Other pancytopenia'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'A084', 'desc': 'Viral intestinal infection, unspecified'}, {'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'D72819', 'desc': 'Decreased white blood cell count, unspecified'}, {'icd_code': 'E559', 'desc': 'Vitamin D deficiency, unspecified'}, {'icd_code': 'E538', 'desc': 'Deficiency of other specified B group vitamins'}, {'icd_code': 'N189', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': 'D638', 'desc': 'Anemia in other chronic diseases classified elsewhere'}], 'summary': "LABS:\n====\n___ 10:30PM BLOOD WBC-14.0* RBC-4.16 Hgb-12.6 Hct-37.9 \nMCV-91 MCH-30.3 MCHC-33.2 RDW-13.5 RDWSD-45.1 Plt ___\n___ 02:13AM BLOOD WBC-7.8 RBC-1.51*# Hgb-4.6*# Hct-14.5*# \nMCV-96 MCH-30.5 MCHC-31.7* RDW-13.2 RDWSD-46.5* Plt Ct-93*#\n___ 04:00AM BLOOD WBC-20.8*# RBC-4.25# Hgb-12.7# Hct-39.1# \nMCV-92 MCH-29.9 MCHC-32.5 RDW-13.3 RDWSD-44.8 Plt ___\n___ 01:05AM BLOOD WBC-14.7* RBC-4.02 Hgb-11.8 Hct-37.0 \nMCV-92 MCH-29.4 MCHC-31.9* RDW-13.2 RDWSD-44.7 Plt ___\n___ 10:31PM BLOOD WBC-13.1* RBC-3.54* Hgb-10.4* Hct-32.9* \nMCV-93 MCH-29.4 MCHC-31.6* RDW-13.2 RDWSD-44.9 Plt ___\n___ 01:58AM BLOOD WBC-12.7* RBC-3.73* Hgb-10.9* Hct-33.9* \nMCV-91 MCH-29.2 MCHC-32.2 RDW-12.8 RDWSD-42.2 Plt ___\n___ 06:10AM BLOOD WBC-10.0 RBC-3.23* Hgb-9.6* Hct-29.7* \nMCV-92 MCH-29.7 MCHC-32.3 RDW-12.9 RDWSD-42.9 Plt ___\n___ 05:30AM BLOOD WBC-13.3* RBC-3.87* Hgb-11.3 Hct-35.1 \nMCV-91 MCH-29.2 MCHC-32.2 RDW-13.2 RDWSD-42.6 Plt ___\n___ 05:00AM BLOOD WBC-16.6* RBC-3.71* Hgb-10.9* Hct-34.2 \nMCV-92 MCH-29.4 MCHC-31.9* RDW-13.1 RDWSD-43.6 Plt ___\n___ 05:30AM BLOOD WBC-14.1* RBC-3.77* Hgb-11.0* Hct-35.0 \nMCV-93 MCH-29.2 MCHC-31.4* RDW-13.4 RDWSD-45.0 Plt ___\n___ 05:35AM BLOOD WBC-10.3* RBC-3.67* Hgb-10.8* Hct-33.9* \nMCV-92 MCH-29.4 MCHC-31.9* RDW-13.3 RDWSD-44.5 Plt ___\n___ 05:30AM BLOOD WBC-12.6* RBC-3.99 Hgb-11.6 Hct-36.3 \nMCV-91 MCH-29.1 MCHC-32.0 RDW-13.5 RDWSD-43.8 Plt ___\n___ 10:30PM BLOOD Neuts-72.5* Lymphs-15.4* Monos-9.9 \nEos-0.8* Baso-0.5 Im ___ AbsNeut-10.14* AbsLymp-2.16 \nAbsMono-1.39* AbsEos-0.11 AbsBaso-0.07\n___ 02:13AM BLOOD Neuts-80.5* Lymphs-10.7* Monos-7.7 \nEos-0.1* Baso-0.0 Im ___ AbsNeut-6.23* AbsLymp-0.83* \nAbsMono-0.60 AbsEos-0.01* AbsBaso-0.00*\n___ 04:00AM BLOOD Neuts-79.5* Lymphs-11.1* Monos-8.0 \nEos-0.1* Baso-0.5 Im ___ AbsNeut-16.54*# AbsLymp-2.31 \nAbsMono-1.67* AbsEos-0.02* AbsBaso-0.11*\n___ 10:30PM BLOOD ___ PTT-25.7 ___\n\n___ 02:13AM BLOOD ___ PTT-43.3* ___\n___ 04:00AM BLOOD ___ PTT-27.4 ___\n___ 01:05AM BLOOD ___ PTT-23.4* ___\n___ 10:31PM BLOOD ___ PTT-27.9 ___\n___ 01:58AM BLOOD ___ PTT-28.2 ___\n___ 06:10AM BLOOD ___ PTT-28.8 ___\n___ 05:30AM BLOOD ___ PTT-27.1 ___\n___ 10:30PM BLOOD Creat-0.7\n___ 10:30PM BLOOD Glucose-183* UreaN-14 Creat-0.7 Na-137 \nK-5.9* Cl-99 HCO3-22 AnGap-16\n___ 02:13AM BLOOD Glucose-87 UreaN-4* Creat-<0.2# Na-148* \nK-<1.5* Cl-131* HCO3-9* AnGap-8*\n___ 04:00AM BLOOD Glucose-234* UreaN-10 Creat-0.6 Na-141 \nK-3.9 Cl-104 HCO3-24 AnGap-13\n___ 01:05AM BLOOD Glucose-161* UreaN-7 Creat-0.6# Na-145 \nK-4.2 Cl-106 HCO3-26 AnGap-13\n___ 10:31PM BLOOD Glucose-150* UreaN-9 Creat-0.5 Na-141 \nK-3.4 Cl-103 HCO3-22 AnGap-16\n___ 01:58AM BLOOD Glucose-201* UreaN-11 Creat-0.6 Na-142 \nK-4.1 Cl-105 HCO3-21* AnGap-16\n___ 06:10AM BLOOD Glucose-205* UreaN-14 Creat-0.6 Na-140 \nK-4.0 Cl-102 HCO3-27 AnGap-11\n___ 05:30AM BLOOD Glucose-266* UreaN-20 Creat-0.7 Na-137 \nK-4.6 Cl-95* HCO3-29 AnGap-13\n___ 05:00AM BLOOD Glucose-267* UreaN-25* Creat-0.7 Na-139 \nK-4.9 Cl-98 HCO3-27 AnGap-14\n___ 05:30AM BLOOD Glucose-158* UreaN-16 Creat-0.6 Na-140 \nK-4.4 Cl-97 HCO3-30 AnGap-13\n___ 05:35AM BLOOD Glucose-161* UreaN-15 Creat-0.6 Na-142 \nK-4.4 Cl-101 HCO3-29 AnGap-12\n___ 09:20PM BLOOD Glucose-94 UreaN-16 Creat-0.6 Na-139 \nK-3.7 Cl-93* HCO3-28 AnGap-18\n___ 05:30AM BLOOD Glucose-178* UreaN-18 Creat-0.6 Na-140 \nK-4.2 Cl-96 HCO3-29 AnGap-15\n___ 10:30PM BLOOD ALT-20 AST-46* AlkPhos-56 TotBili-0.6\n___ 02:13AM BLOOD ALT-5 AST-<5 LD(LDH)-67* AlkPhos-19* \nTotBili-0.2\n___ 04:00AM BLOOD ALT-18 AST-15 LD(LDH)-257* AlkPhos-67 \nTotBili-0.7\n___ 10:31PM BLOOD CK(CPK)-28*\n___ 10:30PM BLOOD cTropnT-<0.01\n___ 10:31PM BLOOD cTropnT-<0.01\n___ 10:30PM BLOOD Albumin-3.4* Calcium-8.4 Phos-5.3* Mg-1.6\n___ 02:13AM BLOOD Albumin-0.8* Calcium-2.5* Phos-0.9*# \nMg-0.4*\n___ 04:00AM BLOOD Albumin-3.3* Calcium-8.7 Phos-3.5 Mg-1.4*\n___ 01:05AM BLOOD Calcium-8.3* Phos-2.7 Mg-1.9 Cholest-192\n___ 10:31PM BLOOD Calcium-7.9* Phos-2.2* Mg-2.0\n___ 01:58AM BLOOD Calcium-8.2* Phos-2.4* Mg-2.0\n___ 06:10AM BLOOD Calcium-8.2* Phos-2.7 Mg-1.9\n___ 05:30AM BLOOD Calcium-9.3 Phos-4.2 Mg-2.1\n___ 05:00AM BLOOD Calcium-9.1 Phos-3.0 Mg-2.0\n___ 05:30AM BLOOD Calcium-9.0 Phos-3.7 Mg-1.9\n___ 05:35AM BLOOD Calcium-9.3 Phos-3.8 Mg-2.0\n___ 09:20PM BLOOD Calcium-9.4 Phos-4.2\n___ 05:30AM BLOOD Calcium-9.5 Phos-4.4 Mg-1.9\n___ 01:05AM BLOOD %HbA1c-7.1* eAG-157*\n___ 01:05AM BLOOD Triglyc-144 HDL-43 CHOL/HD-4.5 \nLDLcalc-120\n___ 10:31PM BLOOD TSH-0.21*\n___ 05:00AM BLOOD TSH-2.6\n___ 05:00AM BLOOD Free T4-1.5\n___ 10:30PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 10:33PM BLOOD Glucose-173* Lactate-1.8 Na-135 K-6.0* \nCl-104 calHCO3-22\n\nMICRO:\n======\n___ 5:38 am BLOOD CULTURE Source: Venipuncture. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH.\n\n___ 5:38 am BLOOD CULTURE Source: Venipuncture. \n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n___ 7:58 am SPUTUM Source: Endotracheal. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n ___ PMNs and <10 epithelial cells/100X field. \n NO MICROORGANISMS SEEN. \n\n RESPIRATORY CULTURE (Final ___: \n SPARSE GROWTH Commensal Respiratory Flora. \n\n___ 1:33 pm URINE Source: Catheter. \n\n URINE CULTURE (Preliminary): \n ENTEROCOCCUS SP.. >100,000 CFU/mL. \n\nIMAGING\n=======\nCTA HEAD/NECK ___:\n1. Early infarction involving the right middle cerebral artery \nterritory. No evidence for intracranial hemorrhage by CT. \n2. Complete occlusion of the proximal right M1 segment with \nasymmetric \narborization of the more distal right-sided MCA branches. \n3. Multiple additional sites of intracranial and cervical \natherosclerotic \ndisease, as detailed above, without additional areas of \nhigh-grade stenosis or vessel occlusion. \n4. Large area of increased mean transit time throughout the \nright middle \ncerebral artery vascular territory with central areas of \ndecreased CBF/CBV \ncompatible with a core area of infarction. \n5. Bilateral atelectasis and diffuse ground-glass opacities, \nmost likely \nrepresenting pulmonary edema. Infectious or inflammatory causes \nare felt less likely. \n \nMRI HEAD ___:\n1. Motion limited exam. \n2. Acute infarction in the right MCA territory involving the \nbasal ganglia, portions of the internal and external capsules, \nand the frontal, parietal, and possibly also temporal cortex. \n3. New hemorrhagic transformation in the right caudate and \nlentiform nuclei compared to head CT from 1 day earlier. \n4. New mild effacement of the body of the right lateral \nventricle compared to head CT from 1 day earlier. \n\nTTE ___:\nThe left atrial volume index is mildly increased. No left atrial \nmass/thrombus seen (best excluded by transesophageal \nechocardiography). No atrial septal defect is seen by 2D or \ncolor Doppler. The estimated right atrial pressure is ___ mmHg. \nLeft ventricular wall thickness, cavity size, and global \nsystolic function are normal (LVEF>60%). Regional left \nventricular wall motion is normal. No masses or thrombi are seen \nin the left ventricle. Tissue Doppler imaging suggests an \nincreased left ventricular filling pressure (PCWP>18mmHg). There \nis no ventricular septal defect. Right ventricular chamber size \nand free wall motion are normal. The diameters of aorta at the \nsinus, ascending and arch levels are normal. Atheroma is \nsuggested in the distal aortic arch (would be better visualized \non CT scanning). The aortic valve leaflets (3) appear \nstructurally normal with good leaflet excursion and no aortic \nstenosis. No aortic regurgitation is seen. The mitral valve \nappears structurally normal with trivial mitral regurgitation. \nThere is mild to moderate pulmonary artery systolic \nhypertension. There is no pericardial effusion. \n IMPRESSION: Normal biventricualr chamber size and \nregional/global systolic function. Mildly dilated left atrium. \nSinus rhythm. No ___ mass/thrombus (would be better \nvisualized on TEE). Mild to moderate pulmonary hypertension. \nIncreased PCWP. \n___ is a ___ yo ___ left handed \nfemale with history of DM, HTN, HLD who presented with left \nsided weakness and facial droop found to have complete right MCA \nocclusion in the M1 segment.\n\n#R MCA Stroke: presents from OSH with acute onset R MCA \nsyndrome, s/p tPA on ___ and s/p thrombectomy with TICI III \nreperfusion. She was intubated for the procedure and remained \nintubated afterwards due to confusion which prevented her from \nlying flat. She was easily extubated on the morning of ___. \nMRI obtained 24 hours after tPA administration showed an acute \ninfarct in the R MCA territory as well as some hemorrhagic \nconversion in the basal ganglia. The etiology of stroke is felt \nto be cardioembolus, given the location and appearance of the \nstroke, her new diagnosis of atrial flutter, and a complex \natheroma in the proximal ascending aorta identified on TEE. \nAspirin was stopped due to the high risk of bleed. She was \nstarted on high dose atorvastatin 80mg daily and apixaban for \nrisk modification. Course was complicated by difficulty \nswallowing, therefore, an NG tube was placed and tube feeds \nmaintained for 1 week. By ___, her swallowing was deem safe \nenough to allow advancement of PO intake during which tube feeds \nwere held. The NG tube was removed on ___. \n\n#Atrial flutter: She was noted to be in an irregular heart \nrhythm on admission. EKG was consistent with what was thought to \nbe atrial fibrillation. This was a new diagnosis for her. On the \nday of admission, she had an episode of rapid rates in the 130s. \nShe was started initially on a diltiazem drip. On the morning of \n___, she converted to sinus rhythm. However, she again went \ninto rapid Afib requiring a diltiazem drip. Oral diltiazem was \nstarted and increased to 90mg q6h and then increased again to \n120mg q6h with fair control of her rate. Digoxin was also added \nfor rate control. Cardiology was consulted and identified the \nrhythm as atrial flutter. She underwent a TEE that revealed no \natrial clot but did show a complex atheroma in the proximal \nascending aorta. She was cardioverted back to sinus rhythm. \nDigoxin was stopped and diltiazem reduced to 60mg every 6 hours \nfor blood pressure and arrhythmia reversion prevention. She was \nstarted on apixaban for a 4 week course post cardioversion. \n\n#Hypoxia/pulmonary edema: Follow cardioversion, she experienced \nsome increased O2 requirement, hypoxia, pulmonary edema, and had \nevidence of volume overload (rales, JVD). She was diuresed with \nLasix 20mg IV bid x 2 days and improved; her dry weight \ndocumented. \n\n#UTI, urinary culture grew Enterococcus. She finished a 3 day \ncourse of ceftriaxone prior to speciation. Was found to be \nsensitive to Ampicillin, therefore, she was discharged on \nAmoxicillin 500mg q12hr x 7 days (started ___.\n\nChronic issues\n\n#HTN\n- Started Diltiazem 60mg every 6 hours\n- Irbesartan 300mg daily was held, PCP to ___ need to \nrestart.\n\n#DM, in consultation with ___ Diabetes Consult service \n- Continue Metformin 500mg bid that was held during admission\n- Started Humalog insulin sliding scale\n\n#HLD\n- Started Atorvastatin 80mg\n\n#Hypothyroid\n- Continue Levothyroxine 50mcg\n\nTransitional issues\n[ ] Irbesartan was held. Considering that Diltiazem was started, \nthe necessity of Irbesartan for blood pressure control should be \nre-evaluated. \n[ ] Humalog insulin sliding scale were started in consultation \nwith ___ to obtain better glucose control and \ncontinued on discharge. Metformin was held during inpatient but \nrestarted on discharge.\n[ ] Please evaluate the patient's tolerance to high dose \natorvastatin.\n[ ] Treat for Enterococcus UTI with Amoxicillin 500mg q12hr x 7 \ndays (started ___.\n\n 1. Dysphagia screening before any PO intake? (x) Yes, confirmed \ndone - () Not confirmed () No \n 2. DVT Prophylaxis administered? (x) Yes - () No \n 3. Antithrombotic therapy administered by end of hospital day \n2? (x) Yes - () No \n 4. LDL documented? (x) Yes (LDL = 120) - () No \n 5. Intensive statin therapy administered? (simvastatin 80mg, \nsimvastatin 80mg/ezetemibe 10mg, atorvastatin 40mg or 80 mg, \nrosuvastatin 20mg or 40mg, for LDL > 70) (x) Yes - () No [if LDL \n>70, reason not given: \n [ ] Statin medication allergy \n [ ] Other reasons documented by physician/advanced practice \nnurse/physician ___ (physician/APN/PA) or pharmacist \n [ ] LDL-c less than 70 mg/dL \n ] \n 6. Smoking cessation counseling given? () Yes - () No [reason \n(x) non-smoker - () unable to participate] \n 7. Stroke education (personal modifiable risk factors, how to \nactivate EMS for stroke, stroke warning signs and symptoms, \nprescribed medications, need for followup) given (verbally or \nwritten)? (x) Yes - () No \n 8. Assessment for rehabilitation or rehab services considered? \n(x) Yes - () No \n 9. Discharged on statin therapy? (x) Yes - () No [if LDL >70, \nreason not given: \n [ ] Statin medication allergy \n [ ] Other reasons documented by physician/advanced practice \nnurse/physician ___ (physician/APN/PA) or pharmacist \n [ ] LDL-c less than 70 mg/dL \n 10. Discharged on antithrombotic therapy? () Yes [Type: () \nAntiplatelet - (x) Anticoagulation] - () No \n 11. Discharged on oral anticoagulation for patients with atrial \nfibrillation/flutter? (x) Yes - () No - () N/A "}}
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{'final_diagnoses': ['R MCA stroke (M1 division)', 'Atrial flutter'], 'procedures': ['tPA ___', 'R MCA thrombectomy ___', 'Cardioversion ___', 'Transesophageal echocardiogram ___'], 'visit_summary': "___ is a ___ yo ___ left handed \nfemale with history of DM, HTN, HLD who presented with left \nsided weakness and facial droop found to have complete right MCA \nocclusion in the M1 segment.\n\n#R MCA Stroke: presents from OSH with acute onset R MCA \nsyndrome, s/p tPA on ___ and s/p thrombectomy with TICI III \nreperfusion. She was intubated for the procedure and remained \nintubated afterwards due to confusion which prevented her from \nlying flat. She was easily extubated on the morning of ___. \nMRI obtained 24 hours after tPA administration showed an acute \ninfarct in the R MCA territory as well as some hemorrhagic \nconversion in the basal ganglia. The etiology of stroke is felt \nto be cardioembolus, given the location and appearance of the \nstroke, her new diagnosis of atrial flutter, and a complex \natheroma in the proximal ascending aorta identified on TEE. \nAspirin was stopped due to the high risk of bleed. She was \nstarted on high dose atorvastatin 80mg daily and apixaban for \nrisk modification. Course was complicated by difficulty \nswallowing, therefore, an NG tube was placed and tube feeds \nmaintained for 1 week. By ___, her swallowing was deem safe \nenough to allow advancement of PO intake during which tube feeds \nwere held. The NG tube was removed on ___. \n\n#Atrial flutter: She was noted to be in an irregular heart \nrhythm on admission. EKG was consistent with what was thought to \nbe atrial fibrillation. This was a new diagnosis for her. On the \nday of admission, she had an episode of rapid rates in the 130s. \nShe was started initially on a diltiazem drip. On the morning of \n___, she converted to sinus rhythm. However, she again went \ninto rapid Afib requiring a diltiazem drip. Oral diltiazem was \nstarted and increased to 90mg q6h and then increased again to \n120mg q6h with fair control of her rate. Digoxin was also added \nfor rate control. Cardiology was consulted and identified the \nrhythm as atrial flutter. She underwent a TEE that revealed no \natrial clot but did show a complex atheroma in the proximal \nascending aorta. She was cardioverted back to sinus rhythm. \nDigoxin was stopped and diltiazem reduced to 60mg every 6 hours \nfor blood pressure and arrhythmia reversion prevention. She was \nstarted on apixaban for a 4 week course post cardioversion. \n\n#Hypoxia/pulmonary edema: Follow cardioversion, she experienced \nsome increased O2 requirement, hypoxia, pulmonary edema, and had \nevidence of volume overload (rales, JVD). She was diuresed with \nLasix 20mg IV bid x 2 days and improved; her dry weight \ndocumented. \n\n#UTI, urinary culture grew Enterococcus. She finished a 3 day \ncourse of ceftriaxone prior to speciation. Was found to be \nsensitive to Ampicillin, therefore, she was discharged on \nAmoxicillin 500mg q12hr x 7 days (started ___.\n\nChronic issues\n\n#HTN\n- Started Diltiazem 60mg every 6 hours\n- Irbesartan 300mg daily was held, PCP to ___ need to \nrestart.\n\n#DM, in consultation with ___ Diabetes Consult service \n- Continue Metformin 500mg bid that was held during admission\n- Started Humalog insulin sliding scale\n\n#HLD\n- Started Atorvastatin 80mg\n\n#Hypothyroid\n- Continue Levothyroxine 50mcg\n\nTransitional issues\n[ ] Irbesartan was held. Considering that Diltiazem was started, \nthe necessity of Irbesartan for blood pressure control should be \nre-evaluated. \n[ ] Humalog insulin sliding scale were started in consultation \nwith ___ to obtain better glucose control and \ncontinued on discharge. Metformin was held during inpatient but \nrestarted on discharge.\n[ ] Please evaluate the patient's tolerance to high dose \natorvastatin.\n[ ] Treat for Enterococcus UTI with Amoxicillin 500mg q12hr x 7 \ndays (started ___.\n\n 1. Dysphagia screening before any PO intake? (x) Yes, confirmed \ndone - () Not confirmed () No \n 2. DVT Prophylaxis administered? (x) Yes - () No \n 3. Antithrombotic therapy administered by end of hospital day \n2? (x) Yes - () No \n 4. LDL documented? (x) Yes (LDL = 120) - () No \n 5. Intensive statin therapy administered? (simvastatin 80mg, \nsimvastatin 80mg/ezetemibe 10mg, atorvastatin 40mg or 80 mg, \nrosuvastatin 20mg or 40mg, for LDL > 70) (x) Yes - () No [if LDL \n>70, reason not given: \n [ ] Statin medication allergy \n [ ] Other reasons documented by physician/advanced practice \nnurse/physician ___ (physician/APN/PA) or pharmacist \n [ ] LDL-c less than 70 mg/dL \n ] \n 6. Smoking cessation counseling given? () Yes - () No [reason \n(x) non-smoker - () unable to participate] \n 7. Stroke education (personal modifiable risk factors, how to \nactivate EMS for stroke, stroke warning signs and symptoms, \nprescribed medications, need for followup) given (verbally or \nwritten)? (x) Yes - () No \n 8. Assessment for rehabilitation or rehab services considered? \n(x) Yes - () No \n 9. Discharged on statin therapy? (x) Yes - () No [if LDL >70, \nreason not given: \n [ ] Statin medication allergy \n [ ] Other reasons documented by physician/advanced practice \nnurse/physician ___ (physician/APN/PA) or pharmacist \n [ ] LDL-c less than 70 mg/dL \n 10. Discharged on antithrombotic therapy? () Yes [Type: () \nAntiplatelet - (x) Anticoagulation] - () No \n 11. Discharged on oral anticoagulation for patients with atrial \nfibrillation/flutter? (x) Yes - () No - () N/A ", 'medications_prescribed': ['Amoxicillin 500 mg PO Q12H Duration: 7 Days', 'Apixaban 5 mg PO BID \nRX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*3', 'Atorvastatin 80 mg PO QPM', 'Diltiazem 60 mg PO Q6H', 'Docusate Sodium 100 mg PO BID', 'Glargine 10 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', '___ ___ UNIT PO Q8H Oral Thrush', 'Levothyroxine Sodium 50 mcg PO DAILY', 'MetFORMIN (Glucophage) 500 mg PO BID', 'ProAir HFA (albuterol sulfate) 90 mcg/actuation inhalation \nQ4H:PRN', 'HELD- irbesartan 300 mg oral QHS This medication was held. \nDo not restart irbesartan until recommended by your primary care \nprovider.', 'HELD- Nabumetone 500 mg PO DAILY This medication was held. \nDo not restart Nabumetone until recommended by your primary care \nprovider.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 57, 'gender': 'M', 'symptoms': '"I\'m not gonna die."', 'medical_history': ['Patient states he has hepatitis and black lung. Unable to\nascertain if hepatitis is true. LFTs currently normal. Per \n___', 'OMR note Past hx of scabies per OMR.'], 'family_history': 'denies family hx of psychiatric illness', 'present_illness': '___ man with a reported history of paranoid schizophrenia, last \nseen in the ___ ED in ___, who presents with self-reports of \na panic attack and was found to be guarded, responding to \ninternal stimuli, and disorganized. Mr. ___ stated: "I \ndon\'t know what\'s going on, I\'m going crazy." He referred \nseveral times to fear that he was going to die: "Someone\'s gonna \nkill me. I get all the death threats." He did not elaborate \nmore about where the death threats come from or in what form he \nreceives them. He states he hears voices at baseline, but "I \ndon\'t know what the hell they are any more. They keep\nthreatening me, people keep threatening me." When asked if he\'s \nbeen eating or sleeping he says not in the past week, he\'s "been \ntoo scared. I\'m just freaking crazy."\n\nHe told the ED resident he has "feelings that his hepatitis,\nblack lung, are going to kill him. He has the feeling that his\nbody is "vomiting inside out." He also states that the voices\nthat were talking to him, "just stopped two minutes ago." He \ndoes\nnot answer when asked about who was talking or what the voices\nthemselves were saying." He also told them he, "feels pain\neverywhere and feels like his body is vomitting itself."\n\nPer BEST, all they can offer is that he was seen in ___ last \nat\n___. Asked for help getting back to a CCS he was admitted to\nafter medication noncompliance with cocaine abuse and alcohol\nabuse. He stated he was thinking all day about his hepatits. \n___ worker in ___ was ___ Case Manager ___. Supervisor is ___: ___ - I tried calling this, \nwas\nnot a working phone number.', 'medications': [{'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': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Heparin', 'proc_type': 'IV Piggyback', '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': '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Furosemide', 'proc_type': 'Unit Dose', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', '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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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 via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Collagenase Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': '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 via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '-8', 'valuenum': -8.0, '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, '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': '116', 'valuenum': 116.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '136', 'valuenum': 136.0, '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': '3526', 'valuenum': 3526.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '4044', 'valuenum': 4044.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 425.0, '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': '23', 'valuenum': 23.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': 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 3.1,. 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': 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': '___', 'valuenum': 4050.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 6.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '___', 'valuenum': 0.35, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '___', 'valuenum': 5.7, '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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '22.3', 'valuenum': 22.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': 'HOLD.'}, {'value': '49.0', 'valuenum': 49.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '33.3', 'valuenum': 33.3, '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': '139', 'valuenum': 139.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '5.14', 'valuenum': 5.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.7', 'valuenum': 59.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.6', 'valuenum': 33.6, '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': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.75', 'valuenum': 4.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4259', 'valuenum': 4259.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, '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': '6277', 'valuenum': 6277.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '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': 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': '1.011', 'valuenum': 1.011, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, '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': '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': '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': 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': '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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', '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': '45', 'valuenum': 45.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, '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': 'ROUTINE', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'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': '22.2', 'valuenum': 22.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '73.3', 'valuenum': 73.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4238', 'valuenum': 4238.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, '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': '5846', 'valuenum': 5846.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '4.6', 'valuenum': 4.6, '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': '4.5', 'valuenum': 4.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3515', 'valuenum': 3515.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, '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': '3082', 'valuenum': 3082.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 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'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': '4.2', 'valuenum': 4.2, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 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{'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': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1098', 'valuenum': 1098.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, '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': '182', 'valuenum': 182.0, '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': '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': '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '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': '5.1', 'valuenum': 5.1, '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': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.9', 'valuenum': 33.9, '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': '183', 'valuenum': 183.0, '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': '4.68', 'valuenum': 4.68, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '3.4', 'valuenum': 3.4, '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': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '218', 'valuenum': 218.0, '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': '5.16', 'valuenum': 5.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '849', 'valuenum': 849.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, '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': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': 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': '349', 'valuenum': 349.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '4.2', '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': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '594', 'valuenum': 594.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '309', 'valuenum': 309.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', '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': '66', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.7', 'valuenum': 48.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '32.8', 'valuenum': 32.8, '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': '220', 'valuenum': 220.0, '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': '5.15', 'valuenum': 5.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.0', 'valuenum': 47.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '34.7', 'valuenum': 34.7, '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': '244', 'valuenum': 244.0, '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': '5.10', 'valuenum': 5.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '418', 'valuenum': 418.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, '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': '59', 'valuenum': 59.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': 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 2.5,. Estimated GFR = 27 if non African-American (mL/min/1.73 m2). Estimated GFR = 32 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': 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': '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': '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': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '32.7', 'valuenum': 32.7, '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': '238', 'valuenum': 238.0, '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': '5.21', 'valuenum': 5.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '294', 'valuenum': 294.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '53', 'valuenum': 53.0, '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': '9.7', 'valuenum': 9.7, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 157.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF 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'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': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '236', 'valuenum': 236.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, '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': '61', 'valuenum': 61.0, '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': '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': '9.5', 'valuenum': 9.5, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 79.0, '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': 358.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'SPECIMEN SLIGHTLY HEMOLYZED. HEMOLYSIS FALSELY ELEVATES LDH..'}, {'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': '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.0', 'valuenum': 52.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, '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': '32.4', 'valuenum': 32.4, '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': '243', 'valuenum': 243.0, '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': '5.54', 'valuenum': 5.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.1', 'valuenum': 50.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '271', 'valuenum': 271.0, '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': '5.33', 'valuenum': 5.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '___', 'valuenum': 358.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'SPECIMEN SLIGHTLY HEMOLYZED. 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'16.6', 'valuenum': 16.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '261', 'valuenum': 261.0, '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': '5.31', 'valuenum': 5.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '56', 'valuenum': 56.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '267', 'valuenum': 267.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, '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': '46.8', 'valuenum': 46.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '33.5', 'valuenum': 33.5, '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': '240', 'valuenum': 240.0, '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': '4.99', 'valuenum': 4.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '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': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Per admission note signed by ___, MD on ___ at \n2:40 pm: \n\nVS: BP: 144/99 HR: 78 temp: 97.7 resp: 16 O2 sat: 100 on RA \n\nGeneral- Skinny, dishelved appearing male. \nSkin- No rashes\nHEENT- EYES PERRLA, MMM, very poor dentition, with few teeth. \nLungs- CTAB, poor inspiratory effort. \nCV- RRR, NMRG, physiologic splitting of s1,s2\nAbdomen: SNTND\nExtremities- 2+ pulses, \nNeuro-\nCranial Nerves: CN II-XII in tact. \nMotor: 5+ strength upper/lower extremities\nDeep tendon Reflexes: Equal R/L Bicip: 2+ Brachial: 2+ \nPatellar: 2+', 'diagnoses': [{'icd_code': '4271', 'desc': 'Paroxysmal ventricular tachycardia'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '42821', 'desc': 'Acute systolic heart failure'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '4255', 'desc': 'Alcoholic cardiomyopathy'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '70713', 'desc': 'Ulcer of ankle'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '4588', 'desc': 'Other specified hypotension'}, {'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '45981', 'desc': 'Venous (peripheral) insufficiency, unspecified'}, {'icd_code': '3558', 'desc': 'Mononeuritis of lower limb, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '79431', 'desc': 'Nonspecific abnormal electrocardiogram [ECG] [EKG]'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': '___ 08:15PM URINE HOURS-RANDOM\n___ 08:15PM URINE HOURS-RANDOM\n___ 08:15PM URINE GR HOLD-HOLD\n___ 08:15PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 08:15PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 08:15PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-10 BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 07:40PM GLUCOSE-104* UREA N-6 CREAT-0.8 SODIUM-134 \nPOTASSIUM-3.9 CHLORIDE-99 TOTAL CO2-23 ANION GAP-16\n___ 07:40PM estGFR-Using this\n___ 07:40PM ALT(SGPT)-20 AST(SGOT)-17 ALK PHOS-83 TOT \nBILI-0.4\n___ 07:40PM LIPASE-17\n___ 07:40PM ALBUMIN-5.0 CALCIUM-9.6 PHOSPHATE-2.7 \nMAGNESIUM-2.2\n___ 07:40PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 07:40PM WBC-12.8* RBC-5.29 HGB-16.4 HCT-47.0 MCV-89 \nMCH-30.9 MCHC-34.8 RDW-14.2\n___ 07:40PM NEUTS-79.9* LYMPHS-13.7* MONOS-5.8 EOS-0.3 \nBASOS-0.4\n___ 07:40PM PLT COUNT-332\n# Psychiatric: \n1.Schizophrenia: On admission, pt stated "I don\'t know what\'s \ngoing on, I\'m going\ncrazy." Pt afraid of dying, stating "Someone\'s gonna kill me. \nI get all the death threats." Home meds were confirmed with \n___ in ___ (___): haldol \ndecanoate 100 mg q4weeks last received ___, haldol 10 mg po \nQHS, haldol 5 mg QAM, cogentin 1 mg, Olanzapine 20 mg po QHS. \nHowever pt reported being noncompliant in past. On admission, pt \nstarted on zyprexa 5mg po daily for paranoid psychosis, home \ncogentin 1mg bid continued. Haldol dec uptitrated to 100mg IM \nq2weeks. Zyprexa uptitrated to 30mg po qhs. Pt had episode of \nurinary and fecal incontinence, believed to be secondary to \novermedication and oversedation. Decreased zyprexa to 15mg po \nqhs at this time, no further episodes of incontinence. Paranoid \ndelusions were persistent throughout hospital stay; however \npatient\'s thoughts became more organized and behavior became \nless withdrawn, and by end of hospital stay pt was denying AH, \ndenying paranoid thoughts, stating it is "quiet."\n2. Cocaine/alcohol abuse: According to collateral, pt has a \nhistory of cocaine and alcohol abuse. No withdrawal sx or \ncravings reported while inpatient.\n\n#) Medical: \n1.GERD: continued home prilosec\n2.Hepatitis: Chart review indicates that pt has a diagnosis of \nhepatitis (not indicated B or C), denied acute sx, LFTs WNL\n\n#)Legal: ___\n# Social/Milieu: Pt spent the majority of his time alone in his \nroom. Towards the end of his hospital stay, pt began spending \nsome time in the common room and attending groups with \nencouragement.'}}
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{'final_diagnoses': ['Axis I: Schizophrenia, paranoid; Alcohol abuse; Cocaine abuse', 'Axis II: deferred', 'Axis III: HTN', 'Axis IV: Chronic mental illness, substance abuse, housing, \n social supports', 'Axis V: 30'], 'procedures': ['None.'], 'visit_summary': '# Psychiatric: \n1.Schizophrenia: On admission, pt stated "I don\'t know what\'s \ngoing on, I\'m going\ncrazy." Pt afraid of dying, stating "Someone\'s gonna kill me. \nI get all the death threats." Home meds were confirmed with \n___ in ___ (___): haldol \ndecanoate 100 mg q4weeks last received ___, haldol 10 mg po \nQHS, haldol 5 mg QAM, cogentin 1 mg, Olanzapine 20 mg po QHS. \nHowever pt reported being noncompliant in past. On admission, pt \nstarted on zyprexa 5mg po daily for paranoid psychosis, home \ncogentin 1mg bid continued. Haldol dec uptitrated to 100mg IM \nq2weeks. Zyprexa uptitrated to 30mg po qhs. Pt had episode of \nurinary and fecal incontinence, believed to be secondary to \novermedication and oversedation. Decreased zyprexa to 15mg po \nqhs at this time, no further episodes of incontinence. Paranoid \ndelusions were persistent throughout hospital stay; however \npatient\'s thoughts became more organized and behavior became \nless withdrawn, and by end of hospital stay pt was denying AH, \ndenying paranoid thoughts, stating it is "quiet."\n2. Cocaine/alcohol abuse: According to collateral, pt has a \nhistory of cocaine and alcohol abuse. No withdrawal sx or \ncravings reported while inpatient.\n\n#) Medical: \n1.GERD: continued home prilosec\n2.Hepatitis: Chart review indicates that pt has a diagnosis of \nhepatitis (not indicated B or C), denied acute sx, LFTs WNL\n\n#)Legal: ___\n# Social/Milieu: Pt spent the majority of his time alone in his \nroom. Towards the end of his hospital stay, pt began spending \nsome time in the common room and attending groups with \nencouragement.', 'medications_prescribed': ['OLANZapine 15 mg PO HS ', 'Haloperidol Decanoate 100 mg IM Q2WEEKS (last dose ___', 'Atenolol 25 mg PO DAILY ', 'Benztropine Mesylate 1 mg PO BID ', 'Omeprazole 20 mg PO DAILY ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'F', 'symptoms': 'Chest pain', 'medical_history': ['-Coronary artery disease status post CABG in ___ with LIMA to \nLAD and SVG to high diag (CABG OR report identifies touch down \nas marginal branch) and drug eluting stents to the RCA in \n___', '-VT arrest ___ ischemia, resolved after DES x2 to RCA', '-Chronic obstructive pulmonary disease/asthma.', '-Morbid obesity.', '-HLP.', '-Peripheral vascular disease with claudication bilaterally.', '-BPH.', '-Colon cancer.', '-Question of a left femoral blockage.', '-Bilateral cataracts.', 'PAST SURGICAL HISTORY: Included a hemorrhoidectomy, TURP, \nquestionable left femoral repair, and bilateral cataract \nsurgery with implants.'], 'family_history': 'Both his mother and father had died of heart attacks.', 'present_illness': '___ year old male with a history of coronary artery disease \nstatus post CABG in ___ with LIMA to LAD and SVG to high diag \n(CABG OR report identifies touch down as marginal branch) and \ndrug eluting stents to the RCA in ___ after VT arrest, who \npresents with an episode of acute onset of chest pain with \ntransient ST elevations inferiorly but with negative biomarkers \nto OSH. There he was treated for ACS with plavix 300 and hep \ngtt. Initially he was going to be taken to the cath lab, however \non arrival to the OSH ED his EKG changes normalized, he was \nwithout CP and his biomarkers were negative so he was treated \nmedically for 48 hours and transferred here for LHC and further \nmanagement. \n\nHe went to cardiac catheterization ___ which showed CAD, no \nintervention undertaken. Post-cath he was doing well and was \nsupposed to go home, however when he was walking out he had \nacute onset lightheadedness and was noted to be pale, that \nresolved with supine position. Portable cardiac monitor at that \ntime showed episodes of NSVT that was asymptomatic. As his NSVT \ndid not resolve, he was admitted for further monitoring. \n\nVT is known to his outpatient cardiologist and he was scheduled \nto be worked up as an outpatient. The ___ describes many \nmonths of worsening episodes of lightheadedness, occasionally \na/w chest burning/SOB, that usually last about 10 seconds and \nthen resolve spontaneously. They occur most often with exertion, \nalthough not always, and most frequently can be remitted with \nsitting or lying down. They started a few years ago and were \nquite sporadic, but now he describes them happening on average \n___ times per day for the past few weeks, up to multiple times \ndaily. He denies syncope with any of these episodes. \n\nHe was kept as an ___ and supposed to have had a cath \ntoday but did not as it was late in the day. He was NPO and did \nnot receive his two amiodarone doses the entire day. He tried \nto get out of his chair into bed and felt a twinge like chest \npain, non-radiating, felt like the pain that brought him into \nhospital a few days ago. A trigger was called and he was \nnoticed as having more pro-longed episodes of Vtach (2 minutes), \nreceived 25mg metoprolol and 200mg amiodarone and was \ntransferred to the CCU. His vitals on transfer to the CCU were \nBP 134/58, HR 168, sats 99% RA.\n\nHis vitals on admission were: BP 163/54, HR 81, RR 16, T 98, \nsats 98% RA. The ___ was entirely asymptomatic. He was going \nin and out of VT (episodes lasting ten seconds and then SR for 5 \nseconds). Blood pressures were in the 120s throughout. By ___.30 \nhe had gone back spontaneously to sinus rhythm. \n\nOn review of systems, he denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, bleeding at the \ntime of surgery, myalgias, joint pains, cough, hemoptysis, black \nstools or red stools. He denies recent fevers, chills or \nrigors. \nCardiac review of systems is notable for lack of orthopnea, PND \nor pedal edema. Remainder as above.', 'medications': [{'medication': 'Vancomycin Oral Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acular', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'sevelamer CARBONATE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID W/MEALS', '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': 'Vancomycin Oral Liquid', '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: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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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}]}, 'clinical_findings': {'labs': [{'value': '39.8', 'valuenum': 39.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '309', 'valuenum': 309.0, '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': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, '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': '17.3', 'valuenum': 17.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '5.4', 'valuenum': 5.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '294', 'valuenum': 294.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LESS THAN 1.9. UPDATED REFERENCE RANGE AS OF ___ == REPRESENTS THERAPEUTIC TROUGH.'}, {'value': '38.3', 'valuenum': 38.3, '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': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '239', 'valuenum': 239.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': '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': '3.9', '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': '12', 'valuenum': 12.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', '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': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '4.0', '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': '___', 'valuenum': 55.0, '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': '___', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '38.5', 'valuenum': 38.5, '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': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '253', 'valuenum': 253.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.93', 'valuenum': 3.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.5, '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.'}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVS: 98.2 130/52 66 20 100%RA \nGeneral: NAD \nHEENT: PERRL, EOMI \nNeck: no JVD when sitting upright \nCV: RRR, S1/S2, distant HS difficult to auscultate for any MRG \nLungs: CTAB -wrr \nAbdomen: soft mildly distended non ttp \nExt: -edema \nNeuro: grossly intact \nPULSES: groin site CDI without bruit or hematoma \n\nDISCHARGE PHYSICAL EXAMINATION:\nTm97.9, BP100-149/40-59, P48-69, R18, O297-100RA, wt93.8kg, \nGENERAL: elderly gentleman, pleasant, NAD \nHEENT: NCAT. Sclera anicteric. \nNECK: Supple w/o elevated JVP. \nCARDIAC: RRR, no m/r/g\nLUNGS: CTA b/l, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, obese, NTND. No HSM or tenderness.\nGROIN: Pt has small palpable (mobile) nodular mass and systolic \nfemoral bruit. He does not have a palpable thrill.\nEXTREMITIES: No edema. Small hematoma w/ dressing c/d/i RRA. \nSKIN: thin, no rashes\nPULSES: dp, pt 2+ bilat', 'diagnoses': [{'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '4210', 'desc': 'Acute and subacute bacterial endocarditis'}, {'icd_code': '29041', 'desc': 'Vascular dementia, with delirium'}, {'icd_code': '00845', 'desc': 'Intestinal infection due to Clostridium difficile'}, {'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': '4370', 'desc': 'Cerebral atherosclerosis'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '04111', 'desc': 'Methicillin susceptible Staphylococcus aureus in conditions classified elsewhere and of unspecified site'}, {'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': 'V4511', 'desc': 'Renal dialysis status'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}, {'icd_code': 'E9342', 'desc': 'Anticoagulants causing adverse effects in therapeutic use'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': '135', 'desc': 'Sarcoidosis'}], 'summary': "Labs:\n___ 12:35AM BLOOD WBC-7.6 RBC-3.91* Hgb-11.0*# Hct-33.2*# \nMCV-85# MCH-28.3# MCHC-33.3 RDW-16.3* Plt ___\n___ 12:35AM BLOOD ___ PTT-30.0 ___\n___ 12:35AM BLOOD UreaN-20 Creat-1.1 Na-138 K-4.1 Cl-103 \nHCO3-25 AnGap-14\n___ 12:35AM BLOOD ALT-41* AST-52* LD(LDH)-193 CK(CPK)-51 \nAlkPhos-43 TotBili-0.4\n___ 05:50AM BLOOD Albumin-4.3 Calcium-9.7 Mg-2.2\n___ 12:35AM BLOOD CK-MB-3 cTropnT-<0.01\n___ 09:25PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 07:00AM BLOOD ALT-60* AST-49* LD(LDH)-196 AlkPhos-64 \nTotBili-0.6\n___ 12:35AM BLOOD T4-7.4\n___ 12:35AM BLOOD TSH-3.4\n___ 07:00AM BLOOD TSH-6.1*\n\nMicro:\nMRSA SCREEN (Final ___: No MRSA isolated. \n\nEKG ___\nPossible ectopic atrial rhythm versus sinus rhythm. Non-specific \nlateral \nST segment abnormality. Compared to the previous tracing of \n___ ventricular bigeminy is absent. ST segment abnormality is \nnew. \nRate PR QRS QT/QTc P QRS T \n60 182 88 436/436 -57 34 45 \n\nEKG ___\nSinus rhythm with premature atrial contractions in a bigeminal \npattern. \nNon-specific slight ST-T wave abnormalities. Compared to the \nprevious tracing of ___ the P waves are now upright in leads \nIII and aVF suggesting sinus rhythm and bigeminal premature \natrial beats are present. \nRate PR QRS QT/QTc P QRS T \n61 0 ___ 0 38 57 \n \nECHO\n___ ECHOCARDIOGRAPHY REPORT\n___ ___ MRN: ___ Portable TTE \n(Complete) Done ___ at 2:54:25 ___ FINAL \nReferring Physician ___ \n___ - Cardiac Services\n___ Status: Inpatient DOB: ___ \nAge (years): ___ M Hgt (in): 70 \nBP (mm Hg): 125/65 Wgt (lb): 210 \nHR (bpm): 80 BSA (m2): 2.13 m2 \nIndication: Coronary artery disease. Left ventricular function. \nVT \nICD-9 Codes: 410.91, 414.8, 424.2, 785.0 \n___ Information \nDate/Time: ___ at 14:54 ___ MD: ___, MD \n___ Type: Portable TTE (Complete) Sonographer: ___, RCS \nDoppler: Full Doppler and color Doppler ___ Location: ___ Floor \nContrast: None Tech Quality: Adequate \nTape #: ___-0:00 Machine: Vivid ___ \nEchocardiographic Measurements \nResults Measurements Normal Range \nLeft Atrium - Long Axis Dimension: *5.5 cm <= 4.0 cm \nLeft Atrium - Four Chamber Length: *6.0 cm <= 5.2 cm \nRight Atrium - Four Chamber Length: *5.1 cm <= 5.0 cm \nLeft Ventricle - Septal Wall Thickness: *1.2 cm 0.6 - 1.1 cm \nLeft Ventricle - Inferolateral Thickness: *1.3 cm 0.6 - 1.1 cm \n \nLeft Ventricle - Diastolic Dimension: 5.4 cm <= 5.6 cm \nLeft Ventricle - Systolic Dimension: 3.5 cm \nLeft Ventricle - Fractional Shortening: 0.35 >= 0.29 \nLeft Ventricle - Ejection Fraction: >= 60% >= 55% \nLeft Ventricle - Stroke Volume: 100 ml/beat \nLeft Ventricle - Cardiac Output: 7.98 L/min \nLeft Ventricle - Cardiac Index: 3.75 >= 2.0 L/min/M2 \nLeft Ventricle - Lateral Peak E': *0.08 m/s > 0.08 m/s \nLeft Ventricle - Septal Peak E': *0.05 m/s > 0.08 m/s \nLeft Ventricle - Ratio E/E': 9 < 15 \nAorta - Sinus Level: 3.3 cm <= 3.6 cm \nAortic Valve - Peak Velocity: 1.9 m/sec <= 2.0 m/sec \nAortic Valve - LVOT VTI: 24 \nAortic Valve - LVOT diam: 2.3 cm \nMitral Valve - E Wave: 0.6 m/sec \nMitral Valve - A Wave: 0.8 m/sec \nMitral Valve - E/A ratio: 0.75 \nMitral Valve - E Wave deceleration time: 219 ms 140-250 ms \n \nFindings \nRIGHT ATRIUM/INTERATRIAL SEPTUM: No ASD by 2D or color Doppler. \n\nLEFT VENTRICLE: Mild symmetric LVH with normal cavity size and \nglobal systolic function (LVEF>55%). Suboptimal technical \nquality, a focal LV wall motion abnormality cannot be fully \nexcluded. Estimated cardiac index is normal (>=2.5L/min/m2). \nDoppler parameters are indeterminate for LV diastolic function. \nNo resting LVOT gradient. \n\nRIGHT VENTRICLE: Normal RV chamber size. Borderline normal RV \nsystolic function. \n\nAORTA: Normal aortic diameter at the sinus level. Focal \ncalcifications in aortic root. \n\nAORTIC VALVE: Mildly thickened aortic valve leaflets (3). No AS. \nNo AR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. \nCalcified tips of papillary muscles. \n\nTRICUSPID VALVE: Normal tricuspid valve leaflets with trivial \nTR. Normal PA systolic pressure. \n\nPULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. \nNo PS. Physiologic PR. \n\nPERICARDIUM: No pericardial effusion. \n\nGENERAL COMMENTS: Frequent atrial premature beats. \nConclusions \nNo atrial septal defect is seen by 2D or color Doppler. There is \nmild symmetric left ventricular hypertrophy with normal cavity \nsize and global systolic function (LVEF>60%). Due to suboptimal \ntechnical quality, a focal wall motion abnormality cannot be \nfully excluded. The estimated cardiac index is normal \n(>=2.5L/min/m2). Doppler parameters are indeterminate for left \nventricular diastolic function. Right ventricular chamber size \nis normal with borderline low systolic free wall function. The \naortic valve leaflets (3) are mildly thickened but aortic \nstenosis is not present. No aortic regurgitation is seen. The \nmitral valve leaflets are mildly thickened. There is no mitral \nvalve prolapse. The estimated pulmonary artery systolic pressure \nis normal. There is no pericardial effusion. \n\nIMPRESSION: Mild symmetric left ventricular hypertrophy with \npreserved global ventricular systolic function. Normal right \nventricular cavity size with borderline low free wall systolic \nfunction. \n\nCXR FINDINGS: As compared to the previous examination, there is \nnow evidence of normal lung volumes without evidence of fibrotic \nchanges. Status post sternotomy with unchanged sternotomy \nwires. Calcified granuloma at the right upper lobe base. \nBorderline size of the cardiac silhouette without overt \npulmonary edema. Moderate tortuosity of the thoracic aorta. No \nevidence of pneumonia. No signs suggesting pulmonary fibrosis. \n\nCARDIAC CATH REPORT ___:\n\nHemodynamic Measurements (mmHg)\nBaseline\nSiteSysDiasEndMeanA WaveV WaveHR\nFA ___\nART ___ ___ ___\n\nContrast Summary\nContrastTotal (ml)\nOptiray (ioversol 320 mg/ml)141\n\nRadiation Dosage\nEffective Equivalent Dose Index (mGy)1827.94\n\nRadiology Summary\nTotal Fluoro Time (minutes)17.4\n\nFindings\nESTIMATED blood loss: \nHemodynamics (see above): \nCoronary angiography: right dominant\nLMCA: ostial calcific 90% stenosis, eccentric\nLAD: ostial occlusion (fills retrograde via the LIMA graft)\nLCX: mild, arises at a right angle to the left main.\nRCA: Dominant, large. Moderate eccentric 40% stenosis in mid\nvessel. Stents in mid and distal RCA widely patent\n(non-overlapping). Ostial segment of the R-PDA that arises from\nthe stented segment of the distal RCA appears to have a sub \ntotal\nocclusion, however there is TIMI III flow in the distal vessel.\nLIMA-LAD: Widely patent\nSVG to high diag: Widely patent (however touch-down on high\ndiagonal, not marginal as per CABG op report)\n\nAssessment & Recommendations\n1.Continue dual anti-platelet therapy\n2.Resume Beta blocker\n3.Consider ___ event monitor to evaluate for Ventricular\narrhythmias\n___ be discharged later today\n5.Out ___ Follow up with Drs.___ (PCP) and ___ (Card)\n\nAddendum by ___, MD on ___ at 2:02 pm:\nLV gram: Overall normal appearing LV systolic function. \nInferior wall Hypokinesis, ? mid inferior wall aneurysm.\n(Catheter induced AI noted)\n\nCARDIAC CATH:\n___\n \nPROCEDURE: \nPlease see note in ___ for full details. (Dr. ___ \nConscious Sedation: was provided with appropriate monitoring \nperformed by\na member of the nursing staff. \n\nTECHNICAL FACTORS: \nTotal time (Lidocaine to ___ complete) = minutes. \nArterial time = \nContrast injected: \n Non-ionic low osmolar (isovue, optiray...), vol ml \nAnesthesia: \n 1% Lidocaine subq. \nAnticoagulation: \n Heparin 5000 units IV \nCardiac Cath Supplies Used: \n - ___, ___ 190CM \n - ___, ___ 190CM \n - ___, APEX ___ \n 4.0MM ___, SPRINTER 12MM \n - ___ APEX ___ \n - ___ APEX ___ \n ___ CORDIS, JL 4.0 \n - TYCO, OPTIRAY 200 ML \n - ___, RESOLUTE ___ \n - VOLCANO, EAGLE EYE CATHETER \n - ALLEGIANCE, CUSTOM STERILE PACK \n - MERIT, LEFT HEART KIT \n ___ TERUMO, GLIDESHEATH \n ___ ARROW, TRANSRADIAL ARTERY ACCESS KIT \n - ___, PRIORITY PACK ___ \n - TERUMO, TR BAND LARGE \n \n \nCOMMENTS: \nSuccessful ___ of the ___. \nPlease see Dr. ___ note in ___ for full details. \n \nFINAL DIAGNOSIS: \n1. Successful stenting of LMCA with DES via RRA. \n \n___ ATTENDING OF RECORD: ___. \nREFERRING PHYSICIAN: ___. \nFELLOW: ___. \nINVASIVE ATTENDING STAFF: ___.\nBRIEF HOSPITAL COURSE\n======================\n___ year old gentleman with history of CAD, (s/p CABG in ___ \nwith LIMA to LAD and SVG to high diag and s/p DES to RCA ___ \nafter VT arrest) who initially presented with chest pain, was \nreferred for cardiac catheterization done on ___, which \nshowed CAD but no intervention undertaken, then noted to have \nprolonged hemodynamically stable NSVT with symptoms of \nlightheadedness and dizziness. He was transferred to the CCU for \nfurther care and closer monitoring on ___. He underwent \nuncomplicated catheterization on ___ with PCI/DES to \nprotected left main. Though he continued to have episodes of \nNSVT post-cath, he was asymptomatic, and they were limited to \n___ per episode. He was fitted for a lifevest \ndefibrillator, started on amiodarone, and was discharged home \nwith appropriate f/u appointments.\n\nACTIVE ISSUES\n==============\n#Symptomatic ventricular tachycardia: Appeared monomorphic on \ntele, spontaneously converted although episodes initially lasted \n~25 seconds, occured frequently, and were a/w chest burning. Per \nhis history of daily episodes of lightheadedness that was a/w \nchest burning and SOB, it was felt that such episodes were \nlikely ___ symptomatic NSVT. Etiology of NSVT likely ___ \nfibrosis or scar formation from old MI. Pt has a normal EF w/o \nevidence of hypertrophic cardiomyopathy but ECHO could not \nexclude a regional wall abnormality. Given that pt was highly \nsymptomatic, he was started on amiodarone. On ___, he was \nhaving prolonged episodes of VT (>2mins) with chest pain and was \ntransferred to the CCU for monitoring. He stopped having the \npain and VT episodes an hour after his amiodarone 200mg was \nadministered. On ___, he experienced the same symptoms and \nwas given a dose of lidocaine and loading dose amiodarone which \nresolved his symptoms and brought him back to sinus rhythm. \nFollowing amiodarone loading, the pt was started on amiodarone \n400 mg PO BID. He had slight improvement in his frequency of \nNSVT episodes, with around 5 episodes overnight ___ all of \nwhich lasted around ___ beats. On ___, the ___ was taken \nfor PCI and had a DES placed in the left main coronary artery. \nHe was observed in the CCU for 24 hours following the procedure, \nwith further improvement in NSVT rhythms. He had two episodes \novrnight on ___, both were ___ beat runs, and the pt was \nasymptomatic and VSS. He was transferred to the floor on ___ \nin the afternoon. EP was consulted and recommended discharge on \nAmiodarone taper (400mg BIDx1wk, then 400mg qdx1wk, then 200mg \nqd thereafter) with lifevest defibrillator and outpt follow-up \nin ___ clinic. Of note, pt continued to have short runs of NSVT \n(___) that were self limiting, and were asymptomatic during \nthe remainder of his hospitalization. Given usage of amiodarone, \npt had baseline LFTs/TFTs, and received an outpatient \nappointment to have baseline PFTs. He was noted to have QT \nprolongation (QTc497@max, QTc464@discharge), and will need to \nhave it followed as an outpatient. \n\n#CAD/CP: Pt has a known history of CAD (s/p CABG in ___ with \nLIMA to LAD and SVG to high diag and s/p DES to RCA ___ after \nVT arrest) who presented initially with chest pain. His chest \npain was likely related to VT as EKG appeared unchanged from \nbaseline and biomarkers were negative. Echo results did not \nexclude a regional wall abnormality. He was continued on \naspirin 81mg daily, plavix 75mg daily, metoprolol 25mg q6 and \natorvastatin 80mg daily. As described in the above problem, pt \nhad 2 cardiac catheterizations during this admission. The ___ \n(___) did not include any intervention but the ___ \ninvolved placing a DES in the LMCA. After stenting and starting \namio, his bouts of NSVT were very short (___), and were no \nlonger symptomatic. \n\n# Hypertension: Mostly normotensive in house. He was continued \non home dose losartan, but had his metoprolol XL decreased to \n25mg daily. \n\nCHRONIC ISSUES\n===============\n# Intermittent Claudication: R>L - PCP was following this issue \nprior to admission and will need to continue as no \ndiagnostic/therapeutic interventions occurred during this \nadmission.\n\nTRANSITIONAL ISSUES\n===================="}}
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{'final_diagnoses': ['Non-sustained ventricular tachycardia', 'Coronary artery disease', 'Acute coronary syndrome'], 'procedures': ['Cardiac Cath, Catheter placement, Coronary Angiography, \nno intervention undertaken', 'Cardiac Cath, Catheter placement, Coronary Angiography, \nIVUS of the left main, PCI of the Left main (protected) with \ndrug-eluting\nstent.'], 'visit_summary': 'BRIEF HOSPITAL COURSE\n======================\n___ year old gentleman with history of CAD, (s/p CABG in ___ \nwith LIMA to LAD and SVG to high diag and s/p DES to RCA ___ \nafter VT arrest) who initially presented with chest pain, was \nreferred for cardiac catheterization done on ___, which \nshowed CAD but no intervention undertaken, then noted to have \nprolonged hemodynamically stable NSVT with symptoms of \nlightheadedness and dizziness. He was transferred to the CCU for \nfurther care and closer monitoring on ___. He underwent \nuncomplicated catheterization on ___ with PCI/DES to \nprotected left main. Though he continued to have episodes of \nNSVT post-cath, he was asymptomatic, and they were limited to \n___ per episode. He was fitted for a lifevest \ndefibrillator, started on amiodarone, and was discharged home \nwith appropriate f/u appointments.\n\nACTIVE ISSUES\n==============\n#Symptomatic ventricular tachycardia: Appeared monomorphic on \ntele, spontaneously converted although episodes initially lasted \n~25 seconds, occured frequently, and were a/w chest burning. Per \nhis history of daily episodes of lightheadedness that was a/w \nchest burning and SOB, it was felt that such episodes were \nlikely ___ symptomatic NSVT. Etiology of NSVT likely ___ \nfibrosis or scar formation from old MI. Pt has a normal EF w/o \nevidence of hypertrophic cardiomyopathy but ECHO could not \nexclude a regional wall abnormality. Given that pt was highly \nsymptomatic, he was started on amiodarone. On ___, he was \nhaving prolonged episodes of VT (>2mins) with chest pain and was \ntransferred to the CCU for monitoring. He stopped having the \npain and VT episodes an hour after his amiodarone 200mg was \nadministered. On ___, he experienced the same symptoms and \nwas given a dose of lidocaine and loading dose amiodarone which \nresolved his symptoms and brought him back to sinus rhythm. \nFollowing amiodarone loading, the pt was started on amiodarone \n400 mg PO BID. He had slight improvement in his frequency of \nNSVT episodes, with around 5 episodes overnight ___ all of \nwhich lasted around ___ beats. On ___, the ___ was taken \nfor PCI and had a DES placed in the left main coronary artery. \nHe was observed in the CCU for 24 hours following the procedure, \nwith further improvement in NSVT rhythms. He had two episodes \novrnight on ___, both were ___ beat runs, and the pt was \nasymptomatic and VSS. He was transferred to the floor on ___ \nin the afternoon. EP was consulted and recommended discharge on \nAmiodarone taper (400mg BIDx1wk, then 400mg qdx1wk, then 200mg \nqd thereafter) with lifevest defibrillator and outpt follow-up \nin ___ clinic. Of note, pt continued to have short runs of NSVT \n(___) that were self limiting, and were asymptomatic during \nthe remainder of his hospitalization. Given usage of amiodarone, \npt had baseline LFTs/TFTs, and received an outpatient \nappointment to have baseline PFTs. He was noted to have QT \nprolongation (QTc497@max, QTc464@discharge), and will need to \nhave it followed as an outpatient. \n\n#CAD/CP: Pt has a known history of CAD (s/p CABG in ___ with \nLIMA to LAD and SVG to high diag and s/p DES to RCA ___ after \nVT arrest) who presented initially with chest pain. His chest \npain was likely related to VT as EKG appeared unchanged from \nbaseline and biomarkers were negative. Echo results did not \nexclude a regional wall abnormality. He was continued on \naspirin 81mg daily, plavix 75mg daily, metoprolol 25mg q6 and \natorvastatin 80mg daily. As described in the above problem, pt \nhad 2 cardiac catheterizations during this admission. The ___ \n(___) did not include any intervention but the ___ \ninvolved placing a DES in the LMCA. After stenting and starting \namio, his bouts of NSVT were very short (___), and were no \nlonger symptomatic. \n\n# Hypertension: Mostly normotensive in house. He was continued \non home dose losartan, but had his metoprolol XL decreased to \n25mg daily. \n\nCHRONIC ISSUES\n===============\n# Intermittent Claudication: R>L - PCP was following this issue \nprior to admission and will need to continue as no \ndiagnostic/therapeutic interventions occurred during this \nadmission.\n\nTRANSITIONAL ISSUES\n====================', 'medications_prescribed': ['Aspirin 81 mg PO DAILY \nRX *aspirin 81 mg 1 tablet,delayed release (___) by mouth \ndaily Disp #*30 Tablet Refills:*3', 'Atorvastatin 80 mg PO DAILY \nRX *atorvastatin 80 mg 1 tablet(s) by mouth daily before bed \nDisp #*30 Tablet Refills:*3', 'Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*3', 'Losartan Potassium 50 mg PO DAILY \nRX *losartan 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*3', 'fenofibrate *NF* 120 mg Oral daily \nRX *fenofibrate [Fenoglide] 120 mg 1 tablet(s) by mouth daily \nDisp #*30 Tablet Refills:*3', 'Amiodarone 400 mg PO BID \n___ mg twice daily until ___, then 400mg daily until ___, \nthen 200mg daily thereafter \nRX *amiodarone 200 mg 2 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*1', 'Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet extended release 24 \nhr(s) by mouth daily Disp #*30 Tablet Refills:*3']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 33, 'gender': 'F', 'symptoms': 'shortness of breath', 'medical_history': ['Hypertension', 'Insulin-depedendent diabetes mellitus', 'Obstructive sleep apnea (utilizes on CPAP)', 'GERD', 'Prior hospitalizations for pneumonia (3 times previously)', 'Tonsillectomy', 'Cholesteatoma surgery', 'Schatzki ring with endoscopic correction', 'Myringotomy tubes as a child'], 'family_history': 'two grandfathers with fatal MIs (ages ___, ___). Father with a \nstroke and mother with hypertension.', 'present_illness': ' ___ old Male with PMH significant for hypertension, \nobesity, obstructive sleep apnea (utilizes CPAP), GERD, \ninsulin-dependent diabetes mellitus who presented to ___ \nwith chest pain on ___. \nThe patient initially presented with substernal chest pressure \nwithout radiation that was non-exertional, lasting 20-minutes \nwhich occurred multiple times over 2-days. While driving to work \nhe had some shortness of breath and lightheadedness with the \nchest tightness, prompting him to present to the ___. \nInitial VS 97.8 88 195/89 14 99% RA. Labs were notable for a WBC \n6.2, HCT 44.5%, PLT 247. Creatinine 0.8. LFTs: AST 32, ALT 55. \nTrop-T < 0.01. CXR was obtained and was negative. EKG \ndemonstrated NSR in the ___ with normal axis and no acute \nischemic changes; a Q-wave in lead III was noted. In the ___ he \nreceived ASA 81 mg PO x 4 in addition to clopidogrel 600 mg PO \nloading dose x 1.\nA stress echocardiogram was performed in the morning on ___ \nafter two negative cardiac biomarker sets. He exercised for \n6-minutes on a modified ___ protocol reaching ___, with a \npeak BP of 244/100 mmHg and the test stopped due to shortness of \nbreath. Ischemic ST-changes were noted and inducible ischemia \nwas noted at achieved workload. LVEF 55-60%. He was transferred \nto the ___ ___ for cardiac catheterization.\nIn the ___, initial vitals were 98.0 84 136/82 14 96% RA. Repeat \nlabs were unremarkable and cardiac biomarkers were again \nnegative. EKG was non-ischemic to the ___. He was admitted \ndirectly to the cardiac catheterization lab. This noted, LMCA \n20% distal disease, proximal LAD ___ stenotic, LAD 60% lesion \nproximal to mid, distal LAD has focal 60% stenosis, LCx had \n40-50% ostial stenosis, RCA 70-80% stenosis noted, overall \n3-vessel disease. No intervention was performed and he tolerated \nthe procedure well.', 'medications': [{'medication': 'NIFEdipine (Immediate Release)', '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 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': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Varicella Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'NIFEdipine (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dermoplast Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate (L&D)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone (Rectal) 2.5% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine (Extended Release)', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', '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': 'NIFEdipine (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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}]}, 'clinical_findings': {'labs': [{'value': '37.7', 'valuenum': 37.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '140', 'valuenum': 140.0, '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': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '44.3', 'valuenum': 44.3, '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': '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': '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '23', 'valuenum': 23.0, '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': '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': '11', 'valuenum': 11.0, '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': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.95', 'valuenum': 3.95, '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': '43.9', 'valuenum': 43.9, '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': 'ROUTINE', 'comments': None}], 'exams': '==============================\nADMISSION PHYSICAL\n==============================\nVS: 98.1 88 170/91 16 99% RA\nGeneral: NAD, comfortable, pleasant, obese-appearing; neck with \nevidence of skin tags\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, JVP at the level of the clavicle at 30-degrees\nCV: regular rhythm, no m/r/g\nLungs: CTAB, no w/r/r\nAbdomen: soft, obese, NT/ND, BS+\nExt: WWP, no c/c/e, 2+ distal pulses bilaterally; RRA access \nsite clean, with TR-band in place and no hematoma or bleeding; \nneurovascularly intact distally in right hand\nNeuro: moving all extremities grossly\n===================================\nDISCHARGE PHYSICAL\n===================================\nOBJECTIVE:\nVS: 97.6 126/78 HR 77 RR 18 98% RA FSBG 113-217\nWeight: 104.3 Kg from 106.5 kg\nI/O since MN: ___\nI/O yesterday: ___\nGeneral: NAD, comfortable, pleasant, obese-appearing; neck with \nevidence of skin tags\nHEENT: NCAT, PERRL, EOMI\nNeck: supple, JVP at the level of the clavicle at 30-degrees\nCV: regular rhythm, no m/r/g\nLungs: CTAB, no w/r/r\nAbdomen: soft, obese, NT/ND, BS+\nExt: WWP, no c/c/e, 2+ distal pulses bilaterally; RRA access \nsite clean, minimal ecchymosis, +2 pulses distally to access \nsite, neurovascularly intact distally in right hand\nNeuro: moving all extremities grossly', 'diagnoses': [{'icd_code': 'O1414', 'desc': 'Severe pre-eclampsia complicating childbirth'}, {'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': 'O701', 'desc': 'Second degree perineal laceration during delivery'}, {'icd_code': 'Z3A39', 'desc': '39 weeks gestation of pregnancy'}, {'icd_code': 'O6989X0', 'desc': 'Labor and delivery complicated by other cord complications, not applicable or unspecified'}], 'summary': '=========================\nADMISSION LABS\n=========================\n___ 02:25PM BLOOD WBC-8.8 RBC-5.36 Hgb-16.2 Hct-48.2 MCV-90 \nMCH-30.3 MCHC-33.6 RDW-12.3 Plt ___\n___ 02:25PM BLOOD Neuts-68.5 ___ Monos-7.6 Eos-1.6 \nBaso-1.7\n___ 02:25PM BLOOD ___ PTT-37.3* ___\n___ 02:25PM BLOOD Glucose-134* UreaN-19 Creat-0.8 Na-137 \nK-3.8 Cl-103 HCO3-24 AnGap-14\n___ 06:00PM BLOOD ALT-52* AST-33 LD(LDH)-135 CK(CPK)-108 \nAlkPhos-44 Amylase-118* TotBili-0.8 DirBili-0.2 IndBili-0.6\n___ 02:25PM BLOOD cTropnT-<0.01\n___ 06:40AM BLOOD cTropnT-<0.01\n___ 02:25PM BLOOD Calcium-9.3 Phos-3.6 Mg-2.0\n\n============================\nPERTINENT RESULTS\n============================\n\n___ 06:00PM BLOOD Triglyc-135 HDL-34 CHOL/HD-5.3 \nLDLcalc-118\n___ 06:00PM BLOOD %HbA1c-10.9* eAG-266*\n___ 06:00PM BLOOD VitB12-613 Folate-19.5 Hapto-115\n\n================================\nIMAGING\n================================\n\n___ CARDIAC CATHETERIZATION: \nAssessment & Recommendations\n1. Successful PTCA and stenting of the [distal RCA with drug-\n eluting stent\n2. Successful PTCA and stenting of the proximal to mid LAD with \n two overlapping drug-eluting stents \n3. Successful deployment of ___ Perclose to the R CFA\n4. Prasugrel 60 mg po given in the lab. Start 10 mg po daily in \n AM for minimum of 12 months. \n5. ___ switch from Prasugrel to Clopidogrel in 3 months if \n needed. \n6. Global CV risk reduction strategies. \n7. Schedule for symptoms limited non-imaging stress test in 2 \n weeks (in preparation for cardiac rehab). \n8. Cardiac rehab in ___ weeks\n9. See me in the office in ___ weeks. \n\n___ ECHO: \nThe left atrium is mildly dilated. Left ventricular wall \nthickness, cavity size and regional/global systolic function are \nnormal (LVEF >55%). Right ventricular chamber size and free wall \nmotion are normal. The aortic valve leaflets (3) appear \nstructurally normal with good leaflet excursion and no aortic \nstenosis or aortic regurgitation. The mitral valve appears \nstructurally normal with trivial mitral regurgitation. There is \nno mitral valve prolapse. The estimated pulmonary artery \nsystolic pressure is normal. There is no pericardial effusion. \n\nIMPRESSION: Normal biventricular cavity sizes with preserved \nregional and global biventricular systolic function. No valvular \npathology or pathologic flow identified.\n\n___ CARDIAC CATHETERIZATION\nFindings\n - ESTIMATED blood loss: <40 cc\n - Hemodynamics (see above): Stage I HTN (SBP 142 mmHg)\n - Coronary angiography: right dominant\n LMCA: Distal 20% plaque extending into the LAD. \n LAD: Proximal ___ then bifurcates giving a large high \n diagonal branch (functionally RI). The high D1 has long \n proximal 30% then bifurcates to a latge lower pole that has \n only mild luminal irregularities and a small diseased upper \n pole. The LAD proper has long 60% lesion from proximal to \n mid, tapering focally to 80% in mid segment. The distal LAD \n has focal 60% and the apical LAD has serial 80% tubular \n lesions. \n LCX: Ostial 40-50%. Distal has 80%. Medium size OM2 has 80% \n proximal. The small OM3 ghas diffuse disease distally \n (degenerates to tiny branches). \n RCA: The distal RCA has severe (70-80%) stenosis at the \n bifurcation. The RPDA takes off early and has 80% \n proximally. The RCA distal to the early RPDA takeoff has \n tapers to 90% tapering beyond the RPDA 90% stenosis. The \n distal RPDA has severe 80% disease at the bifurcation \n (origin of LVB ___. \nAssessment & Recommendations\n1. Severe 3 vessel disease. The mid-distal RCA lesion (at and \n beyond the bifurcation) is likely culprit. \n2. CTS evaluation. CABG versus multivessel stenting.\n\n============================\n___ RESULTS\n============================\n___ CXR:\nCLINICAL HISTORY: Chest pain.\nTwo views. The lungs are clear. The heart and mediastinal\nstructures are unremarkable in appearance. Degenerative changes \nare present in the thoracic spine. There is mild compression \ndeformity of two mid-thoracic vertebral bodies and there is a \nvery mild thoracic scoliosis, convex to the right.\nIMPRESSION:\nNO ACTIVE PULMONARY DISEASE. DEGENERATIVE ARTHRITIC CHANGE\nEKG (___): NSR @ 80 bpm. Normal axis and intervals. Q-wave \nin lead III. No other ST-changes other than peak T-waves noted \nin leads V2-3, non-specific (my read).\n___ ETT:\nEXERCISE PERFORMANCE:\nTime on treadmill: 6:00.\nMax. Heart Rate: 155.\n% Max. Heart Rate: 91%.\nMax. BP: 244/100.\nRate-Pressure Product: 37,820.\nMets of Activity: 7.\nExercise Tolerance: Fair.\nReason for Termination: Dyspnea symptoms. There was no chest \npain during exercise.\nExercise EKG: At peak exercise there was 1 to 2 mm of slowly \nupsloping ST depressions in the inferolateral leads. At 4 \nminutes of recovery, these become 1 mm of downsloping ST \ndepressions in the inferolateral leads. These changes resolved \nby 12 minutes of recovery. The rhythm was sinus throughout with \nrare VPCs and 1 ventricular couplet.\nConclusions:\n1. Fair exercise tolerance for age.\n2. Resting hypertension with hypertensive response to exercise\nperformed.\n3. Significant dyspnea with exercise but no chest pain.\n4. Ischemic EKG changes.\n5. Echocardiographic images reported separately.\n___ STRESS ECHO:\nThe patient exercised for 6 minutes 0 seconds according to a \n___ treadmill protocol ___ METS) reaching a peak heart rate of \n155 bpm and a peak blood pressure of 244/100 mmHg. The test was \nstopped because of shortness of breath. This level of exercise \nrepresents a fair exercise tolerance for age. In response to \nstress, the ECG showed ischemic ST changes (see exercise report \nfor details). There is resting hypertension. The blood pressure \nresponse to stress was abnormal/hypertensive.\n.\nResting images were acquired at a heart rate of 85 bpm and a \nblood pressure of 168/94 mmHg. These demonstrated normal \nregional and global left ventricular systolic function. Right \nventricular free wall motion is normal. There is no pericardial \neffusion. Doppler demonstrated no aortic stenosis, aortic \nregurgitation or significant mitral regurgitation or resting \nLVOT gradient.\nEcho images were acquired within 80 seconds after peak stress at \nheart rates of 146 - 128 bpm. These demonstrated new regional \ndysfunction with hypokinesis of the mid to basal anteroseptum. \nThe remaining segments augment appropriately.\nIMPRESSION: Fair functional exercise capacity. Ischemic ECG \nchanges with 2D echocardiographic evidence of inducible ishemia \nat achieved workload. Resting hypertension. Abnormal hemodynamic \nresponse to physiologic stress (hypertensive).\n___ with PMH significant for hypertension, obesity, obstructive \nsleep apnea (utilizes CPAP), GERD, insulin-dependent diabetes \nmellitus who presented to ___ with chest pain found to \nhave negative cardiac biomarkers and non-ischemic EKG changes \nbut stress echocardiography findings concerning for inducible \nischemia with cardiac catheterization demonstrating 3-vessel \ndisease.\n\n# Coronary artery disease - Abnormal stress echo with regional \ndysfunction and hypokinesis of the mid to basal anteroseptum \nwith hypertension noted at rest consistent with inducible \nischemia. Cardiac cath (___) with 3-vessel disease and thus no \nintervention was pursued, but there was concern for the \nmid-distal RCA lesion (at and beyond the bifurcation) being the \nculprit lesion. There was concern that the distal vessels are \nnot ideal for bypass grafting and therefore a stage PCI was \nfavored per cardiac surgery. He underwent a second \ncatheterization on ___ and had 2 DES to LAD and 1 DES to \nRCA. He was medically optimized on aspirin, prasugrel, \nmetoprolol, and atorvastatin. \n\n# Hypertension - Hypertensive on arrival to floor; did not \nreceive AM meds. Hypertension improved with administration of \nhis medications. Continued on lisinopril/HCTZ and started on \nmetoprolol. \n\n# Insulin-dependent diabetes mellitus - Repeat A1c 10.9 \nindicating diabetes is poorly controlled. Continued on home \ninsulin regimen. Metformin held in setting of dye load from two \ncardiac catheterizations. \n\n# hyperlipidemia - LDL calculated at 118. Goal LDL <100 with \noptimal goal <70. Started on atorvastatin 80mg daily. \n\n# OSA - continue home CPAP use.'}}
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{'final_diagnoses': ['Coronary artery disease', 'Insulin dependent diabetes, poorly controlled', 'Obstructive sleep apnea', 'Hypertension'], 'procedures': ['Cardiac catheterization x ___ s/p DESx2 to LAD and DESx1 to RCA'], 'visit_summary': '___ with PMH significant for hypertension, obesity, obstructive \nsleep apnea (utilizes CPAP), GERD, insulin-dependent diabetes \nmellitus who presented to ___ with chest pain found to \nhave negative cardiac biomarkers and non-ischemic EKG changes \nbut stress echocardiography findings concerning for inducible \nischemia with cardiac catheterization demonstrating 3-vessel \ndisease.\n\n# Coronary artery disease - Abnormal stress echo with regional \ndysfunction and hypokinesis of the mid to basal anteroseptum \nwith hypertension noted at rest consistent with inducible \nischemia. Cardiac cath (___) with 3-vessel disease and thus no \nintervention was pursued, but there was concern for the \nmid-distal RCA lesion (at and beyond the bifurcation) being the \nculprit lesion. There was concern that the distal vessels are \nnot ideal for bypass grafting and therefore a stage PCI was \nfavored per cardiac surgery. He underwent a second \ncatheterization on ___ and had 2 DES to LAD and 1 DES to \nRCA. He was medically optimized on aspirin, prasugrel, \nmetoprolol, and atorvastatin. \n\n# Hypertension - Hypertensive on arrival to floor; did not \nreceive AM meds. Hypertension improved with administration of \nhis medications. Continued on lisinopril/HCTZ and started on \nmetoprolol. \n\n# Insulin-dependent diabetes mellitus - Repeat A1c 10.9 \nindicating diabetes is poorly controlled. Continued on home \ninsulin regimen. Metformin held in setting of dye load from two \ncardiac catheterizations. \n\n# hyperlipidemia - LDL calculated at 118. Goal LDL <100 with \noptimal goal <70. Started on atorvastatin 80mg daily. \n\n# OSA - continue home CPAP use.', 'medications_prescribed': ['Prasugrel 10 mg PO DAILY \nRX *prasugrel [Effient] 10 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*3', 'HumuLIN ___ (insulin NPH and regular human) 40 units \nsubcutaneous BID', 'Lantus (insulin glargine) 30 units subcutaneous QHS', 'lisinopril-hydrochlorothiazide ___ mg ORAL DAILY', 'MetFORMIN (Glucophage) 1000 mg PO BID', 'Aspirin 325 mg PO DAILY \nRX *aspirin 325 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', 'Atorvastatin 80 mg PO DAILY \nRX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*1', 'Metoprolol Succinate XL 75 mg PO DAILY \nRX *metoprolol succinate 50 mg 1.5 tablet extended release 24 \nhr(s) by mouth daily Disp #*60 Tablet Refills:*1', 'Aspirin 81 mg PO DAILY \nRX *aspirin 81 mg 1 tablet,chewable(s) by mouth daily Disp #*30 \nTablet Refills:*1']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 73, 'gender': 'F', 'symptoms': 'cyclophosphamide prior to stem cell mobilization', 'medical_history': ['History of kidney lesion first noted in ___, followed \npreviously\nby serial ultrasounds / MRI but lost to follow up more recently', 'History of Right inguinal hernia repair'], 'family_history': 'NO known history of myeloma', 'present_illness': '___ with Stage III monosomy 13 multiple myeloma, now s/p RVD x 4\ncycles with good response, who presents for cyclophosphamide\nchemotherapy prior to stem cell mobilization for autologous stem\ncell transplantation.\n\nHe stopped his lovenox as directed by his outpatient oncologist,\nand has no complaints on arrival. He denies any active bone \npain.\nDenies fevers/chills, night sweats, headache, vision changes,\ndizziness/lightheadedness, weakness/numbnesss, shortness of\nbreath, cough, hemoptysis, chest pain, palpitations, abdominal\npain, nausea/vomiting, diarrhea, hematemesis,\nhematochezia/melena, dysuria, hematuria, and new rashes.', 'medications': [{'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'ED', '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': 'Pregabalin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ON CALL TO OR', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Senna', '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', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROcodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxepin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS: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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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: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': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Methylnaltrexone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SUBCUT', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '30.5', 'valuenum': 30.5, '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': '31.0', 'valuenum': 31.0, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '221', 'valuenum': 221.0, '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': '3.23', 'valuenum': 3.23, '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': '49.5', 'valuenum': 49.5, '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': '23', 'valuenum': 23.0, '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': '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': 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 (eGFR) is likely between 70 and >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': 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': '4', 'valuenum': 4.0, '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': '1.8', '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': '___', 'valuenum': 4.4, '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': 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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '200', 'valuenum': 200.0, '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': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, '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': '___', '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': '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': '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': 126.0, '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': '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': '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': '___', 'valuenum': 3.9, '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': '7', 'valuenum': 7.0, '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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.02', 'valuenum': 1.02, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': 59.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '133', 'valuenum': 133.0, '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': 'VEN.', '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': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.37', 'valuenum': 1.37, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76.9', 'valuenum': 76.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '198', 'valuenum': 198.0, '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': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.77', 'valuenum': 0.77, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.14', 'valuenum': 8.14, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '57.0', 'valuenum': 57.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '30.5', 'valuenum': 30.5, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '179', 'valuenum': 179.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, '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': 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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '14', 'valuenum': 14.0, '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': '___', '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': 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': '8', 'valuenum': 8.0, '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': '___', '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 121.0, '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, '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': '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': '24.0', 'valuenum': 24.0, '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': '29.3', 'valuenum': 29.3, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.66', 'valuenum': 2.66, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.6', 'valuenum': 57.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': 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': '7', 'valuenum': 7.0, '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': '28.4', 'valuenum': 28.4, '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': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '188', 'valuenum': 188.0, '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': '3.11', 'valuenum': 3.11, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54.3', 'valuenum': 54.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS: ___ 1719 Temp: 98.4 PO BP: 118/76 HR: 65 RR: 18 O2 sat:\n97% O2 delivery: RA Dyspnea: 0 RASS: 0 Pain Score: ___\nGENERAL: Pleasant man, in no distress, lying in bed comfortably.\nHEENT: Anicteric, PERLL, OP clear.\nCARDIAC: RRR, normal s1/s2, no m/r/g.\nLUNG: Appears in no respiratory distress, clear to auscultation\nbilaterally, no crackles, wheezes, or rhonchi.\nABD: Soft, non-tender, non-distended, normal bowel sounds, no\nhepatomegaly, no splenomegaly.\nEXT: Warm, well perfused, no lower extremity edema, erythema or\ntenderness.\nNEURO: A&Ox3, good attention and linear thought, motor function\ngrossly intact\nSKIN: No significant rashes.\nACCESS: PIV\n\nDISCHARGE PHYSICAL EXAM:\n___ 0822 Temp: 97.6 PO BP: 103/61 Lying HR: 58 RR: 18 O2\nsat: 97% O2 delivery: Ra \nGENERAL: Pleasant man, in no distress, lying in bed comfortably.\nHEENT: Anicteric, PERLL, OP clear.\nCARDIAC: RRR, normal s1/s2, no m/r/g.\nLUNG: Appears in no respiratory distress, clear to auscultation\nbilaterally, no crackles, wheezes, or rhonchi.\nABD: Soft, non-tender, non-distended, normal bowel sounds, no\nhepatomegaly, no splenomegaly.\nEXT: Warm, well perfused, no lower extremity edema, erythema or\ntenderness.\nNEURO: A&Ox3, good attention and linear thought, motor function\ngrossly intact\nSKIN: No significant rashes.\nACCESS: PIV', 'diagnoses': [{'icd_code': 'M47816', 'desc': 'Spondylosis without myelopathy or radiculopathy, lumbar region'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'M4126', 'desc': 'Other idiopathic scoliosis, lumbar region'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'M48061', 'desc': 'Spinal stenosis, lumbar region without neurogenic claudication'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6831', 'desc': 'Body mass index [BMI] 31.0-31.9, adult'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'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': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': 'ADMISSION LABS:\n\n___ 09:35AM BLOOD WBC-4.3 RBC-3.33* Hgb-10.7* Hct-32.0* \nMCV-96 MCH-32.1* MCHC-33.4 RDW-13.5 RDWSD-47.7* Plt ___\n___ 09:35AM BLOOD Neuts-59.2 ___ Monos-12.5 Eos-5.6 \nBaso-1.4* Im ___ AbsNeut-2.56 AbsLymp-0.91* AbsMono-0.54 \nAbsEos-0.24 AbsBaso-0.06\n___ 09:35AM BLOOD UreaN-21* Creat-1.1 Na-139 K-5.0 Cl-108 \nHCO3-26 AnGap-5*\n___ 09:35AM BLOOD ALT-15 AST-16 AlkPhos-84 TotBili-0.3\n\nDISCHARGE LABS:\n\n___ 08:05AM BLOOD WBC-5.5 RBC-3.02* Hgb-9.8* Hct-29.7* \nMCV-98 MCH-32.5* MCHC-33.0 RDW-13.6 RDWSD-48.6* Plt ___\n___ 08:05AM BLOOD Neuts-90.9* Lymphs-6.4* Monos-2.0* \nEos-0.0* Baso-0.2 Im ___ AbsNeut-4.99 AbsLymp-0.35* \nAbsMono-0.11* AbsEos-0.00* AbsBaso-0.01\n___ 08:05AM BLOOD Glucose-132* UreaN-23* Creat-1.0 Na-143 \nK-5.1 Cl-113* HCO3-19* AnGap-11\n___ 08:05AM BLOOD ALT-13 AST-12 LD(LDH)-133 AlkPhos-77 \nTotBili-<0.2\n___ 09:35AM BLOOD PEP-PND ___ Fr \nK/L-1.0 IgG-644* IgA-72 IgM-34*\n___ with Stage III monosomy 13 multiple myeloma, now s/p RVD x 4 \ncycles with good response, who presents for cyclophosphamide \nchemotherapy prior to stem cell mobilization for autologous stem \ncell transplantation.\n\nHe tolerated infusion well and was discharged. Medication \ninstructions provided prior to discharge. He will follow-up with \noutpatient providers as scheduled on ___, hold lovenox, and \nstart cipro and neupogen on ___.'}}
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{'final_diagnoses': ['multiple myeloma', 'cyclophosphamide infusion'], 'procedures': ['none'], 'visit_summary': '___ with Stage III monosomy 13 multiple myeloma, now s/p RVD x 4 \ncycles with good response, who presents for cyclophosphamide \nchemotherapy prior to stem cell mobilization for autologous stem \ncell transplantation.\n\nHe tolerated infusion well and was discharged. Medication \ninstructions provided prior to discharge. He will follow-up with \noutpatient providers as scheduled on ___, hold lovenox, and \nstart cipro and neupogen on ___.', 'medications_prescribed': ['1. Acyclovir 400 mg PO BID ', '2. Calcium 500 (calcium carbonate) 500 mg calcium (1,250 mg) \noral DAILY ', '3. Docusate Sodium 100 mg PO BID:PRN Constipation - First Line ', '4. Omeprazole 20 mg PO DAILY ', '5. Ondansetron 8 mg PO Q8H:PRN nausea ', '6. Pyridoxine 100 mg PO DAILY ', '7. Vitamin D 5000 UNIT PO DAILY ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 19, 'gender': 'F', 'symptoms': 'Left frontal meningioma', 'medical_history': ['- refractory epilepsy as above', '- history of migraines (none currently)', '- rosacea', '- injuries following seizures, including elbow fracture status\npost repair and head lacerations', "- undergoing evaluation by GI for recurrent diarrhea, has had 2\ncolonoscopies and was recently started on mesalamine and\nprobiotics, presumed Crohn's disease", '- up to date on mammographies, colonoscopies'], 'family_history': "Mother and maternal grandmother died from breast cancer. Brother \nwith cerebral palsy and blindness, sister with blindness, \nanother brother died at birth. Father with abdominal hernias, \nBell's palsy.", 'present_illness': '___ YO F presents for elective resection of left frontal \nmeningioma.', 'medications': [{'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}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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}]}, 'clinical_findings': {'labs': [{'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': '90', 'valuenum': 90.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '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': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': 1.5, 'ref_range_upper': 2.2, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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}], 'exams': 'On Discharge:\nShe opens her eyes spontaneously. She is alert and oriented to \nself, location, and date. PERRL ___ bilaterally. Face symmetric, \ntongue midline. No pronator drift. Moves all extremities ___ \nstrength. Sensation intact to light touch bilaterally throughout \nall extremities.', 'diagnoses': [{'icd_code': 'F4321', 'desc': 'Adjustment disorder with depressed mood'}, {'icd_code': 'E109', 'desc': 'Type 1 diabetes mellitus without complications'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}], 'summary': '___ CT HEAD W/O CONTRAST (POST-OP)\nExpected postsurgical changes. There is minimal fluid, blood \nproducts at the surgical bed.\n___ YO F presents for elective resection of Left frontal \nmeningioma.\n\n#Left craniotomy for resection of frontal meningioma \nThe patient was taken to the operating room and underwent her \nelective procedure without complications. Please see the \noperative report for more detail of the procedure. She recovered \nin the PACU and when stable she was transferred to the ___ for \nfurther care. Routine postop NCHCT demonstrated expected post \noperative changes with a small amount of pneumocephalus. Patient \nwill have MRI as an outpatient, therefore VNS was turned back \non. Patient will continue with Keppra until follow up \nappointment. On POD 2, she complained of intermittent nausea and \nhad minimal PO intake. She was transferred to the floor. On POD \n3, her nausea had resolved and her PO intake began to improve. \nOn POD 4, she was off all anti-nausea medication, was tolerating \na regular diet, ambulating independently, afebrile with stable \nvital signs. She was discharged to home.'}}
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{'final_diagnoses': ['Left frontal meningioma'], 'procedures': ['___- Left craniotomy for resection of frontal meningioma'], 'visit_summary': '___ YO F presents for elective resection of Left frontal \nmeningioma.\n\n#Left craniotomy for resection of frontal meningioma \nThe patient was taken to the operating room and underwent her \nelective procedure without complications. Please see the \noperative report for more detail of the procedure. She recovered \nin the PACU and when stable she was transferred to the ___ for \nfurther care. Routine postop NCHCT demonstrated expected post \noperative changes with a small amount of pneumocephalus. Patient \nwill have MRI as an outpatient, therefore VNS was turned back \non. Patient will continue with Keppra until follow up \nappointment. On POD 2, she complained of intermittent nausea and \nhad minimal PO intake. She was transferred to the floor. On POD \n3, her nausea had resolved and her PO intake began to improve. \nOn POD 4, she was off all anti-nausea medication, was tolerating \na regular diet, ambulating independently, afebrile with stable \nvital signs. She was discharged to home.', 'medications_prescribed': ['1. Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild', '2. Bisacodyl 10 mg PO DAILY:PRN constipation', '3. Dexamethasone 3 mg PO Q12H Duration: 4 Doses \nThis is dose # 1 of 3 tapered doses', '4. Dexamethasone 2 mg PO Q12H Duration: 4 Doses \nThis is dose # 2 of 3 tapered doses', '5. Dexamethasone 1 mg PO Q12H Duration: 4 Doses \nThis is dose # 3 of 3 tapered doses', '6. Docusate Sodium 100 mg PO BID:PRN constipation', '7. Famotidine 20 mg PO BID', '8. LevETIRAcetam 500 mg PO BID', '9. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate', '10. Senna 8.6 mg PO BID:PRN constipation', '11. felbamate 1200 mg oral BID', '12. mesalamine 600 mg oral QAM']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 71, 'gender': 'M', 'symptoms': 'Shortness of breath', 'medical_history': ['-Multiple myeloma on Velcade diagnosed ___ followed by \nOncology at ___.', '-h/o DVT ___ not currently on anticoagulation due to \nthrombocytopenia', '-?Atrial fibrillation - part of PMH though unwitnessed', '-Aortic stenosis ___ cm2), peak velocity 4.3, peak gradient \n76, mean 58 on TTE in ___ ', '-HTN ', '-HLD ', '-GERD ', '-Asthma ', '-Left hip fx s/p ORIF ', '-s/p hysterectomy ', '-s/p removal of cyst from back ___ or ___.'], 'family_history': '-Father died at ___ from PD, had AS \n-Sister died at ___ suddenly, had AS \n-Mother died from gastric cancer \n-Brother had amyloidosis', 'present_illness': "Patient is a ___ year old female with a h/o recently diagnosed \nmultiple myeloma on velcade/cytoxan (most recent treatment \n___, DVT in ___ not on anticoagulation due to \nthrombocytopenia, severe aortic stenosis ___ cm2), \nresolving kidney dysfunction, ?Afib, asthma, HTN, and GERD who \npresents with shortness of breath x 1 day. \n\nShe reports that while in bed after reading a book, she had an \nacute onset of shortness of breath associated with coughing. The \ncough was productive of clear phlegm. She reports that her lungs \nfelt as if they were full. She had an accompanying chest \npressure located in the top ___ her chest. The day prior \nto presentation, the patient had received treatment as an \noutpatient for her multiple myeloma. The patient reports \nreceiving a lot of fluids as part of her treatment. She reports \n___ pillow orthopnea on the night prior to admission. She \nreports that when she initially returned home she was sleeping \nwell, but in the past couple of nights, she has only been able \nto sleep ___ hours. She denies PND. She has also noticed a \nfeeling of heaviness in her lower extremities and has noticed \nswelling. The patient denies increased salt intake, but reports \nthat she has been eating foods prepared by neighbors, so she is \nunsure of her salt intake. She denies DOE. She thinks her normal \nweight is 140lbs.\n\nOf note, the patient was dc'ed from ___ service on ___ after \nnew diagnosis of mutliple myeloma (___ chain disease). \nAt that time, she had ___ and underwent plasmapheresis. She was \nseen by Cards Consult service and required IV diuresis during \nher last hospitalization as well. TTE at the time showed severe \nAS, symmetric LVH, preserved EF.\n\nIn regards to her chest pressure, she notes an episode when she \nwas walking in her house with chest pressure. She states that \nthis resolved with rest immediately. Sometimes associated with \nanxiety and food intake. \n\nIn the ED, initial vs were: 136 111/65 28 88%. Patient was \nplaced on nasal canula initially at 5L than at 3L. Oxygen \nsaturation improved. Labs were remarkable for BNP 5619, TnT \n0.03, Cr 1.3, INR 1.2, HCT 24.9, lactate 2.1. Patient was given \nnothing in the ED. Vitals on Transfer: 97 93/53 20 99%. \n \nOn the floor, the patient notes ___ chest discomfort, not \npleuritic in nature. Notes some dyspnea as well but is able to \ntalk in full sentences.", 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', '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', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H: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': '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS: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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', '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': 'SC', 'frequency': 'BREAKFAST', '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': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': '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': '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen w/Codeine', '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', 'route': 'PO', 'frequency': 'Q4H: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': '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': '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, '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': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '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': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '448', 'valuenum': 448.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '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': '135', 'valuenum': 135.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '343', 'valuenum': 343.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, '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', 'valuenum': 1.0, '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': '166', 'valuenum': 166.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '271', 'valuenum': 271.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.8', 'valuenum': 5.8, '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': '159', 'valuenum': 159.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, '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': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, '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': '35.1', 'valuenum': 35.1, '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': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.9', 'valuenum': 84.9, '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': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.9', 'valuenum': 17.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '27', 'valuenum': 27.0, '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': 100.0, 'ref_range_upper': 112.0, 'flag': None, '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': '151', 'valuenum': 151.0, '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.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '50', 'valuenum': 50.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '320', 'valuenum': 320.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, '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': '25', 'valuenum': 25.0, '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': '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 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '34.9', 'valuenum': 34.9, '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': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, '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': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.90', 'valuenum': 3.9, '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': '1.1', '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': '32.7', 'valuenum': 32.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, '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': '1.20', 'valuenum': 1.2, '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': '49', 'valuenum': 49.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 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'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': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, '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': '34.5', 'valuenum': 34.5, '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': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals: T: 98.6 BP: 119/61 P: 104 R: 16 O2: 97% on 2L via NC. \nGeneral: Alert, oriented, no acute distress \nHEENT: EOMI. PERRL. Sclera anicteric. MMM. Oropharynx clear. \nNeck: supple, JVP elevated to the ear lobe. Radiation of murmur \nto the carotids bilaterally. \nLungs: No breath sounds appreciated at the bases bilaterally. \nCrackles extending ___ up the lung fields posteriorly. No \nwheezes. Coarse breath sounds at the apices. \nCV: Regular rate and rhythm, ___ Crescendo decrescendo murmur \nobscuring S2 appreicated through the precordium, but loudest at \nRUSB. No rubs or gallops appreicated. \nAbdomen: Bowel sounds present. Distended, but soft, non-tender, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ DP pulses bilaterally. No clubbing, \ncyanosis. 2+ pitting edema to the thighs b/l. No calf \ntenderness, asymmetery\nSkin: Benign \nNeuro: CN ___ grossly intact. STRENGTH: ___ biceps/triceps, \ndorsiflexion and plantar flexion. Sensation to light touch \ngrossly intact in the UE and ___. \n.\nDISCHARGE PHYSICAL EXAM:\n101/62-127/73 69-102 16 95%RA 57.3kg\nGeneral: Alert, oriented, no acute distress \nHEENT: EOMI. PERRL. Sclera anicteric. MMM. Oropharynx clear. \nNeck: supple, no JVD\nLungs: clear without crackles\nCV: Regular rate and rhythm, ___ Crescendo decrescendo murmur \nobscuring S2 appreicated through the precordium, but loudest at \nRUSB. No rubs or gallops appreicated. \nAbdomen: Bowel sounds present. Distended, but soft, non-tender, \nno rebound tenderness or guarding, no organomegaly \nExt: Warm, well perfused, 2+ DP pulses bilaterally. No clubbing, \ncyanosis or edema', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '2777', 'desc': 'Dysmetabolic syndrome X'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '78062', 'desc': 'Postprocedural fever'}], 'summary': 'ADMISSION LABS:\n\n___ 01:15PM BLOOD WBC-5.7# RBC-2.51* Hgb-8.0* Hct-23.2* \nMCV-92 MCH-32.1* MCHC-34.8 RDW-17.6* Plt ___\n___ 01:15PM BLOOD Neuts-16* Bands-0 Lymphs-64* Monos-13* \nEos-3 Baso-1 Atyps-1* ___ Myelos-0 Promyel-2*\n___ 01:15PM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-1+ \nMacrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL \nOvalocy-OCCASIONAL Burr-OCCASIONAL Tear Dr-OCCASIONAL\n___ 01:15PM BLOOD ___\n___ 01:15PM BLOOD UreaN-19 Creat-1.3* Na-136 K-4.1 Cl-104 \nHCO3-23 AnGap-13\n___ 01:15PM BLOOD ALT-36 AST-20 AlkPhos-126* TotBili-0.3\n___ 01:50AM BLOOD proBNP-5619*\n___ 01:15PM BLOOD Calcium-8.3* Phos-2.6* Mg-1.5*\n___ 01:59AM BLOOD Lactate-2.1*\n___ 01:50AM BLOOD cTropnT-0.03*\n\nINTERIM LABS:\n___ 12:55PM BLOOD CK-MB-6 cTropnT-0.18*\n___ 06:50PM BLOOD CK-MB-6 cTropnT-0.24*\n___ 01:20AM BLOOD CK-MB-5 cTropnT-0.25*\n___ 06:40AM BLOOD CK-MB-4 cTropnT-0.21*\n___ 01:45PM BLOOD CK-MB-3 cTropnT-0.25*\n\nDISCHARGE LABS:\n___ 06:50AM BLOOD WBC-12.8* RBC-3.56* Hgb-10.7* Hct-31.8* \nMCV-89 MCH-30.1 MCHC-33.7 RDW-18.2* Plt ___\n___ 06:25AM BLOOD ___ PTT-63.2* ___\n___ 01:20PM BLOOD Glucose-200* UreaN-52* Creat-1.3* Na-136 \nK-4.5 Cl-97 HCO3-25 AnGap-19\n___ 05:35AM BLOOD ALT-48* AST-25 LD(LDH)-308* AlkPhos-149* \nTotBili-0.3\n___ 06:50AM BLOOD Calcium-8.8 Phos-3.7 Mg-2.0\n\nSTUDIES:\n\nEKG ___:\nSinus tachycardia. Left atrial abnormality. Left ventricular \nhypertrophy.\nCompared to the previous tracing of ___ atrial ectopy is no \nlonger\nrecorded. The rate has increased. The lateral ST-T wave changes \nare more\nprominent and the Q-T interval has normalized. Otherwise, no \ndiagnostic\ninterim change.\n\nTTE ___:\n-The left atrium is moderately dilated. There is mild symmetric \nleft ventricular hypertrophy with normal cavity size and \nregional/global systolic function (LVEF>55%). Right ventricular \nchamber size and free wall motion are normal. The diameters of \naorta at the sinus, ascending and arch levels are normal. The \naortic valve leaflets are severely thickened/deformed. There is \ncritical aortic valve stenosis (valve area <0.8cm2). No aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. There is mild functional mitral stenosis (mean \ngradient 6 mmHg) due to mitral annular calcification. Mild to \nmoderate (___) mitral regurgitation is seen. [Due to acoustic \nshadowing, the severity of mitral regurgitation may be \nsignificantly UNDERestimated.] There is mild pulmonary artery \nsystolic hypertension. There is no pericardial effusion. \n-Compared with the prior study (images reviewed) of ___, \nthe degree of calcific aortic stenosis is now in the critical \nrange. Mild-moderate mitral regurgitation is now appreciated. \nPulmonary pressures can now be estimated and are mildly \nelevated. \n\nCXR ___:\nModerate interstitial pulmonary edema is new compared to ___. Small bilateral pleural effusions are now present. There \nis no pneumothorax. The heart is mildly enlarged.\n\nLENIs ___:\nNo left lower extremity deep vein thrombosis.\n\nVQ Scan\nLow likelihood ratio for recent pulmonary embolism\n___ with critical AS, recently diagnosed multiple myeloma on \nvelcade/cytoxan, DVT not on anticoagulation due to previous \nthrombocytopenia, and resolving kidney dysfunction here with \nshortness of breath and peripheral edema.\n\n# Acute exacerbation of diastolic heart failure: TTE shows \npreserved EF and critical AS ___ <0.8 cm, peak gradient 84, \npeak velocity 4.6) and patient presented with significant volume \noverload and dyspnea in the setting of chemotherapy. PE (see \nbelow) felt to be less likely given improvement in symptoms \nafter fluid removal; patient eventually had low probability VQ \nscan. Admit weight was 66.4kg and was 57.3kg on discharge. \nDischarged on torsemide 20mg daily.\n\n# Multiple myeloma: Kappa light chain disease. Currently cycle 2 \nof velcade/dexamethasone. She received dexamethasone on ___, \nvelcade/dexamethasone on ___ and ___. She also received 1U \npRBC on ___ with appropriate response. Decision was made to hold \non further cytoxan as she responded so well to her first cycle \nof chemotherapy. Due for next dose on ___.\n \n# H/o DVT: Diagnosed on ___, not on coumadin on admission due \nto thrombocytopenia. Completed approximately 6 months of therapy \nthough pt has malignancy so could qualify for extended therapy. \nPE was considered given tachycardia on admission, so she was \nempirically started on heparin gtt because her kidney disease \nmade CTPA nonoptimal and V/Q scan initially felt to be \nunreliable given volume overload. LENIs were negative ___. \nV/Q scan obtained after diuresis was low probability for PE. \nDespite these negative results, she was started on coumadin with \na lovenox bridge given her high risk of recurrent clot. \n\n# Critical AS: TTE ___ showed worsening of her aortic stenosis, \nwith ___ <0.8 cm, peak gradient 84, peak velocity 4.6. As \nabove, likely had flash pulmonary edema in the setting of volume \noverload and severe AS. She was diuresed as above. Consideration \nwas made for valvuloplasty to prevent recurrent volume overload \nbut this was deferred as it was decided that patient would no \nlonger be receiving cytoxan as part of her regimen. She should \n___ as an outpatient for consideration of TAVR or aortic \nvalve replacement.\n\n# Atrial tachycardia: Previously had been told she had Afib but \nonly demonstrated atrial tachycardia during this admission. \nSwitched diltiazem to metoprolol to decrease frequency of these \nepisodes. Remained asymptomatic and episodes were self-limited.\n\n# CKD: Cr is markedly improved from one month ago (1.3 from as \nhigh as 10), though GFR still depressed at ~40. Remained at 1.3 \nafter diuresis.\n\n# HTN: Stable. Developed atrial tachycardia while diuresing so \nswitched from diltiazem to beta-blocker. \n\n# GERD: Stable. Omeprazole was continued.'}}
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{'final_diagnoses': ['acute diastolic heart failure exacerbation', 'critical aortic stenosis', 'multiple myeloma', 'Atrial tachycardia', 'history of deep vein thrombosis'], 'procedures': ['None'], 'visit_summary': '___ with critical AS, recently diagnosed multiple myeloma on \nvelcade/cytoxan, DVT not on anticoagulation due to previous \nthrombocytopenia, and resolving kidney dysfunction here with \nshortness of breath and peripheral edema.\n\n# Acute exacerbation of diastolic heart failure: TTE shows \npreserved EF and critical AS ___ <0.8 cm, peak gradient 84, \npeak velocity 4.6) and patient presented with significant volume \noverload and dyspnea in the setting of chemotherapy. PE (see \nbelow) felt to be less likely given improvement in symptoms \nafter fluid removal; patient eventually had low probability VQ \nscan. Admit weight was 66.4kg and was 57.3kg on discharge. \nDischarged on torsemide 20mg daily.\n\n# Multiple myeloma: Kappa light chain disease. Currently cycle 2 \nof velcade/dexamethasone. She received dexamethasone on ___, \nvelcade/dexamethasone on ___ and ___. She also received 1U \npRBC on ___ with appropriate response. Decision was made to hold \non further cytoxan as she responded so well to her first cycle \nof chemotherapy. Due for next dose on ___.\n \n# H/o DVT: Diagnosed on ___, not on coumadin on admission due \nto thrombocytopenia. Completed approximately 6 months of therapy \nthough pt has malignancy so could qualify for extended therapy. \nPE was considered given tachycardia on admission, so she was \nempirically started on heparin gtt because her kidney disease \nmade CTPA nonoptimal and V/Q scan initially felt to be \nunreliable given volume overload. LENIs were negative ___. \nV/Q scan obtained after diuresis was low probability for PE. \nDespite these negative results, she was started on coumadin with \na lovenox bridge given her high risk of recurrent clot. \n\n# Critical AS: TTE ___ showed worsening of her aortic stenosis, \nwith ___ <0.8 cm, peak gradient 84, peak velocity 4.6. As \nabove, likely had flash pulmonary edema in the setting of volume \noverload and severe AS. She was diuresed as above. Consideration \nwas made for valvuloplasty to prevent recurrent volume overload \nbut this was deferred as it was decided that patient would no \nlonger be receiving cytoxan as part of her regimen. She should \n___ as an outpatient for consideration of TAVR or aortic \nvalve replacement.\n\n# Atrial tachycardia: Previously had been told she had Afib but \nonly demonstrated atrial tachycardia during this admission. \nSwitched diltiazem to metoprolol to decrease frequency of these \nepisodes. Remained asymptomatic and episodes were self-limited.\n\n# CKD: Cr is markedly improved from one month ago (1.3 from as \nhigh as 10), though GFR still depressed at ~40. Remained at 1.3 \nafter diuresis.\n\n# HTN: Stable. Developed atrial tachycardia while diuresing so \nswitched from diltiazem to beta-blocker. \n\n# GERD: Stable. Omeprazole was continued.', 'medications_prescribed': ['1. Acyclovir 400 mg PO Q8H ', '2. Docusate Sodium 100 mg PO BID ', '3. Lidocaine 5% Patch 1 PTCH TD DAILY ', '4. Nystatin Oral Suspension 5 mL PO QID ', '5. Omeprazole 40 mg PO DAILY ', '6. Senna 1 TAB PO BID:PRN constipation ', '7. Vitamin D 1000 UNIT PO DAILY ', '8. potassium & sodium phosphates *NF* ___ mg Oral BID ', '9. Enoxaparin Sodium 60 mg SC Q12H Duration: 10 Days \nRX *enoxaparin 60 mg/0.6 mL 60 mg twice a day Disp #*20 Syringe \nRefills:*0', '10. Dexamethasone 20 mg PO ON DAY OF AND DAY AFTER VELCADE \nRX *dexamethasone 4 mg 5 tablet(s) by mouth once on ___ Disp \n#*30 Tablet Refills:*0', '11. Metoprolol Succinate XL 150 mg PO DAILY \nRX *metoprolol succinate 100 mg 1.5 tablet extended release 24 \nhr(s) by mouth daily Disp #*45 Tablet Refills:*0', '12. Torsemide 20 mg PO DAILY \nRX *torsemide 20 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', '13. Warfarin 5 mg PO DAILY16 \nRX *warfarin 2 mg 2.5 tablet(s) by mouth daily Disp #*75 Tablet \nRefills:*0', '14. Outpatient Lab Work\nPlease have INR and Chem 10 drawn on ___ with results faxed to \nDr. ___ at ___.\nDiastolic heart failure 428.30']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 86, 'gender': 'F', 'symptoms': 'Syncope, melena', 'medical_history': ['- MDD. Multpile psych admissions and ECT treatments', '- PTSD', '- Heroin and Alcohol abuse reportedly abstinent for ___ years', '- Chronic Pain', '- Osteoarthritis', '- HCV, suspected but unproven cirrhosis', '- H/O GIB - ___ due to ulcerations at GE junction, no \nvarices at time. ', '- Hiatal hernia', '- Neuropathy in left leg', '- GERD', '- Hyperlipidemia', '- Hypertension'], 'family_history': 'Cousin with "severe mental illness" requiring ECT. Father was \nalcoholic. Brother was cocaine addict, died of massive MI age \n___. Sister is "___"- addicted to many different \npills.\n- Mother died of MI in her ___. \n- Father died of skin vs bladder cancer.\n- Sister died of diabetes complications.', 'present_illness': 'HPI: ___ year old male with hx of major depression, esophagitis, \nhiatal hernia, and recent hospitalization for suicide attempt, \npresenting with melena x1 week and two falls in the past couple \nof days. \nHe has a history of GI bleeds from a ___ ulcer at his GE \njunction which have required blood transfusions and an ICU stay \nin the recent past. No history of esophageal varices (most \nrecent EGD ___. He recently had FibroScan to assess for \nsuspected cirrhosis, however he had stage 0 liver scarring. The \npt reports ___ dark black stools daily for the past week. \nWith regard to his falls, pt notes loss of consciousness and a \nperiod of approximately 2 hours after his LOC during which he \nfeels sleepy. He does not loose control of his bowel or bladder \nduring these episodes. Prior to syncopal episodes, pt felt dizzy \nand lightheaded. No CP, palpitations prior to LOC. No LOC at \nrest or while supine. Pt sustained a fall down 10 stairs \nyesterday, with trauma to his head and back. He has worsening of \nhis chronic back pain and a slight headache now. \nPt presented to his primary care office today, found to be \nincredibly dry on exam and symptomatic with unsteady gait with a \npulse to 130 on ambulation. EKG at rest showed sinus tachycardia \nwith rate of 105. Referred to ED for fluid resuscitation. \n\nIn the ED, initial vs were: T 99.6, HR 114, BP 67/42, RR 18, O2 \n100% RA. Pt was mentating well. One rectal exam by the ED \nresident was notable for BRBPR, while exam by the GI fellow was \nnotable for guaiac + stool but no melena or BRB. Pt received 2 L \nIVF, IV PPI, octreotide, and ceftriaxone. BPs improved to \nsystolics of 130. Labs were notable for ___ with Cr 2.8, H/H of \n12.3 and 37.9, lactate normal at 1.8, negative troponin and EKG \nwithout ischemic changes. \n\nIn the MICU, pt complaining of some new suprapubic abdominal \npain, slight headache, and slight worsening of his chronic \nblurry vision. He also has worsening of his chronic back pain. \nHe has a cough which is new in the last week and feels somewhat \nshort of breath.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': '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', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Latanoprost 0.005% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Succinate XL', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '2X/WEEK', 'doses_per_24_hrs': 0.0}, {'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': 'Discontinued', 'route': 'PO/NG', 'frequency': '5X/WEEK', '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}]}, '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': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '24', 'valuenum': 24.0, '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': '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': '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': 0.4, '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 = 52 if non African-American (mL/min/1.73 m2). Estimated GFR = 63 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': 115.0, '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': '___', 'valuenum': 1592.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, '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': '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': '___', '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': '1.98', 'valuenum': 1.98, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '32.4', 'valuenum': 32.4, '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': '9.1', 'valuenum': 9.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.5', 'valuenum': 49.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, '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': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.26', 'valuenum': 0.26, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.51', 'valuenum': 0.51, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, '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': None, 'ref_range_upper': None, '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': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, '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': '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': 'NEG.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': 'LG.'}, {'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': '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': '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': '33', 'valuenum': 33.0, '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': 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': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.2', 'valuenum': 38.2, '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': 82.0, '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': '1.9', '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': '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': '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '31.9', 'valuenum': 31.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.54', 'valuenum': 4.54, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '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': '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': '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': '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': '___', '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': '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '173', 'valuenum': 173.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, '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': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVitals: Afebrile, HR 108, BP 156/96, RR 24, O2 96% RA \nGeneral: Alert, oriented, obese male in mild distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP difficult to assess given body habitus, no LAD \n \nLungs: Diffuse wheezing, no rales or rhonchi \nCV: Tachycardic, regular rhythm, normal S1 + S2, no murmurs, \nrubs, gallops \nAbdomen: soft, mildly TTP in RUQ and suprapubic regions, \nnon-distended, bowel sounds present, no rebound tenderness or \nguarding, no organomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \n\nDISCHARGE PHYSICAL EXAM:\nVitals: 98.8 88 125/90 18 98%RA\nGeneral: Alert, oriented, obese male in no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP difficult to assess given body habitus, no LAD \n \nLungs: clear to auscultation bilaterally \nCV: RRR, normal S1 + S2, no murmurs, rubs, gallops \nAbdomen: soft, mildly TTP in epigastrum, non-distended, bowel \nsounds present, no rebound tenderness or guarding, no \norganomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema ', 'diagnoses': [{'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4289', 'desc': 'Heart failure, unspecified'}, {'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': '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)'}], 'summary': "ADMISSION LABS:\n---------------\n___ 04:45PM WBC-17.3*# RBC-4.54* HGB-12.3* HCT-37.9* \nMCV-84# MCH-27.0 MCHC-32.4 RDW-18.3*\n___ 04:45PM NEUTS-73.0* ___ MONOS-6.6 EOS-0.7 \nBASOS-0.5\n___ 04:45PM PLT COUNT-170\n___ 04:45PM ___ PTT-29.7 ___\n___ 04:45PM ALBUMIN-3.8\n___ 04:45PM cTropnT-<0.01\n___ 04:45PM LIPASE-23\n___ 04:45PM ALT(SGPT)-64* AST(SGOT)-69* ALK PHOS-78 TOT \nBILI-0.3\n___ 04:45PM GLUCOSE-79 UREA N-38* CREAT-2.8*# SODIUM-138 \nPOTASSIUM-5.0 CHLORIDE-104 TOTAL CO2-22 ANION GAP-17\n___ 04:57PM HGB-12.5* calcHCT-38\n___ 04:57PM LACTATE-1.8 K+-4.9\n\nPERTINENT IMAGING:\n------------------\n___ LIVER/GALLBLADDER U/S\n1. No focal liver lesions identified. \n2. Stable appearance of cortical microcysts in the kidneys. \n3. Previously noted 5mm pancreatic tail lesion is not identified \non today's\nstudy due to overlying bowel gas. \n\n___ PORTABLE ABDOMEN:\nNo dilated loops of small or large bowel to suggest obstruction \nor ileus. No\nfree air.\n\n___ ECHO:\nThe left atrium is elongated. No atrial septal defect is seen by \n2D or color Doppler. The estimated right atrial pressure is ___ \nmmHg. There is moderate symmetric left ventricular hypertrophy. \nThe left ventricular cavity size is normal. Regional left \nventricular wall motion is normal. Left ventricular systolic \nfunction is hyperdynamic (EF>75%). There is no left ventricular \noutflow obstruction at rest or with Valsalva. There is no \nventricular septal defect. 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 stenosis or aortic \nregurgitation. The pulmonary artery systolic pressure could not \nbe determined. There is no pericardial effusion. \n\nDISCHARGE LABS:\n---------------\n___ 03:38AM BLOOD WBC-12.9* RBC-4.26* Hgb-11.4* Hct-35.3* \nMCV-83 MCH-26.7* MCHC-32.2 RDW-18.6* Plt ___\n___ 03:38AM BLOOD Plt ___\n___ 03:38AM BLOOD Glucose-103* UreaN-26* Creat-1.3* Na-141 \nK-4.6 Cl-110* HCO3-21* AnGap-15\n___ 03:38AM BLOOD Calcium-8.2* Phos-2.7 Mg-1.9\nMr. ___ is a ___ male with a history of hepatitis C \nand ___ ulcer esophagitis who presented to ___ s/p two \npresyncopal falls with one week of melena and guaiac-positive \nstools in the ED. \n\n# GI bleed: Hypotensive in the ED, found to have BRBPR on ED \nresident exam and trace guaiac positive stool on GI fellow exam. \nHis hypotension was fluid-responsive and did normalize on \nadmission to the ICU. Octreotide and ceftriaxone were \ndiscontinued on arrival to the unit given the patient's lack of \nhistory of variceal hemorrhage and stage 0 cirrhosis. He was \ntyped and screen for PRBC but did not require a transfusion \ngiven stable serial hematocrits (37.9 --> 35.3 --> 35.4). His \npantoprazole drip was continued and an arterial line was placed \nfor hemodynamic monitoring while two additional 18-gauge PIVs \nwere in place. Pt was transferred to the floor on ___ given \nhis ongoing hemodynamic stability and no recurrence of melena. \n\n# Abdominal pain: LFTs were mildly elevated. Given his complaint \nof persistent abdominal pain a repeat lipase was obtained and \nindeed elevated beyond 3x ULN, consistent with mild \npancreatitis. A KUB x-ray was essentially normal. The patient \nwas transitioned to NPO with IVF. Given his possible history of \ncirrhosis a RUQ US was performed that did not reveal any focal \nliver lesions. Pt was treated supportively with IVF and pain \nmedications, and his diet was advanced to full without issue by \nthe time of discharge.\n\n# Acute Kidney Injury: In the setting of hypotension and GI \nbleed, elevated Cr likely prerenal. The patient's creatinine \ndowntrended from 2.8 to 1.3 after IVF hydration in the ICU. UA \nwas unremarkable. The patient should follow-up with his \noutpatient provider regarding further surveillance for renal \ndisease. \n\n# Syncope: Likely orthostatic syncope in the setting of \nhypovolemia and possible blood loss. Other potential etiologies \ninclude med effect after restarting toprol (pt states he has had \nsyncopal episodes while on this medication in the past) vs \ncardiogenic (arrhythmia vs. structural defect) vs. vasovagal. \nThe patient's blood pressure normalized with IVF rehydration. A \nsurface echo was ordered and showed a hyperdynamic LV with EF of \n75-80%. He was restarted on metoprolol 25mg BID (home dose 50mg \nBID) and discharged on this lowered dose to minimized potential \nmedication effect on his syncopal episodes."}}
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{'final_diagnoses': ['GI bleed', 'Syncope', 'Dehydration', 'Acute kidney injury'], 'procedures': ['None'], 'visit_summary': "Mr. ___ is a ___ male with a history of hepatitis C \nand ___ ulcer esophagitis who presented to ___ s/p two \npresyncopal falls with one week of melena and guaiac-positive \nstools in the ED. \n\n# GI bleed: Hypotensive in the ED, found to have BRBPR on ED \nresident exam and trace guaiac positive stool on GI fellow exam. \nHis hypotension was fluid-responsive and did normalize on \nadmission to the ICU. Octreotide and ceftriaxone were \ndiscontinued on arrival to the unit given the patient's lack of \nhistory of variceal hemorrhage and stage 0 cirrhosis. He was \ntyped and screen for PRBC but did not require a transfusion \ngiven stable serial hematocrits (37.9 --> 35.3 --> 35.4). His \npantoprazole drip was continued and an arterial line was placed \nfor hemodynamic monitoring while two additional 18-gauge PIVs \nwere in place. Pt was transferred to the floor on ___ given \nhis ongoing hemodynamic stability and no recurrence of melena. \n\n# Abdominal pain: LFTs were mildly elevated. Given his complaint \nof persistent abdominal pain a repeat lipase was obtained and \nindeed elevated beyond 3x ULN, consistent with mild \npancreatitis. A KUB x-ray was essentially normal. The patient \nwas transitioned to NPO with IVF. Given his possible history of \ncirrhosis a RUQ US was performed that did not reveal any focal \nliver lesions. Pt was treated supportively with IVF and pain \nmedications, and his diet was advanced to full without issue by \nthe time of discharge.\n\n# Acute Kidney Injury: In the setting of hypotension and GI \nbleed, elevated Cr likely prerenal. The patient's creatinine \ndowntrended from 2.8 to 1.3 after IVF hydration in the ICU. UA \nwas unremarkable. The patient should follow-up with his \noutpatient provider regarding further surveillance for renal \ndisease. \n\n# Syncope: Likely orthostatic syncope in the setting of \nhypovolemia and possible blood loss. Other potential etiologies \ninclude med effect after restarting toprol (pt states he has had \nsyncopal episodes while on this medication in the past) vs \ncardiogenic (arrhythmia vs. structural defect) vs. vasovagal. \nThe patient's blood pressure normalized with IVF rehydration. A \nsurface echo was ordered and showed a hyperdynamic LV with EF of \n75-80%. He was restarted on metoprolol 25mg BID (home dose 50mg \nBID) and discharged on this lowered dose to minimized potential \nmedication effect on his syncopal episodes.", 'medications_prescribed': ['1. Omeprazole 40 mg PO BID ', '2. Multivitamins 1 TAB PO DAILY ', '3. Lisinopril 20 mg PO DAILY ', '4. OxycoDONE (Immediate Release) ___ mg PO TID:PRN pain ', '5. Zolpidem Tartrate 10 mg PO HS ', '6. Gabapentin 600 mg PO TID \nRX *gabapentin 600 mg 1 tablet(s) by mouth three times a day \nDisp #*90 Capsule Refills:*0', '7. Metoprolol Tartrate 25 mg PO BID \nRX *metoprolol tartrate 25 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', '8. Simvastatin 20 mg PO DAILY ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 67, 'gender': 'M', 'symptoms': 'Hematuria', 'medical_history': ['-HIV well controlled', '-Hepatitis B, chronic', '-HLD', '-HTN', '-CKD (baseline Cr 1.5-1.8)', '-H/o Syphilis', '-Prostate Cancer s/p brachytherapy ___', '-Urinary retention requiring self-cath?', '-Neurogenic bladder', '-Suprapubic catheter placed ___', '-Multiple urethral strictures s/p correction', '-Colonic adenoma', '-Internal Hemorrhoids', '-OSA', '-Osteoarthritis', '-condyloma accuminata', '-recurrent UTIs', '-rhinitis', '-obstructive sleep apnea', '-prior syphilis', '-prior chlamydia'], 'family_history': ' + diabetes (mother)\n + prostate cancer (dad)\n + CAD (dad)', 'present_illness': 'Mr. ___ is a ___ man with CKD (b/l Cr 1.3-1.8), HIV, \nHBV, prostate cancer s/p brachytherapy with resulting urethral \nstricture s/p SP catheter with recent admission for ___ (___) \nfound to have b/l hydronephrosis and R ureteral stone c/f \nobstructive uropathy s/p R and L PCN placement as well as recent \nadmission (___) for sepsis ___ pyelonephritis who presents \nwith 1 week of intermittent hematuria and suprapubic pain. \n\nPatient was last seen at ___ on ___ where he presented with\nfever to 103, WBC of 15 and + UA eventually growing Klebsiella\nand Pseudomonas. SPT was exchanged at the time. Renal US showed\nno hydronephrosis. Patient was discharged on 14 days of\nciprofloxacin for pyelonephritis. Prior to this stay, pt was\nadmitted ___ with obstructive ___. CT-U showed bilateral\nhydronephrosis and a possible obstruction and urology was\nconsulted. He first had a right nephrostomy tube placed but \nfollowing his Cr did not\nimprove and so left nephrostomy tube was placed. Patient\'s\ncreatinine subsequently trended back to baseline over the course\nof the next month. \n\nToday patient complains of intermittent hematuria for 1 week. He\nwas in ___ last week and noted red urine coming from his\nsuprapubic catheter ranging in color from dark red to dark \nbrown,\nintermittently associated with clot. His wife states that he was\nalso feeling cold at the time and "was always cranking up the\nheat" but that they did not have a thermometer to check his\ntemperature. When he returned earlier this week he noted\nintermittent fever, with Tmax of 104 by oral home thermometer on\n___. As well as continued hematuria from SPT and from\nright PCN. He presented to ___ urgent care on ___ and was\ntold "that I have a urinary tract infection." He was prescribed\noral ciprofloxacin but was unable to pick up the Rx at the\npharmacy. He then presented to the ED with continued hematuria\nfrom SPT and from right PCN.\n\nIn the ED, initial VS were: Temp 98.2 HR 89 BP 127/66 RR 17 SaO2\n100% RA', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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: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': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', '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': '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': 'Expired', 'route': 'IV', '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': 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': 'NG', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Insulin', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Influenza Vaccine Quadrivalent', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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', 'doses_per_24_hrs': 4.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', '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': 'Discontinued', 'route': 'IV', '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': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.24', 'valuenum': 1.24, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '13.8', 'valuenum': 13.8, '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': '1.1', 'valuenum': 1.1, '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': '247', 'valuenum': 247.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 140.0, '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': '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': '1.13', 'valuenum': 1.13, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, '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.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 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'comments': None}, {'value': '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': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.30', 'valuenum': 7.3, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '140', 'valuenum': 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'comments': '___'}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', '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': None, 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 11.0, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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', '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': 4.0, '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': 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': '10', 'valuenum': 10.0, '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': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '___', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '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 between 75 and >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': 115.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': '17', 'valuenum': 17.0, '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': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, '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': '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '47.5', 'valuenum': 47.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 8.0, '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': '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': 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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': 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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '26', 'valuenum': 26.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': '19', 'valuenum': 19.0, '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': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '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': '4.4', 'valuenum': 4.4, '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': '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': '1', 'valuenum': 1.0, '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': '___', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM\n==============\n\nVS: 99.6 BP 137 / 73 HR 103 RR ___\nGENERAL: Well-appearing man, NAD\nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva,\nMMM\nNECK: supple, 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, nontender in all quadrants, no\nrebound/guarding, no hepatosplenomegaly\nEXTREMITIES: no cyanosis, clubbing, or edema\nPULSES: 2+ DP pulses bilaterally\nNEURO: A&Ox3, moving all 4 extremities with purpose\nSKIN: warm and well perfused, no excoriations or lesions, no\nrashes\nGU: Bilateral PCN. Right PCN insertion site with some \ngranulation\ntissue, tender. Yellow urine draining from bilateral PCNs.\nMerlot-colored urine without clot from SPT.\n\nDISCHARGE EXAM\n==============\n\nVS reviewed in POE, wnl except for 146 / 79\nGENERAL: Lying in bed, NAD\nHEENT: AT/NC, anicteric sclera, pink conjunctiva,\nMMM\nNECK: supple\nHEART: RRR, S1/S2, no murmurs, gallops, or rubs\nLUNGS: CTAB, no wheezes, rales, rhonchi, breathing comfortably\nwithout use of accessory muscles\nABDOMEN: nondistended, nontender in all quadrants, no\nrebound/guarding\nEXTREMITIES: no cyanosis, clubbing, or edema\nNEURO: A&Ox3, moving all 4 extremities with purpose\nGU: No suprapubic tenderness. No CPA tenderness. PCN insertion\nsites wrapped. both nephrostomy tubes are draining yellow urine.\nSPT draining small amount of red fluid.', 'diagnoses': [{'icd_code': 'I25119', 'desc': 'Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': 'ADMISSION LABS\n==============\n\n___ 04:20PM BLOOD WBC-7.7 RBC-2.85* Hgb-7.5* Hct-23.6*\nMCV-83 MCH-26.3 MCHC-31.8* RDW-14.5 RDWSD-44.1 Plt ___\n___ 04:20PM BLOOD Neuts-56.6 ___ Monos-9.2 Eos-3.1\nBaso-0.3 Im ___ AbsNeut-4.35 AbsLymp-2.27 AbsMono-0.71\nAbsEos-0.24 AbsBaso-0.02\n___ 07:25AM BLOOD ___ PTT-25.9 ___\n___ 04:20PM BLOOD Glucose-87 UreaN-21* Creat-1.7* Na-137\nK-4.8 Cl-100 HCO3-24 AnGap-13\n___ 07:25AM BLOOD Calcium-9.0 Phos-3.4 Mg-1.9 Iron-16*\n___ 04:40PM BLOOD Lactate-1.3\n\nPERTINANT INTERVAL LABS\n=======================\n\n___ 07:25AM BLOOD WBC-14.4*# RBC-3.04* Hgb-8.1* Hct-25.4*\nMCV-84 MCH-26.6 MCHC-31.9* RDW-14.7 RDWSD-44.7 Plt ___\n___ 06:34AM BLOOD WBC-11.9* RBC-3.02* Hgb-8.2* Hct-25.1*\nMCV-83 MCH-27.2 MCHC-32.7 RDW-14.7 RDWSD-44.7 Plt ___\n___ 06:34AM BLOOD Glucose-109* UreaN-18 Creat-1.6* Na-137\nK-4.9 Cl-100 HCO3-26 AnGap-11\n\nDISCHARGE LABS\n==============\n\n___ 07:00AM BLOOD WBC-9.7 RBC-3.06* Hgb-8.3* Hct-25.9*\nMCV-85 MCH-27.1 MCHC-32.0 RDW-14.7 RDWSD-45.4 Plt ___\n___ 07:00AM BLOOD Glucose-117* UreaN-17 Creat-1.5* Na-138\nK-4.8 Cl-99 HCO3-26 AnGap-13\n\nMICROBIOLOGY\n============\n\n \n \n___ 5:15 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\n \n \n___ 9:26 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n\n \n \n___ 10:26 am BLOOD CULTURE\n\n Blood Culture, Routine (Pending):\n___ 12:00 pm URINE Source: Kidney LEFT NEPHROSTOMY\nTUBE. \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\n \n \n___ 12:00 pm URINE Source: Kidney RIGHT NEPHROSTOMY\nTUBE. \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\nURINE STUDIES\n=============\n\n___ 05:15PM URINE Color-Straw Appear-Hazy* Sp ___\n___ 05:15PM URINE Blood-SM* Nitrite-NEG Protein-30*\nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-LG*\n___ 05:15PM URINE RBC-13* WBC->182* Bacteri-NONE Yeast-NONE\nEpi-0\n___ 05:15PM URINE WBC Clm-MANY*\n\nIMAGING\n=======\n\nGU ULTRASOUND\n\nIMPRESSION: \n \nMild bilateral hydronephrosis with percutaneous nephrostomy\ntubes in place, \nunchanged since ___.\n___ yo man with CKD (b/l Cr 1.3-1.8), HIV (on \ndarunavir/ritonavir/dolutegravir, last CD4 374, VL ___, \nHBV (on entecavir), prostate cancer s/p brachytherapy with \nresulting urethral stricture s/p SP catheter with recent \nadmission for ___ secondary to b/l hydronephrosis and R ureteral \nstone c/f obstructive uropathy s/p R and L PCN placement \n(___) as well as recent admission (___) for sepsis ___ \npyelonephritis p/w 1 week of intermittent hematuria and fevers.\n\n# Fevers:\n# Leukocytosis:\n# UTI:\nPatient presented with fevers and leukocytosis, most consistent \nwith complicated ascending UTI in this patient with suprapubic \ncatheter and bilateral PCNs. He was started on CTX empirically \nin the ED. Given UCx from ___ growing Klebsiella and \nPseudomonas (for which he had been prescribed ciprofloxacin that \nhad not yet been initiated), he was broadened to ceftazidime, \ntransitioned to PO ciprofloxacin after confirmation that outside \ncultures were ciprofloxacin sensitive. He defervesced and \nleukocytosis resolved. UCx this admission from multiple sites \nwere contaminated and BCx were NGTD. Renal U/S performed with \nstable b/l hydronephrosis without e/o perinephric abscess. \nUrology was consulted and evaluated the patient in the ED. They \ndid not feel that suprapubic catheter exchange was necessary \n(given recent exchange ___ and will f/u with him at the \n___. He will continue ciprofloxacin 500mg BID to \ncomplete a 10d course (___).\n\n# Hematuria:\nPatient presented with intermittent gross hematuria from his L \nPCN and suprapubic catheter and Hgb of 7.5 from 8.7 on discharge \n___. He was transfused 1u pRBCs with appropriate bump. He \nintermittently had trace amounts of hematuria in house without \nclots and with stable Hct. Urology was consulted and recommended \nno further inpatient w/u. He will f/u with urology as an \noutpatient. Hgb on discharge was 8.3.\n\n# OSA. \nContinued on home CPAP.\n\n#CKD. \nB/l Cr 1.7. No e/o ___ this admission.\n\n#HIV. \nRegimen was changed on last admissin due to ___. Continued home \nRitonavir, Darunavir, Dolutegravir. All steroids were avoided \ngiven Ritonavir.'}}
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{'final_diagnoses': ['Hematuria'], 'procedures': ['None.'], 'visit_summary': '___ yo man with CKD (b/l Cr 1.3-1.8), HIV (on \ndarunavir/ritonavir/dolutegravir, last CD4 374, VL ___, \nHBV (on entecavir), prostate cancer s/p brachytherapy with \nresulting urethral stricture s/p SP catheter with recent \nadmission for ___ secondary to b/l hydronephrosis and R ureteral \nstone c/f obstructive uropathy s/p R and L PCN placement \n(___) as well as recent admission (___) for sepsis ___ \npyelonephritis p/w 1 week of intermittent hematuria and fevers.\n\n# Fevers:\n# Leukocytosis:\n# UTI:\nPatient presented with fevers and leukocytosis, most consistent \nwith complicated ascending UTI in this patient with suprapubic \ncatheter and bilateral PCNs. He was started on CTX empirically \nin the ED. Given UCx from ___ growing Klebsiella and \nPseudomonas (for which he had been prescribed ciprofloxacin that \nhad not yet been initiated), he was broadened to ceftazidime, \ntransitioned to PO ciprofloxacin after confirmation that outside \ncultures were ciprofloxacin sensitive. He defervesced and \nleukocytosis resolved. UCx this admission from multiple sites \nwere contaminated and BCx were NGTD. Renal U/S performed with \nstable b/l hydronephrosis without e/o perinephric abscess. \nUrology was consulted and evaluated the patient in the ED. They \ndid not feel that suprapubic catheter exchange was necessary \n(given recent exchange ___ and will f/u with him at the \n___. He will continue ciprofloxacin 500mg BID to \ncomplete a 10d course (___).\n\n# Hematuria:\nPatient presented with intermittent gross hematuria from his L \nPCN and suprapubic catheter and Hgb of 7.5 from 8.7 on discharge \n___. He was transfused 1u pRBCs with appropriate bump. He \nintermittently had trace amounts of hematuria in house without \nclots and with stable Hct. Urology was consulted and recommended \nno further inpatient w/u. He will f/u with urology as an \noutpatient. Hgb on discharge was 8.3.\n\n# OSA. \nContinued on home CPAP.\n\n#CKD. \nB/l Cr 1.7. No e/o ___ this admission.\n\n#HIV. \nRegimen was changed on last admissin due to ___. Continued home \nRitonavir, Darunavir, Dolutegravir. All steroids were avoided \ngiven Ritonavir.', 'medications_prescribed': ['Ciprofloxacin HCl 500 mg PO Q12H', 'END ___. Acetaminophen 1000 mg PO Q8H:PRN Pain - Mild', 'Darunavir 800 mg PO DAILY', 'Dolutegravir 50 mg PO DAILY', 'Entecavir 0.5 mg PO Q48H', 'RiTONAvir 100 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 74, 'gender': 'M', 'symptoms': 'Right basal ganglia hemorrhage with IV extension', 'medical_history': ['- DM', '- HLD', '- HTN', '- HCV', '- Depression, anxiety'], 'family_history': 'Unable to obtain', 'present_illness': 'Ms. ___ is a ___ year old female with a past medical history \nof DM, HTN, HLD who is transferred here from ___ due to right \nbasal ganglia bleed. History is obtained from the ED resident \nand from the chart as she is unresponsive and her family is \ncurrently not present.\n\n"Per EMS, patient last seen normal by her husband at 9am when he \nleft for work. Severe migraine at 9pm and went to bed. Husband \nfound her on the floor at 9:30pm. Patient stated she was normal \nexcept for a severe headache at 9pm." \n\nInitial vitals at ___ 187/110, 78. 28. 98.4, 98%RA\n\nNursing note 10:45 "patient returned from CT with R facial \ndroop, slurred speech and left sided weakness." CT scan showed R \nbasal ganglia bleed.\n\nBPs then up to 190s. She was given several doses of IV \nlabetalol, wherein blood pressures went down to 160s, and she \nwas transferred to ___. She became apneic and was intubated on \nthe way, for this given rocuronium and etomodate. Blood pressure \nup to 230s upon arrival in the ___ ED.\n\nROS unable to be obtained due to patient comatose.', 'medications': [{'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'Admission Physical Exam:\nVitals: P: 70s R: 16 BP: 230s SaO2: intubated\nGeneral: Awake, cooperative, NAD.\nHEENT: Eyes closed. No scleral icterus\nPulmonary: Intubated. Lungs CTA bilaterally without R/R/W\nCardiac: RRR, nl. S1S2, no M/R/G noted\nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or \norganomegaly noted.\nExtremities: No edema.\nSkin: no rashes or lesions noted.\n\nNeurologic:\n-Mental Status: Intubated, not sedated. Not responding to \nnoxious stimuli or following commands. Eyes closed.\n\n-Cranial Nerves:\nI: Olfaction not tested.\nII: PERRL 3 to 2mm and brisk.\nIII, IV, VI: horizontal VOR intact, gaze is conjugate but \ndeviated to right.\nV: +corneal on right, no corneal on the left.\nVII: Unable to assess.\nVIII: Unable to assess.\nIX, X: Unable to assess.\nXI: Unable to assess.\nXII: Unable to assess.\n\n-Motor: Normal bulk, decreased tone throughout. Does not move \nany extremity to noxious stimuli, and no posturing. No abnormal \nmovements.\n-Sensory: Does not react to noxious stimuli in any extremity\n-DTRs: Poor reflexes throughout, toes are mute.\n-Coordination: Unable to assess, no nystagmus.\n-Gait: Unable to assess\n.\nDischarge Physical Exam:\nAdmission Physical Exam:\nVitals: P: 70s R: 16 SBP: 130s SaO2:98%RA\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT. No scleral icterus\nPulmonary: CTA B\nCardiac: RRR, nl. S1S2, no M/R/G noted\nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or \norganomegaly noted.\nExtremities: No edema.\nSkin: no rashes or lesions noted.\n\nNeurologic:\n-Mental Status: Alert, Awake, Knows she is at ___ and \nthat it is the middle of ___. \n-Motor: Normal bulk, decreased tone throughout. Left continues \nto be more weak than the right but able to move the upper and \nlower extremities against gravity.\n-Sensory: equal and symmetric to light touch \n-Gait: Unable to assess', 'diagnoses': [{'icd_code': '43491', 'desc': 'Cerebral artery occlusion, unspecified with cerebral infarction'}, {'icd_code': '3484', 'desc': 'Compression of brain'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'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': '3694', 'desc': 'Legal blindness, as defined in U.S.A.'}], 'summary': 'ADMISSION LABS:\n___ 12:25AM BLOOD WBC-7.8 RBC-5.11 Hgb-13.0 Hct-44.2 MCV-87 \nMCH-25.4* MCHC-29.3* RDW-14.0 Plt ___\n___ 12:25AM BLOOD Neuts-63.3 ___ Monos-5.1 Eos-1.8 \nBaso-1.3\n___ 12:25AM BLOOD ___ PTT-34.7 ___\n___ 12:25AM BLOOD Glucose-212* UreaN-9 Creat-0.7 Na-143 \nK-3.4 Cl-109* HCO3-20* AnGap-17\n___ 03:40AM BLOOD ALT-29 AST-38 LD(LDH)-189 CK(CPK)-210* \nAlkPhos-57 TotBili-0.5 Albumin-3.6 Calcium-8.4 Phos-3.0 Mg-2.2\n___ 04:57PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 03:40AM BLOOD CK-MB-1 cTropnT-<0.01\n.\nDISCHARGE LABS:\n___ 05:54AM BLOOD WBC-3.7* RBC-3.62* Hgb-9.8* Hct-29.9* \nMCV-83 MCH-27.0 MCHC-32.7 RDW-14.7 Plt ___\n___ 05:54AM BLOOD Glucose-171* UreaN-11 Creat-0.9 Na-143 \nK-2.9* Cl-106 HCO3-26 AnGap-14\n___ 05:54AM BLOOD Calcium-9.3 Phos-4.7* Mg-1.8\n.\nURINE:\n___ 06:24AM URINE Color-Yellow Appear-Clear Sp ___\n___ 06:24AM URINE Blood-NEG Nitrite-NEG Protein-30 \nGlucose-70 Ketone-TR Bilirub-NEG Urobiln-2* pH-6.5 Leuks-TR\n___ 06:24AM URINE RBC-0 WBC-4 Bacteri-FEW Yeast-NONE Epi-0 \nTransE-<1\n___ 01:02PM URINE Color-Yellow Appear-Hazy Sp ___\n___ 01:02PM URINE Blood-NEG Nitrite-NEG Protein-TR \nGlucose-70 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-NEG\n___ 01:02PM URINE RBC-2 WBC-1 Bacteri-FEW Yeast-NONE Epi-0 \nTransE-<1\n.\nMICROBIOLOGY:\n# Blood Cultures (___): No growth.\n# Urine Cultures (___): No growth.\n# Blood Cultures x2 (___): No growth.\n# Urine Cultures (___): Coag Negative Staph.\n.\nIMAGING: \n# NCHCT ___: Large right basal ganglionic hemorrhage with mass \neffect on the right lateral ventricle and 5-mm leftward \nsubfalcine herniation, but no uncal or other central herniation, \nnot significantly changed (allowing for the limitations, above) \nsince the OSH study of approximately 2.5 hours earlier. 2. A \nsmall amount of blood layering in the occipital horn of the \nright lateral ventricle indicates intraventricular extension of \nhemorrhage, not seen on the prior study. 3. Fluid in the \nsinuses, likely secondary to intubation and supine positioning. \n# NCHCT ___: 1. Increased size of intraparenchymal hemorrhage \ncentered in the right putamen compared to the outside head CT \nperformed approximately 11 hr earlier. 2. Interval \nintraventricular extension of hemorrhage with trace blood \nproducts in the bilateral occipital horns, new from the prior \nCT. 3. Unchanged mass effect with compression of the right \nlateral ventricle and minimal leftward shift of the \nnormally-midline structures, predominantly involving the septum \npellucidum. \n# NCHCT ___: Intraparenchymal hemorrhage in the right putamen, \nglobus pallidus and head of the caudate is unchanged in size. \nThere is no significant change in effacement of the right \nlateral ventricle or right-to-left midline shift. No evidence of \nnew hemorrhage or acute infarction.\n# Lower Extremity Non-invasive Vascular US (___): No evidence \nof deep venous thrombosis in the bilateral lower extremity \nveins.\n# NCHCT (___): Large parenchymal hemorrhage centered in the \nright putamen is unchanged in size from the prior CT examination \non ___. No evidence of new hemorrhage or acute \nterritorial infarction. \n# CXR (___): Left PICC has been withdrawn, now terminating \nin the proximal to mid superior vena cava. Nasogastric tube \nterminates in the stomach. Stable cardiomegaly. Resolution of \nmild pulmonary edema.\nMs. ___ is a ___ year-old woman with a history of DM, HTN, \nHLD who was found down at home and ultimately found to have \nright basal ganglia bleed with intraventricular extension, \nlikely secondary to hypertension (SBP to 230s). \n\n# NEURO: right basal ganglia bleed\nShe was admitted to the Neuro ICU for close monitoring. Initial \nexamination was notable for left sided weakness (face, arm, \nleg), slurred speech and left neglect. NCHCT showed a right \nbasal ganglia bleed with intraventricular extension and so she \nwas intubated for concern of possible herniation. The \nhemorrhage remained stable and she was extubated within 24 \nhours. Her blood pressure was tightly controlled (SBP<140) with \nlabetalol and losartan while in the ICU. She failed speech and \nswallow evaluation and an NGT was placed for tube feeding and \nmeds. She was transferred to the Neurology floor within 48 hours \nof admission and started on SQH. On ___ there was an acute \nchange in her mental status compared to her morning neurological \nexam. Her stroke risk factors were assessed and her LDL is 189 \nand her HbA1c 7.3%. Repeat NCHCT at the time showed no \ndifference in the size of her hemorrhage. Her mental status \nimproved the following day and her home dose of risperidone was \ngiven to her secondary to aggitation. She continued to be \nhypertensive for several days after her stroke. Her home blood \npressure medications were added back after she was cleared by \nspeech and swallow to resume a regular diet. Her tube feeds and \nNGT were discontinued once she was taking in enough calories \norally. She was started on atorvastatin 80mg and ASA 81mg. Her \nleftsided weakness and dysarthria improved. \n\nAHA/ASA Core Measures for Intracerebral Hemorrhage\n\n1. Dysphagia screening before any PO intake? (x) Yes [performed \nand documented by admitting resident] \x96 () No\n\n2. DVT Prophylaxis administered by the end of hospital day 2? \n(x) Yes - () No\n\n3. Smoking cessation counseling given? () Yes - (x) No [reason \n(x) non-smoker - () unable to participate]\n\n4. Stroke education given (written form in the discharge \nworksheet)? (x) Yes - () No\n(stroke education = personal modifiable risk factors, how to \nactivate EMS for stroke, stroke warning signs and symptoms, \nprescribed medications, need for followup)\n\n5. Assessment for rehabilitation or rehab services considered? \n(x) Yes - () No [if no, reason not assessed: ____ ]\n\n#ID: aspiration pneumonia\nHospital course was complicated by tachypnea and fevers \nsecondary to an aspiration pneumonia. She underwent a fever work \nup which included a CXR, blood and urine cultures. She was \ntreated with IV vancomycin and piperacillin/tazobactam to treat \nthe aspiration pneumonia. Her tachypnea improved after she was \ngiven 20mg IV Lasix. She had a PICC line placed and will \ncomplete a 14 day course of Vanc/Zosyn ending on ___. \n\n#Endocrine: Diabetes Mellitus Type 2\n___ was consulted and she was continued on a Humalog insulin \nsliding scale and Lantus was increased. Her home metformin and \nglipizide was held during this hospitalization. \n\n#Chronic Hypokalemia: K+ repleted daily, started on home \npotassium regimen at the time of discharge. \n\nTRANSITIONAL ISSUES:\n- Vancomycin/Zosyn will stop on ___. \n- She will need to have her diabetes monitored more closely in \nthe outpatient setting.'}}
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{'final_diagnoses': ['Right basal ganglia hemorrhage'], 'procedures': ['none'], 'visit_summary': 'Ms. ___ is a ___ year-old woman with a history of DM, HTN, \nHLD who was found down at home and ultimately found to have \nright basal ganglia bleed with intraventricular extension, \nlikely secondary to hypertension (SBP to 230s). \n\n# NEURO: right basal ganglia bleed\nShe was admitted to the Neuro ICU for close monitoring. Initial \nexamination was notable for left sided weakness (face, arm, \nleg), slurred speech and left neglect. NCHCT showed a right \nbasal ganglia bleed with intraventricular extension and so she \nwas intubated for concern of possible herniation. The \nhemorrhage remained stable and she was extubated within 24 \nhours. Her blood pressure was tightly controlled (SBP<140) with \nlabetalol and losartan while in the ICU. She failed speech and \nswallow evaluation and an NGT was placed for tube feeding and \nmeds. She was transferred to the Neurology floor within 48 hours \nof admission and started on SQH. On ___ there was an acute \nchange in her mental status compared to her morning neurological \nexam. Her stroke risk factors were assessed and her LDL is 189 \nand her HbA1c 7.3%. Repeat NCHCT at the time showed no \ndifference in the size of her hemorrhage. Her mental status \nimproved the following day and her home dose of risperidone was \ngiven to her secondary to aggitation. She continued to be \nhypertensive for several days after her stroke. Her home blood \npressure medications were added back after she was cleared by \nspeech and swallow to resume a regular diet. Her tube feeds and \nNGT were discontinued once she was taking in enough calories \norally. She was started on atorvastatin 80mg and ASA 81mg. Her \nleftsided weakness and dysarthria improved. \n\nAHA/ASA Core Measures for Intracerebral Hemorrhage\n\n1. Dysphagia screening before any PO intake? (x) Yes [performed \nand documented by admitting resident] \x96 () No\n\n2. DVT Prophylaxis administered by the end of hospital day 2? \n(x) Yes - () No\n\n3. Smoking cessation counseling given? () Yes - (x) No [reason \n(x) non-smoker - () unable to participate]\n\n4. Stroke education given (written form in the discharge \nworksheet)? (x) Yes - () No\n(stroke education = personal modifiable risk factors, how to \nactivate EMS for stroke, stroke warning signs and symptoms, \nprescribed medications, need for followup)\n\n5. Assessment for rehabilitation or rehab services considered? \n(x) Yes - () No [if no, reason not assessed: ____ ]\n\n#ID: aspiration pneumonia\nHospital course was complicated by tachypnea and fevers \nsecondary to an aspiration pneumonia. She underwent a fever work \nup which included a CXR, blood and urine cultures. She was \ntreated with IV vancomycin and piperacillin/tazobactam to treat \nthe aspiration pneumonia. Her tachypnea improved after she was \ngiven 20mg IV Lasix. She had a PICC line placed and will \ncomplete a 14 day course of Vanc/Zosyn ending on ___. \n\n#Endocrine: Diabetes Mellitus Type 2\n___ was consulted and she was continued on a Humalog insulin \nsliding scale and Lantus was increased. Her home metformin and \nglipizide was held during this hospitalization. \n\n#Chronic Hypokalemia: K+ repleted daily, started on home \npotassium regimen at the time of discharge. \n\nTRANSITIONAL ISSUES:\n- Vancomycin/Zosyn will stop on ___. \n- She will need to have her diabetes monitored more closely in \nthe outpatient setting.', 'medications_prescribed': ['1. ALPRAZolam 0.5 mg PO BID:PRN anxiety \n2. Glargine 35 Units Breakfast\nInsulin SC Sliding Scale using REG Insulin\n3. Losartan Potassium 100 mg PO DAILY \n4. RISperidone 3 mg PO BID \n5. Sertraline 100 mg PO BID \n6. Topiramate (Topamax) 25 mg PO QID:PRN seizures \n7. Acetaminophen 1000 mg PO Q8H:PRN headache/fever \n8. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB \n9. Docusate Sodium 100 mg PO BID \n10. Ipratropium Bromide Neb 1 NEB IH Q6H \n11. Labetalol 200 mg PO QID \n12. Senna 8.6 mg PO BID:PRN constipation \n13. Potassium Chloride 40 mEq PO QAM \nHold for K > 4.5 \n14. Potassium Chloride 60 mEq PO QPM \nHold for K > 4.5 \n15. Aspirin 81 mg PO DAILY \n16. Atorvastatin 80 mg PO DAILY \n17. Piperacillin-Tazobactam 4.5 g IV Q8H \n18. Vancomycin 1000 mg IV Q 8H \n19. Ibuprofen 600 mg PO Q8H:PRN pain \n20. Lidocaine 5% Patch 1 PTCH TD QAM']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 37, 'gender': 'M', 'symptoms': 'Dyspnea on exertion', 'medical_history': ['Hypertension', 'Asthma-asthmatic bronchitis', 'Left heart failure', 'Obesity', 'Vestibular neuritis', 'Ulcerative colitis- in ______', 'Restless leg syndrome', 'Dysthymia'], 'family_history': 'Father- no cardiac HX\nMother- no Cardiac HX\nGrandmother- CHF', 'present_illness': 'Very nice ___ y.o female with known aortic bicuspid valve \n(diagnosed in her ___) which has become significantly stenotic \n___ 0.8 cm) and regurgitant over the past ___ years, with \nascending aortic dilatation (45 mm) causing symptoms of\nexertional dyspnea, wheezing and decline in activity tolerance. \nA cardiac catheterization was performed which showed a right \nostial stenosis but otherwise normal coronaries.', 'medications': [{'medication': 'Hydrocerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Cosyntropin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 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', 'doses_per_24_hrs': 2.0}, {'medication': 'Quetiapine Fumarate', '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 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': 'Topiramate (Topamax)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'RiTONAvir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atazanavir', '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}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aripiprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clobetasol Propionate 0.05% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '320', 'valuenum': 320.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, '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': '4.8', 'valuenum': 4.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, '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': '86', 'valuenum': 86.0, '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': 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': '2.85', 'valuenum': 2.85, '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': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'THIN AND THICK SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '382', 'valuenum': 382.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.93', 'valuenum': 2.93, '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': '12', 'valuenum': 12.0, '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': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '4.2', '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': '17', 'valuenum': 17.0, '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': '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': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.9, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'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': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'THIN AND THICK SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': '25.1', 'valuenum': 25.1, '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': '27.6', 'valuenum': 27.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '374', 'valuenum': 374.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.7', 'valuenum': 15.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.90', 'valuenum': 2.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.5, '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': 12.5, '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.'}], 'exams': 'Pulse: 71 Resp: 20 O2 sat: 99 RA \nB/P Left: 107/92 \nHeight:63.5 Weight: 212 lb\n\nGeneral: WDWN in NAD\nSkin: Dry [X] intact [X]\nHEENT: PERRLA [X] EOMI [X]\nNeck: Supple [X] Full ROM [X]\nChest: Lungs clear bilaterally \nHeart: RRR [X] Irregular [] Murmur [X] grade IV/VI, RUSB harsh \nsystolic, crescendo-decrscendo \nAbdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds \n+[X]\nExtremities: Warm [X], well-perfused [X] No Edema \nVaricosities: None [X]\nNeuro: Grossly intact [X]\nPulses:\nDP Right:2+ Left:2+\n___ Right:2+ Left:2+\nRadial Right:2+ Left:2+\n\nCarotid Bruit: Transmitted', 'diagnoses': [{'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': '44629', 'desc': 'Other specified hypersensitivity angiitis'}, {'icd_code': '25541', 'desc': 'Glucocorticoid deficiency'}, {'icd_code': 'E9310', 'desc': 'Sulfonamides causing adverse effects in therapeutic use'}, {'icd_code': 'V08', 'desc': 'Asymptomatic human immunodeficiency virus [HIV] infection status'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': "Echo ___:\n___\n\n___ ECHOCARDIOGRAPHY REPORT\n\n___ ___ MRN: ___ TEE \n(Complete) Done ___ at 9:19:09 AM PRELIMINARY \nReferring Physician ___ \n___ of Cardiothoracic Surg\n___ Status: Inpatient DOB: ___ \nAge (years): ___ F Hgt (in): \nBP (mm Hg): / Wgt (lb): \nHR (bpm): BSA (m2): \nIndication: Aortic valve disease. Congenital heart disease. \nHypertension. \nDiagnosis: I35.9, I71.2, Q23.1 \n___ Information \nDate/Time: ___ at 09:19 ___ MD: ___, MD \n___ Type: TEE (Complete) Sonographer: ___, MD \nDoppler: Full Doppler and color Doppler ___ Location: \nAnesthesia West OR cardiac \nContrast: None Tech Quality: Adequate \n Machine: 23 \nEchocardiographic Measurements \n\nResults \n\nMeasurements \n\nNormal Range \n\nLeft Ventricle - Septal Wall Thickness: 1.0 cm 0.6 - 1.1 cm \n \nLeft Ventricle - Inferolateral Thickness: 0.9 cm 0.6 - 1.1 \ncm \nLeft Ventricle - Diastolic Dimension: *5.8 cm <= 5.6 cm \nLeft Ventricle - Ejection Fraction: 55% to 60% >= 55% \nLeft Ventricle - Stroke Volume: 96 ml/beat \nLeft Ventricle - Lateral Peak E': *0.07 m/s > 0.08 m/s \nLeft Ventricle - Ratio E/E': 13 < 13 \nAorta - Annulus: 2.7 cm <= 3.0 cm \nAorta - Sinus Level: *4.0 cm <= 3.6 cm \nAorta - Sinotubular Ridge: *4.0 cm <= 3.0 cm \nAorta - Ascending: *4.5 cm <= 3.4 cm \nAortic Valve - Peak Velocity: *3.1 m/sec <= 2.0 m/sec \nAortic Valve - Peak Gradient: *40 mm Hg < 20 mm Hg \nAortic Valve - Mean Gradient: 26 mm Hg \nAortic Valve - LVOT VTI: 23 \nAortic Valve - LVOT diam: 2.3 cm \nAortic Valve - Valve Area: *1.1 cm2 >= 3.0 cm2 \nAortic Valve - Pressure Half Time: 384 ms \nMitral Valve - Mean Gradient: 1 mm Hg \nMitral Valve - Pressure Half Time: 102 ms \nMitral Valve - MVA (P ___ T): 2.2 cm2 \nMitral Valve - E Wave: 0.9 m/sec \nMitral Valve - A Wave: 0.7 m/sec \nMitral Valve - E/A ratio: 1.29 \n \nFindings \nLEFT ATRIUM: Dilated ___. No spontaneous echo contrast in the \nbody of the ___. Good (>20 cm/s) ___ ejection velocity. \n\nRIGHT ATRIUM/INTERATRIAL SEPTUM: Dilated RA. No spontaneous echo \ncontrast in the body of the RA. Normal interatrial septum. No \nASD by 2D or color Doppler. \n\nLEFT VENTRICLE: Normal LV wall thickness. Mildly dilated LV \ncavity. Normal regional LV systolic function. Overall normal \nLVEF (>55%). \n\nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Mildy dilated aortic root. Moderately dilated ascending \naorta Normal aortic arch diameter. Normal descending aorta \ndiameter. Focal calcifications in descending aorta. Normal \nabdominal aorta diameter. Focal calcifications in abdominal \naorta. \n\nAORTIC VALVE: Bicuspid aortic valve. Severely thickened/deformed \naortic valve leaflets. Moderate AS (area 1.0-1.2cm2) Moderate \n(2+) AR. Eccentric AR jet directed toward the anterior mitral \nleaflet. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. No MVP. No \nMS. ___ MR. \n\n___ VALVE: Normal tricuspid valve leaflets. Mild [1+] TR. \n\nPULMONIC VALVE/PULMONARY ARTERY: Normal pulmonic valve leaflet. \nNo PS. Physiologic PR. \n\nPERICARDIUM: No pericardial effusion. \n\nGENERAL COMMENTS: Written informed consent was obtained from the \n___. A TEE was performed in the location listed above. I \ncertify I was present in compliance with ___ regulations. The \n___ was under general anesthesia throughout the procedure. \nThe TEE probe was passed with assistance from the \nanesthesioology staff using a laryngoscope. No TEE related \ncomplications. \nConclusions \nPre-Bypass Exam\n rhythm: sinus\n infusions: norepinephrine 0.015 mcg/kg/min\n\n 1. The left atrium is dilated. No spontaneous echo contrast is \nseen in the body of the left atrium or left atrial appendage. \n 2. The right atrium is dilated. No spontaneous echo contrast is \nseen in the body of the right atrium. No atrial septal defect is \nseen by 2D or color Doppler. \n 3. Left ventricular wall thicknesses are normal. The left \nventricular cavity is mildly dilated. Regional left ventricular \nwall motion is normal. Overall left ventricular systolic \nfunction is normal (LVEF>55%). \n 4. Right ventricular chamber size and free wall motion are \nnormal. The aortic root is mildly dilated at the sinus level. \nThe ascending aorta is moderately dilated. There is significant \neffacement of the Right sinotubular junction. \n 5. The aortic valve is bicuspid. The aortic valve leaflets are \nseverely thickened/deformed. There is moderate aortic valve \nstenosis (valve area 1.0-1.2cm2). Moderate (2+) aortic \nregurgitation is seen. The aortic regurgitation jet is \neccentric, directed toward the anterior mitral leaflet. AR P1/2T \nis 384, consistent with moderate AR. The color M mode proportion \nof LVOT also consistent with moderate AR. There is no \nsignificant diasolic flow reversal in the descending aorta. \n 6. The mitral valve leaflets are mildly thickened. There is no \nmitral valve prolapse. Trivial mitral regurgitation is seen. \n 7. There is no pericardial effusion. \n\n Post Bypass Exam\n rhythm: Atrial Pacing\n Infusions: norepinephrine 0.02 mcg/kg/min\n\n 1. Left ventricular function intact, unchanged from pre-bypass\n 2. Right ventricular function is intact and unchanged from \npre-bypass\n 3. Aortic valve prosthesis visualized, well seated, No \nsignificant intravalvular or paravalvular regurgitation. \nMechanical valve with significant shadowing making visualization \nof leaflets difficult. No Aortic stenosis, peak gradient 17, \nmean 10. \n 4. Aorta intact, no evidence of dissection. Aortic root and \nascending graft visualized. \n 5. Other valvular function intact and unchanged from pre-bypass \nexamination.\n\n Findings communicated with Dr. ___ at the time of \nexamination \n I certify that I was present for this procedure in compliance \nwith ___ regulations.\n\nInterpretation assigned to ___, MD, Interpreting physician \n \n \n© ___ ___. All rights reserved.\n.\n\n___ 04:50AM BLOOD WBC-10.8* RBC-2.99* Hgb-9.3* Hct-28.5* \nMCV-95 MCH-31.1 MCHC-32.6 RDW-12.1 RDWSD-42.3 Plt ___\n___ 04:40AM BLOOD WBC-20.2* RBC-3.34* Hgb-10.4* Hct-32.0* \nMCV-96 MCH-31.1 MCHC-32.5 RDW-12.6 RDWSD-43.8 Plt ___\n___ 12:34PM BLOOD WBC-25.3* RBC-3.36* Hgb-10.8* Hct-31.4* \nMCV-94 MCH-32.1* MCHC-34.4 RDW-12.0 RDWSD-41.1 Plt ___\n___ 01:00PM BLOOD ___\n___ 04:50AM BLOOD ___ PTT-38.2* ___\n___ 03:30AM BLOOD ___\n___ 04:40AM BLOOD ___ PTT-26.6 ___\n___ 02:57AM BLOOD ___ PTT-25.1 ___\n___ 12:34PM BLOOD ___ PTT-25.8 ___\n___ 11:20AM BLOOD ___ PTT-24.3* ___\n___ 04:50AM BLOOD Glucose-115* UreaN-8 Creat-0.6 Na-139 \nK-3.4* Cl-90* HCO3-37* AnGap-12\n___ 04:40AM BLOOD Glucose-116* UreaN-8 Creat-0.6 Na-135 \nK-4.6 Cl-97 HCO3-28 AnGap-10\n___ 04:50AM BLOOD Mg-2.2\nMrs. ___ was a same day admit and on ___ she was taken \ndirectly to the operating room where she underwent a Bentall \nprocedure with 23 mm On-X mechanical\ncomposite graft. Please see operative note for surgical details. \nFollowing surgery she was transferred to the CVICU for invasive \nmonitoring in stable condition. Later this day she weaned from \nsedation, awoke neurologically intact and extubated. She awoke \nneurologically intact and weaned to extubate. Initially coming \nout from the operating room she required Atrial pacing for \nunderlying bradycardia. Beta-blocker was held to allow her \nrhythm time to recover. Statin/ASA and diuresis were initiated. \nChest tubes and pacing wires were discontinued per protocol \nwithout incident. Anticoagulation for her mechanical valve was \nstarted. Postop leukocytosis resolved. She was transferred to \nthe step down unit for further monitoring. Physical Therapy was \nconsulted for evaluation of strength and mobility.\nBy the time of pod 4 she was ambulating independently, wounds \nhealing, and pain controlled. She was discharged to home with \n___ services. All follow up appointments were advised. ___ has \nagreed to manage Coumadin beginning next week."}}
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{'final_diagnoses': ['Bicuspid aortic valve with aortic stenosis/regurgitation and \nascending aortic aneurysm s/p Bentall procedure', 'Hypertension', 'Asthma-asthmatic bronchitis', 'Left heart failure', 'Obesity', 'Vestibular neuritis', 'Ulcerative colitis- in ___', 'Restless leg syndrome', 'Dysthymia'], 'procedures': ['Bentall procedure with 23 mm On-X mechanical composite graft'], 'visit_summary': 'Mrs. ___ was a same day admit and on ___ she was taken \ndirectly to the operating room where she underwent a Bentall \nprocedure with 23 mm On-X mechanical\ncomposite graft. Please see operative note for surgical details. \nFollowing surgery she was transferred to the CVICU for invasive \nmonitoring in stable condition. Later this day she weaned from \nsedation, awoke neurologically intact and extubated. She awoke \nneurologically intact and weaned to extubate. Initially coming \nout from the operating room she required Atrial pacing for \nunderlying bradycardia. Beta-blocker was held to allow her \nrhythm time to recover. Statin/ASA and diuresis were initiated. \nChest tubes and pacing wires were discontinued per protocol \nwithout incident. Anticoagulation for her mechanical valve was \nstarted. Postop leukocytosis resolved. She was transferred to \nthe step down unit for further monitoring. Physical Therapy was \nconsulted for evaluation of strength and mobility.\nBy the time of pod 4 she was ambulating independently, wounds \nhealing, and pain controlled. She was discharged to home with \n___ services. All follow up appointments were advised. ___ has \nagreed to manage Coumadin beginning next week.', 'medications_prescribed': ['Aspirin EC 81 mg PO DAILY \nRX *aspirin 81 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*1', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Severe \nRX *hydromorphone 2 mg ___ tablet(s) by mouth every four (4) \nhours Disp #*60 Tablet Refills:*0', 'Metoprolol Tartrate 12.5 mg PO BID \nRX *metoprolol tartrate 25 mg 0.5 (One half) tablet(s) by mouth \ntwice a day Disp #*60 Tablet Refills:*1', 'Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*1', 'Potassium Chloride 20 mEq PO DAILY \nRX *potassium chloride 20 mEq 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*1', 'Warfarin ___ mg PO DAILY mechanical AVR \nas directed for goal INR ___ \nRX *warfarin 2 mg ___ tablet(s) by mouth daily Disp #*90 Tablet \nRefills:*1', 'Furosemide 40 mg PO DAILY \n40mg daily x 10 days, then resume 20mg daily dosing \nRX *furosemide 20 mg 2 tablet(s) by mouth daily Disp #*40 Tablet \nRefills:*1', 'Pramipexole 0.125 mg PO DAILY', 'Citalopram 10 mg PO DAILY', 'Qvar (beclomethasone dipropionate) 80 mcg/actuation \ninhalation BID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 21, 'gender': 'F', 'symptoms': 'AMS, urinary retention, fecal incontinence', 'medical_history': ['Multiple myeloma s/p 1 round of velcade/decadron', 'Hypertension', 'Hyperlipidemia', 'Osteoarthritis', 'Right knee ___ cyst', 'Shingles involving left neck - ___', 'Right femur distal enchondroma', 'Left breast atypical ductal hyperplastia on biopsy - ___', '___: T9-L2 fusion, T11 laminectomy for vertebral \ninvolvement of MM concern for cord compression'], 'family_history': "Significant for a history of Wegener's disease in her mother, no \nother family members with known renal disease. No family history \nof cancer. Hypertension. Sister had RA. No diabetes, clotting, \nbleeding disorders.", 'present_illness': 'Ms. ___ is a ___ yo woman with a history of multiple\nmyeloma, status post T9-L2 instrumentation and T11 laminectomy \non\n___ for cord compression with Dr. ___ presents\nwith acute urinary retention (foley drained 900 cc) and fecal\nincontinence, also conern for possible confusion that may be\nworse than baseline yesterday AM.\nOn arrival she was afebrile without leukocytosis. MRI showed\nknown post-surgical changes. Dr. ___ was contacted by ED\nstaff, who wanted Neurology input on need for meningitic\ncoverage.', 'medications': [{'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', 'route': 'IV', 'frequency': 'ASDIR', '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': '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', '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 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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H: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': 'Docusate Sodium', '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': 'OxycoDONE Liquid', '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', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.31', 'valuenum': 1.31, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, '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': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '6.1', 'valuenum': 6.1, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.1', 'valuenum': 79.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '201', 'valuenum': 201.0, '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': '3.87', 'valuenum': 3.87, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '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': '0.57', 'valuenum': 0.57, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '38.2', 'valuenum': 38.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '174', 'valuenum': 174.0, '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': '3.94', 'valuenum': 3.94, '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': '40.5', 'valuenum': 40.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 148.0, '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', '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': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, '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': '29.9', 'valuenum': 29.9, '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': '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, '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': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '37.8', 'valuenum': 37.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PE:\nGEN: anxious appearing, uncomfortable with current sitting\nposition\nVS: T 98.6 HR 104 BP 150/88 Resp 18 spO2 95%\nHEENT: MMM, no OP lesions, no cervical, supraclavicular, or\naxillary LAD\nCV: Regular, normal S1 and S2 no S3, S4, or murmurs\nPULM: Clear to auscultation bilaterally\nABD: BS+, soft, non-tender, non-distended, no masses, no\nhepatosplenomegaly\nLIMBS: No edema, no inguinal adenopathy\nSKIN: No rashes or skin breakdown\nNEURO: Grossly nonfocal, alert and oriented \n\nDISCHARGE PE:\nVS: T 98.3 BP 100/70 HR 80 RR 18 O2 97%\nGen: WDWN NAD A&Ox4. appropriate content. no tearfulness.\nHEENT: oropharynx dry no lesions\nneck: supple\nCV: RRR no m/r/g\nLS: CTA b/l\nAbd: soft NT -HSM +BS\nExtr: no edema\nSkin: no rash\nNeuro: nonfocal\nAccess: PIV', 'diagnoses': [{'icd_code': 'S02652A', 'desc': 'Fracture of angle of left mandible, initial encounter for closed fracture'}, {'icd_code': 'S62322A', 'desc': 'Displaced fracture of shaft of third metacarpal bone, right hand, initial encounter for closed fracture'}, {'icd_code': 'Z720', 'desc': 'Tobacco use'}, {'icd_code': 'S0181XA', 'desc': 'Laceration without foreign body of other part of head, initial encounter'}, {'icd_code': 'S0269XA', 'desc': 'Fracture of mandible of other specified site, initial encounter for closed fracture'}, {'icd_code': 'V475XXA', 'desc': 'Car driver injured in collision with fixed or stationary object in traffic accident, initial encounter'}, {'icd_code': 'Y92410', 'desc': 'Unspecified street and highway as the place of occurrence of the external cause'}], 'summary': "___ 06:10AM BLOOD WBC-5.5 RBC-2.23* Hgb-7.2* Hct-20.5* \nMCV-92 MCH-32.3* MCHC-35.0 RDW-20.9* Plt ___\n___ 01:11PM BLOOD WBC-4.9 RBC-2.88* Hgb-8.9* Hct-25.6* \nMCV-89 MCH-30.9 MCHC-34.7 RDW-18.5* Plt Ct-37*\n___ 06:10AM BLOOD Neuts-85.3* Lymphs-7.1* Monos-6.5 Eos-0.9 \nBaso-0.3\n___ 06:10AM BLOOD Glucose-89 UreaN-13 Creat-0.8 Na-143 \nK-3.9 Cl-110* HCO3-22 AnGap-15\n___ 01:11PM BLOOD Glucose-119* UreaN-16 Creat-0.9 Na-135 \nK-3.1* Cl-101 HCO3-25 AnGap-12\n___ 06:10AM BLOOD ALT-32 AST-25 LD(LDH)-172 AlkPhos-129* \nTotBili-0.2\n___ 06:30AM BLOOD ALT-60* AST-34 AlkPhos-138* TotBili-0.7\n___ 06:10AM BLOOD Albumin-3.2* Calcium-8.5 Phos-3.6 Mg-2.2\n___ 01:11PM BLOOD Calcium-8.2* Phos-2.6* Mg-1.9\nMs ___ is a ___ yr old female with hx of MM most recently\ntreated with C2 velcade/dex ___ admitted with new urinary\nretention, fecal incontinence and AMS.\n\nC1D16 CyBorD\n\n# Myeloma, IgG kappa\n- resent FLC ___ still shows K/L ratio > 1000\n- d/c to rehab today\n- next chemotherapy due on ___ and ___, dex weekly on\n___. This cyle's dates are modified from the standard \nregimen\n- f/u with Dr ___ next cycle ___ or sooner if issues \narise \n\n# AMS - concern for neurologic symptoms in the setting of a\nrecent myeloma diagnosis\n- marked improvement over the past few days on new pain meds and\noff gabapentin\n\n# RSV URTI- resolved\n- IgG level low at 280, gave 200mg/m2 of IVIG ___\n- added azithro for ppx if develops supraimposed bacterial infx-\nbut d/c on ___ secondary to increase in stool frequency\n- monitor sx, may repeat IVIG if needed\n- slowly improving \n\n# Stool incont/urinary incont: \n- stool incont again this am, improved a few days prior, patient \nstates she had an urge to go but couldnt get to the bathroom in \ntime, no diarrhea \n- cdiff neg\n- foley for urine incont (see below)\n\n# elevated CSF protein: \n- repeat LP if any further MS changes\n\n# acute urinary retention - per past notes has been concern for\nincomplete bladder emptying. Does have hx of cord compression \nbut\nMRI C/T/L spine clear on arrival. \n- foley catheter placed for relief, trialed d/c over weekend \n___\nbut retention again shortly afterwards, foley back in place\n- wean off at rehab once strength improves \n\n# pain ___ marked lytic lesions: \n- started MsContin 15BID on ___\n- pain markedly improved over past 3 days\n- uptitrate as needed\n\n# Hx T11 compression frx w/ cord compression \n- s/p T9 - L2 fusion ___ and XRT\n- pain management as above\n\n# pancytopenia: ___ chemotherapy \n- prn products, received 1 unit RBC on ___ prior to d/c\n\n# Hx recurrent UTI: reportedly had an E. coli UTI sensitive to \ncipro, gent, ertapenem, and levofloxacin earlier in ___. Treated\nwith cipro 10 days (___. UA with 7 wbc on broad spec \nabx\nas above\n- +enterococcus 10,000-100,000-completed tx\n\n# HTN: started amlodopine ___ for elevated BP readings\n\n# Access: PIV\n# FEN: regular diet\n# Bowel regimen: prn\n# Contact: ___\n# Disposition: ___ for now, xfer to rehab \n# Code status: full"}}
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{'final_diagnoses': ['myeloma', 'AMS', 'urinary retention', 'bowel incontinence'], 'procedures': ['LP', 'paraneoplastic panel PND'], 'visit_summary': "Ms ___ is a ___ yr old female with hx of MM most recently\ntreated with C2 velcade/dex ___ admitted with new urinary\nretention, fecal incontinence and AMS.\n\nC1D16 CyBorD\n\n# Myeloma, IgG kappa\n- resent FLC ___ still shows K/L ratio > 1000\n- d/c to rehab today\n- next chemotherapy due on ___ and ___, dex weekly on\n___. This cyle's dates are modified from the standard \nregimen\n- f/u with Dr ___ next cycle ___ or sooner if issues \narise \n\n# AMS - concern for neurologic symptoms in the setting of a\nrecent myeloma diagnosis\n- marked improvement over the past few days on new pain meds and\noff gabapentin\n\n# RSV URTI- resolved\n- IgG level low at 280, gave 200mg/m2 of IVIG ___\n- added azithro for ppx if develops supraimposed bacterial infx-\nbut d/c on ___ secondary to increase in stool frequency\n- monitor sx, may repeat IVIG if needed\n- slowly improving \n\n# Stool incont/urinary incont: \n- stool incont again this am, improved a few days prior, patient \nstates she had an urge to go but couldnt get to the bathroom in \ntime, no diarrhea \n- cdiff neg\n- foley for urine incont (see below)\n\n# elevated CSF protein: \n- repeat LP if any further MS changes\n\n# acute urinary retention - per past notes has been concern for\nincomplete bladder emptying. Does have hx of cord compression \nbut\nMRI C/T/L spine clear on arrival. \n- foley catheter placed for relief, trialed d/c over weekend \n___\nbut retention again shortly afterwards, foley back in place\n- wean off at rehab once strength improves \n\n# pain ___ marked lytic lesions: \n- started MsContin 15BID on ___\n- pain markedly improved over past 3 days\n- uptitrate as needed\n\n# Hx T11 compression frx w/ cord compression \n- s/p T9 - L2 fusion ___ and XRT\n- pain management as above\n\n# pancytopenia: ___ chemotherapy \n- prn products, received 1 unit RBC on ___ prior to d/c\n\n# Hx recurrent UTI: reportedly had an E. coli UTI sensitive to \ncipro, gent, ertapenem, and levofloxacin earlier in ___. Treated\nwith cipro 10 days (___. UA with 7 wbc on broad spec \nabx\nas above\n- +enterococcus 10,000-100,000-completed tx\n\n# HTN: started amlodopine ___ for elevated BP readings\n\n# Access: PIV\n# FEN: regular diet\n# Bowel regimen: prn\n# Contact: ___\n# Disposition: ___ for now, xfer to rehab \n# Code status: full", 'medications_prescribed': ['1. Acyclovir 400 mg PO TID', '2. Atovaquone Suspension 1500 mg PO DAILY', '3. Cyanocobalamin 1000 mcg PO DAILY', '4. FoLIC Acid 1 mg PO DAILY', '5. Nystatin Oral Suspension 5 mL PO QID oral thrush', '6. Omeprazole 20 mg PO DAILY', '7. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN pain', '8. Polyethylene Glycol 17 g PO DAILY', '9. Simethicone 80 mg PO QID:PRN gas cramping', '10. Thiamine 100 mg PO DAILY', '11. Bisacodyl 10 mg PO DAILY:PRN constipation', '12. Milk of Magnesia 30 mL PO Q6H:PRN constipation', '13. Ondansetron 8 mg PO Q8H:PRN nausea/vomiting', '14. TraMADOL (Ultram) 25 mg PO Q6H:PRN pain', '15. Docusate Sodium 100 mg PO BID:PRN constipation', '16. Senna 17.2 mg PO QHS:PRN constipation', '17. Amlodipine 5 mg PO DAILY', '18. Morphine SR (MS ___ 15 mg PO Q12H \nRX *morphine 15 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 70, 'gender': 'F', 'symptoms': 'Wound infection', 'medical_history': ['HTN', 'HLD', 'NASH', 'Hypothyroidism', 'Choledocholithiasis s/p lap CCY (___)'], 'family_history': 'Father with CAD', 'present_illness': "___ is a ___ s/p recurrent periumbilical\ncomplex incisional hernia repair with mesh (gore bioplug then\nprolene mesh overlay) with ___ (___) who presents\nwith 2 days of erythema and drainage from his surgical wound.\nPatient was intially evaluated ___ ___ for his first\npostoperative visit when he was evaluated to have a small seroma\nby his wound which was draining and there was no evidence of\ninfection. Patient was seen ___ ___ ___ twice\nsince then, last on ___ where he reported no drainage with a \nwell\nhealing wound and the staples were removed. He represented to\nclinic today with progressive erythema and serous drainage from\nhis umbilicus and subjective fevers x2 days. His wound was I&D'd\n___ clinic with drainage of approximately ___ of somewhat\nthick brown serous fluid. Swab cultures sent. Because patient \nhas\na overlay mesh just under his incision patient was sent for\nadmission and intraoperative washout scheduled for today. \nPatient otherwise has no other complaints.", 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin-Sulbactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'HS: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': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H: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': 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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '453', 'valuenum': 453.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '68', 'valuenum': 68.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '8.5', 'valuenum': 8.5, '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 = >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': 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': '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': '4.5', 'valuenum': 4.5, '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': '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': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '339', 'valuenum': 339.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.43', 'valuenum': 3.43, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': 'HOLD.'}, {'value': '29.9', 'valuenum': 29.9, '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': '26.6', 'valuenum': 26.6, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '363', 'valuenum': 363.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '3.60', 'valuenum': 3.6, '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}, {'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': '434', 'valuenum': 434.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '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': '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': '___', 'valuenum': 66.0, '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': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.1', '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': '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': '___', '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': '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': 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': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '374', 'valuenum': 374.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '37', 'valuenum': 37.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, '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': '___', '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '389', 'valuenum': 389.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '3.51', 'valuenum': 3.51, '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\nVital Signs sheet entries for ___:\nBP: 149/75. Heart Rate: 97. Weight: 225.1 (Patient Reported).\nBMI: 35.0. Temperature: 97.3. Resp. Rate: 16. Pain Score: 2. O2\nSaturation%: 95.\n\nGEN: A&O, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: Soft, nondistended, midline periumbilical surgical wound\npacked with wet to dry dressing. Healing ridge with mild \nerythema\nand a path of erythema on the left lateral aspect of umbilicus.\nNo induration.\nExt: No ___ edema, ___ warm and well perfused\n\nDISCHARGE\n\nGEN: A&O, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l, No W/R/R\nABD: Soft, nondistended, midline periumbilical surgical wound\nwith a wound vac to low continuous sunction. Mild erythema, no \ninduration or fluctuance.\nExt: No ___ edema, ___ warm and well perfused', 'diagnoses': [{'icd_code': '1560', 'desc': 'Malignant neoplasm of gallbladder'}, {'icd_code': '5762', 'desc': 'Obstruction of bile duct'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': 'Time Taken Not Noted ___ Date/Time: ___ 3:36 pm\n ABSCESS SURGICAL WOUND. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n 3+ ___ per 1000X FIELD): GRAM POSITIVE COCCI. \n ___ PAIRS AND CLUSTERS. \n\n WOUND CULTURE (Final ___: \n STAPH AUREUS COAG +. MODERATE GROWTH. \n Staphylococcus species may develop resistance during \nprolonged\n therapy with quinolones. Therefore, isolates that are \ninitially\n susceptible may become resistant within three to four \ndays after\n initiation of therapy. Testing of repeat isolates may \nbe\n warranted. \n\n SENSITIVITIES: MIC expressed ___ \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n | \nCLINDAMYCIN-----------<=0.25 S\nERYTHROMYCIN----------<=0.25 S\nGENTAMICIN------------ <=0.5 S\nLEVOFLOXACIN---------- 0.25 S\nOXACILLIN-------------<=0.25 S\nTETRACYCLINE---------- <=1 S\nTRIMETHOPRIM/SULFA---- <=0.5 S\n\n ANAEROBIC CULTURE (Preliminary): NO ANAEROBES ISOLATED.\nPatient was directly admitted to the ___ surgery service from \n___ after bedside incision and drainage of the \nsurgical wound. Please refer to the above HPI for details of his \ninitial presentation. Upon admission, patient was afebrile with \nnormal vital signs. He was made NPO and was started on IV-Ancef \nfor empiric coverage. Although his wound was adequately drained \nat the bedside, given the presence of an overlay mesh just \nbeneath his infected seroma, he was recommended a formal washout \n___ the operating room with a possible wound vac placement. \nInformed consent was obtained and patient was taken to the \noperating on the night of admission and underwent a wound \nexploration, mesh overlay removal/replacement, and a wound vac \nplacement under general anesthesia. He tolerated it well and was \nextubated immediately post surgery. He had an uneventful \npostoperative course. His pain was well controlled, his diet was \nwell tolerated. His wound vac was low continuous suction at \n125mmHg. He was established with a home portable wound vac. His \nwound culture grew Staph aureas and his anbitiotic was changed \nto oral Bactrim according to his sensitivities. Patient was \ndischarged home with adequate teaching on HD3 with a wound vac. \nHe is to continue 2 weeks of oral antibiotics and follow up with \n___ as detailed ___ his discharge instructions.'}}
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{'final_diagnoses': ['Wound infection'], 'procedures': ['___: Incision and drainage of incisional wound (clinic)', '___: wound exploration, mesh overlay removal, vac placement \n(OR)'], 'visit_summary': 'Patient was directly admitted to the ___ surgery service from \n___ after bedside incision and drainage of the \nsurgical wound. Please refer to the above HPI for details of his \ninitial presentation. Upon admission, patient was afebrile with \nnormal vital signs. He was made NPO and was started on IV-Ancef \nfor empiric coverage. Although his wound was adequately drained \nat the bedside, given the presence of an overlay mesh just \nbeneath his infected seroma, he was recommended a formal washout \n___ the operating room with a possible wound vac placement. \nInformed consent was obtained and patient was taken to the \noperating on the night of admission and underwent a wound \nexploration, mesh overlay removal/replacement, and a wound vac \nplacement under general anesthesia. He tolerated it well and was \nextubated immediately post surgery. He had an uneventful \npostoperative course. His pain was well controlled, his diet was \nwell tolerated. His wound vac was low continuous suction at \n125mmHg. He was established with a home portable wound vac. His \nwound culture grew Staph aureas and his anbitiotic was changed \nto oral Bactrim according to his sensitivities. Patient was \ndischarged home with adequate teaching on HD3 with a wound vac. \nHe is to continue 2 weeks of oral antibiotics and follow up with \n___ as detailed ___ his discharge instructions.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain \nRX *acetaminophen [8 HOUR PAIN RELIEVER] 650 mg 1 tablet(s) by \nmouth q6hrs prn Disp #*30 Tablet Refills:*0', 'Levothyroxine Sodium 150 mcg PO DAILY', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth q4hrs prn Disp #*30 \nTablet Refills:*0', 'Pantoprazole 40 mg PO Q24H', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice a day Disp \n#*30 Tablet Refills:*0', 'Cephalexin 500 mg PO Q8H \nRX *cephalexin 500 mg 1 tablet(s) by mouth three times a day \nDisp #*42 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'F', 'symptoms': 'mental status change', 'medical_history': ['1. Seizure disorder with history of recurrent bouts of\nnonconvulsive status epilepticus. Had onset of seizure disorder\nwas at ___ years of age, described as complex partial seizures\nwith secondary generalization. She has had multiple admissions\nsince the ___ (when care was transferred from ___\nfacility to ___ in the setting of mental status changes with\nworsening of her seizures. These have been induced by urinary\ntract infection subtherapeutic levels of seizure medication and\nother infections.', '2. History of hysterectomy for endometrial cancer in ___. History of recurrent aspiration pneumonias', '4. Atrial fibrillation', '5. History of urinary retention with recurrent urinary tract\ninfections with Klebsiella, Proteus, E. Coli', '6. History of postictal psychosis', '7. History of critical illness polyneuropathy', '8. History of sepsis', '9. Hypothyroidism', '10. Depression', '11. Left knee surgery in ___', '12. Left wrist ORIF', '13. History of sacral decubiti', '14. Colonized with VRE', '15. C. diff colitis in ___ treated with prolonged vancomycin\ntaper', '16. History of MRSA/Staph bacteremia ___'], 'family_history': 'Father had depression and psychosis.', 'present_illness': '___ yo woman with a history of seizure disorder well known to the\nNeurology service from numerous admissions for recurrent\nnon-convulsive status epilepticus since ___ frequently in the\nsetting of infections, such as UTIs. She was last admitted to\nthe Epilepsy service from ___. She was monitored\non LTM EEG for 2 days, without evidence of seizures or\nnon-convulsive status epilepticus. She was afebrile, though\nurinaylsis here showed 45 WBCs, few bacteria, and mod leuks. \nShe\nwas started on a 5 day course of Nitrofurantoin on ___. \nPhenobarbital was in her target range (40-45) at 40.2 and the\ndose was not changed. Zonegran was increased from 200 mg daily\nto 300 mg daily. Throughout the stay she was "awake, oriented \nto\nthe hospital floor and the reason for her hospitalization,\npleasant and talkative with staff." She was discharged to\nfollow-up with her primary neurologist, Dr. ___, as an\noutpatient.\n\nThis morning, the patient was noted at her facility, ___, to have "mental status change." In particular, both eyes\nwere closed and she appeared to demonstrate a "slow verbal\nresponse." Both hands were "rigid." Vitals were documented as\ntemperature 99.4, pulse 84, blood pressure 110/72, and SaO2 94\nRA. She was sent to the ___ for further evaluation. Of note,\nher last phenobarbital level, drawn on ___ was 42.3, in \nher\ntarget window. On ___, while inpatient her zonisamide and\nlamotrigine levels were low, at 4.5 and 1.4, respectively.\nOxcarbazepine metabolite level was normal at 28.5.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H: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': '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methocarbamol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', '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': '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': 'PO/NG', 'frequency': 'Q3H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': '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': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY: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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '40.3', 'valuenum': 40.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '34.3', 'valuenum': 34.3, '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': '247', 'valuenum': 247.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.64', 'valuenum': 4.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', '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': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '217', 'valuenum': 217.0, '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': '3.92', 'valuenum': 3.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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': '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': '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': 0.4, '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 = 59 if non African-American (mL/min/1.73 m2). Estimated GFR = 72 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': 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': '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': '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}], 'exams': "Vitals: T 97.9 F BP 136/77 P 76 RR 16 SaO2 99 RA\nGeneral: appears pale and sleepy\nHEENT: NC/AT, dry mucous membranes\nNeck: actively resists efforts at passive neck range of motion\nLungs: decreased effort, but clear to auscultation \nCV: regular rate and rhythm, no MMRG \nAbdomen: soft, non-tender, mildly distended, bowel sounds\npresent\nExt: cool, dry, no edema\n\nNeurologic Examination:\nUpon walking into the room, I encounter two visitors speaking\nwith the patient, who seems to occasionally reply with a brief\nappropriate sentence. Speech is slowed but non-dysarthric. \nHowever, upon their departure, the patient keeps her eyes closed\nand does not respond to questioning. She initially appeared to\ntrack her visitors across the room, and pupils looked grossly\nsymmetric, though she forcefully closed her eyelids precluding\nformal examination of the eyes once the visitors leave. Face\nappeared normal and symmetric. Observed possible occasional\ntwitches of the eyelids, and resting tremor of left arm. No\ngeneralized convulsive activity. Normal bulk and tone\nthroughout, her hands do not seem rigid. Moves all four\nextremities symmetrically and purposefully, and withdraws all\nfour extremities to noxious. Formal strength testing could not\nbe performed. Reflexes generally 2's throughout with downgoing\ntoes. Coordination and gait could not be assessed due to the\nlevel of obtundation. ", 'diagnoses': [{'icd_code': '72252', 'desc': 'Degeneration of lumbar or lumbosacral intervertebral disc'}, {'icd_code': '7213', 'desc': 'Lumbosacral spondylosis without myelopathy'}, {'icd_code': 'V1042', 'desc': 'Personal history of malignant neoplasm of other parts of uterus'}, {'icd_code': 'V1041', 'desc': 'Personal history of malignant neoplasm of cervix uteri'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}], 'summary': '___ 02:01PM URINE bnzodzpn-NEG barbitrt-POS opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 12:20PM URINE COLOR-Yellow APPEAR-Hazy SP ___\n___ 12:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.0 \nLEUK-SM\n___ 12:20PM URINE ___ BACTERIA-MANY \nYEAST-NONE ___ 10:30AM GLUCOSE-103 UREA N-20 CREAT-0.7 SODIUM-143 \nPOTASSIUM-4.2 CHLORIDE-107 TOTAL CO2-24 ANION GAP-16\n___ 10:30AM estGFR-Using this\n___ 10:30AM ALT(SGPT)-18 AST(SGOT)-23 LD(LDH)-394* ALK \nPHOS-173* AMYLASE-60 TOT BILI-0.5\n___ 10:30AM LIPASE-26\n___ 10:30AM ALBUMIN-4.7 CALCIUM-9.7 PHOSPHATE-3.7 \nMAGNESIUM-2.2\n___ 10:30AM TSH-11*\n___ 10:30AM PHENOBARB-33.3\n___ 10:30AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-POS tricyclic-NEG\n___ 10:30AM WBC-10.7 RBC-4.21# HGB-13.7# HCT-40.9 MCV-97 \nMCH-32.5* MCHC-33.5 RDW-13.8\n___ 10:30AM NEUTS-81.7* LYMPHS-14.6* MONOS-3.0 EOS-0.3 \nBASOS-0.3\n___ 10:30AM PLT COUNT-294\nNeurology: Head CT limited due to motion artifact but negative. \n On admission started on standing ativan. Placed on LTM ___, \nnoted to be in non-convulsive status epilepticus. Received \nativan 2mg then again 1 mg, then EEG improved. Persistent \nfrequent spikes but no longer in non-convulsive status \nepilepticus. Mental status improved, less perseverative and \noriented to person and place still not month/year. \nPhenobarbital levels low, received extra 90mg each ___, and \n___. Level 31 on ___, slowly increasing. Plan to continue \nphenobarbital 75mg po bid. continue to follow weekly levels, \nadjust dose and check levels as indicated in instructions. Slow \nweaned off standing ativan, on ___ decreased to 0.5mg bid. Plan \nfor one dose of 0.5mg ___ then off.\n\nID: Urine culture positive for klebsiella sensitive to ___ \ngeneration cephalosporins. Treated with cefpodoxime x 10 days. \nC diff negative. CXR negative. Question of mild L maxillary \nsinusitis on CT but clinically does not seem to be the source of \ninfection. \n\nFEN/GI: Speech swallow team evaluated, ok for ground solids and \nnectar thick liquids. At baseline takes a regular diet. Should \ncontinue ground solids and nectar thick liquids, with crushed \nmeds for now, can be re-evaluated at facility. \n\nCV/Resp: Stable throughout without desaturations. \n\nEndo: TSH 11, increased synthroid to ___ Qday. Will \nneed repeat TSH in ___ weeks.'}}
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{'final_diagnoses': ['Urinary tract infection', 'Seizures'], 'procedures': ['none'], 'visit_summary': 'Neurology: Head CT limited due to motion artifact but negative. \n On admission started on standing ativan. Placed on LTM ___, \nnoted to be in non-convulsive status epilepticus. Received \nativan 2mg then again 1 mg, then EEG improved. Persistent \nfrequent spikes but no longer in non-convulsive status \nepilepticus. Mental status improved, less perseverative and \noriented to person and place still not month/year. \nPhenobarbital levels low, received extra 90mg each ___, and \n___. Level 31 on ___, slowly increasing. Plan to continue \nphenobarbital 75mg po bid. continue to follow weekly levels, \nadjust dose and check levels as indicated in instructions. Slow \nweaned off standing ativan, on ___ decreased to 0.5mg bid. Plan \nfor one dose of 0.5mg ___ then off.\n\nID: Urine culture positive for klebsiella sensitive to ___ \ngeneration cephalosporins. Treated with cefpodoxime x 10 days. \nC diff negative. CXR negative. Question of mild L maxillary \nsinusitis on CT but clinically does not seem to be the source of \ninfection. \n\nFEN/GI: Speech swallow team evaluated, ok for ground solids and \nnectar thick liquids. At baseline takes a regular diet. Should \ncontinue ground solids and nectar thick liquids, with crushed \nmeds for now, can be re-evaluated at facility. \n\nCV/Resp: Stable throughout without desaturations. \n\nEndo: TSH 11, increased synthroid to ___ Qday. Will \nneed repeat TSH in ___ weeks.', 'medications_prescribed': ['1. Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours) as needed for pain or fever. ', '2. Lamotrigine 100 mg Tablet Sig: Two (2) Tablet PO BID (2 times \na day). ', '3. Oxcarbazepine 600 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day). ', '4. Ascorbic Acid ___ mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '5. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '6. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day). ', '7. Docusate Sodium 50 mg/5 mL Liquid Sig: One Hundred (100) mg \nPO BID (2 times a day). ', '8. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '9. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '10. Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '11. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday). ', '12. Zonisamide 50 mg Capsule Sig: Three Hundred Fifty (350) mg \nPO DAILY (Daily). ', '13. Levothyroxine 112 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '14. Phenobarbital 15 mg Tablet Sig: ___ (75) mg PO BID \n(2 times a day). ', '15. Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO twice a day \nfor 1 days: One dose 0.5mg ___ ___ then 0.5mg po x1 on ___ then \noff. . ', '16. Cefpodoxime 100 mg Tablet Sig: One (1) Tablet PO twice a day \nfor 7 days.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'Dyspnea on exertion', 'medical_history': ['Hypertension.', 'Hypothyroidism.', 'BPH', 'Osteoarthritis, esp left knee', 'glaucoma right eye', 'Iron deficiency anemia'], 'family_history': 'Noncontributory, does not recall any significant family history.', 'present_illness': "___ year old gentleman with history of hypothyroidism, \nhypertension, osteoarthritis, who presented with dyspnea on \nexertion since ___. He noted the dyspnea has progressed \nso much that he was unable to walk up a flight of stairs without \nresting. He has also experienced orthopnea and PND. Throughout \nthese several weeks, has denied any chest pain, chest pressure, \nor chest palpitations. \n\nIn the ED, initial vitals were: 97.8, 110, 122/88, 18, 98% on \nRA. \nLabs notable for anemia with H/H of 10.9/34.0. Normal LFT's, \nproBNP 6213, chemistry panel was unremarkable. Troponin 0.10 but \nCK-MB 4. \nCXR notable for pulmonary edema and small bilateral effusions, \nwith bibasilar opacities that likely reflect atelectasis, \nalthough infection could not be ruled out. \nPatient received 324 mg aspirin in setting of elevated troponin, \nand 40 mg IV furosemide. \n\nOn the floor, he noted that he urinated a large volume since \nreceiving the furosemide. He felt his shortness of breath was \nimproved. Currently denied any chest pain, chest pressure, chest \npalpitations. Able to lay flat at a slightly inclined angle.", 'medications': [{'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 (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Protamine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Lansoprazole Oral Disintegrating Tab', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Torsemide', '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': 'PO/NG', '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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', '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': 'Q6H: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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID: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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'DAILY', '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'ONCE', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, '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': '7', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, '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': '22', 'valuenum': 22.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '___', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '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': '1.5', 'valuenum': 1.5, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, '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': "Using this patient's age, gender, and serum creatinine value of 1.6,. Estimated GFR = 30 if non African-American (mL/min/1.73 m2). Estimated GFR = 36 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': 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': '___', 'valuenum': 5187.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '4.1', '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': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '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': '31.2', 'valuenum': 31.2, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '223', 'valuenum': 223.0, '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': '3.79', 'valuenum': 3.79, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'ROUTINE', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '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': '1.4', 'valuenum': 1.4, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, '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': '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': '35', 'valuenum': 35.0, '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': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 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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': '4.3', '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': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '___', 'valuenum': 19.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '72.2', 'valuenum': 72.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.5', 'valuenum': 25.5, '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': '31.9', 'valuenum': 31.9, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '248', 'valuenum': 248.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '2.68', 'valuenum': 2.68, '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': '26.8', 'valuenum': 26.8, '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': '22.1', 'valuenum': 22.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '32.8', 'valuenum': 32.8, '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': '235', 'valuenum': 235.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.33', 'valuenum': 2.33, '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': '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.2', '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, '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': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89.8', 'valuenum': 89.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.8', 'valuenum': 24.8, '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': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, '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': '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': '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': '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 = 42 if non African-American (mL/min/1.73 m2). Estimated GFR = 51 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': 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': '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': '2.6', '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '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': '30.3', 'valuenum': 30.3, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '294', 'valuenum': 294.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '2.82', 'valuenum': 2.82, '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': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', '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': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '372', 'valuenum': 372.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', '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': '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': '4.4', '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': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n================================\nVital Signs: 97.7, 129/78, 67, 16, 98% on RA. Admission Weight: \n98.2 kg. \nGeneral: Alert, oriented, laying in bed comfortably in NAD. \nHEENT: Sclerae anicteric, MMM, oropharynx clear, neck supple, \nJVD elevated. \nCV: RRR, S1 and S2 present, no murmurs. \nLungs: bibasilar crackles, otherwise no wheezes. \nAbdomen: soft, non-tender, non-distended, no rebound or \nguarding. \nExt: Warm, well perfused, 1+ pitting edema to the knees. \nNeuro: grossly normal neuro exam, moving arms and legs without \ndifficulty. \n\nDISCHARGE PHYSICAL EXAM\n=================================\nVitals: 98.1, 92-114/56-68, 70s-80s, ___, 97-99% RA. Discharge \nweight: 87.7 kg. \nGeneral: Alert, oriented, laying in bed comfortably in NAD. \nHEENT: Sclerae anicteric, MMM, oropharynx clear, neck supple, no \nelevation in JVP \nCV: RRR, S1 and S2 present, no murmurs. \nLungs: Faint crackles in bilateral lung bases, no wheezing or \nrhonchi. \nAbdomen: soft, non-tender, non-distended, no rebound or \nguarding. \nExt: Warm, well perfused, no pitting edema of lower extremities. \n\nNeuro: grossly normal neuro exam, moving arms and legs without \ndifficulty.', 'diagnoses': [{'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '4295', 'desc': 'Rupture of chordae tendineae'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': 'V462'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '95909', 'desc': 'Injury of face and neck'}, {'icd_code': 'V707'}, {'icd_code': '99812', 'desc': 'Hematoma complicating a procedure'}, {'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'}, {'icd_code': 'E8781', 'desc': 'Surgical operation with implant of artificial internal device 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': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': 'V851'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '7823', 'desc': 'Edema'}, {'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'}], 'summary': 'ADMISSION LABS\n=============================\n___ 08:50PM BLOOD WBC-7.5 RBC-5.00 Hgb-10.9* Hct-34.0* \nMCV-68* MCH-21.8* MCHC-32.1 RDW-16.4* RDWSD-38.6 Plt ___\n___ 08:50PM BLOOD Neuts-69.9 Lymphs-17.0* Monos-9.1 Eos-2.7 \nBaso-0.8 Im ___ AbsNeut-5.23 AbsLymp-1.27 AbsMono-0.68 \nAbsEos-0.20 AbsBaso-0.06\n___ 08:50PM BLOOD Plt ___\n___ 08:50PM BLOOD Glucose-103* UreaN-19 Creat-0.9 Na-142 \nK-3.8 Cl-100 HCO3-29 AnGap-17\n___ 08:50PM BLOOD ALT-15 AST-25 CK(CPK)-84 AlkPhos-73 \nTotBili-1.1\n___ 08:50PM BLOOD CK-MB-4 proBNP-6213*\n___ 08:50PM BLOOD Calcium-9.1 Phos-3.4 Mg-1.8 Iron-45\n___ 08:50PM BLOOD calTIBC-303 Ferritn-300 TRF-233\n___ 04:13AM BLOOD TSH-3.1\n\nPERTINENT LABS\n=============================\n___ 08:50PM BLOOD cTropnT-0.10*\n___ 04:13AM BLOOD CK-MB-4 cTropnT-0.13*\n___ 11:25AM BLOOD CK-MB-4 cTropnT-0.11*\n___ 10:04AM BLOOD cTropnT-0.12*\n___ 03:11PM BLOOD CK-MB-3 cTropnT-0.14*\n\nDISCHARGE LABS\n==============================\n___ 06:35AM BLOOD Calcium-8.7 Phos-3.3 Mg-2.2\n___ 06:35AM BLOOD Glucose-96 UreaN-52* Creat-1.4* Na-138 \nK-5.0 Cl-97 HCO3-25 AnGap-21*\n___ 06:35AM BLOOD WBC-6.6 RBC-5.65 Hgb-12.4* Hct-38.4* \nMCV-68* MCH-21.9* MCHC-32.3 RDW-16.0* RDWSD-36.8 Plt ___\n\nIMAGING\n==============================\nRight lower extremity US ___ IMPRESSION: \nLimited exam as the right calf veins are not well visualized \nhowever, no evidence of deep venous thrombosis in the right \nlower extremity veins.\n\nCXR ___ IMPRESSION:\nPulmonary edema and small bilateral effusions. Bibasilar \nopacities likely reflect atelectasis however infection should be \nconsidered the appropriate setting.\n\nTransthoracic ECHO ___: The left atrium and right atrium are \nnormal in cavity size. The estimated right atrial pressure is \n___ mmHg. Left ventricular wall thicknesses are normal. The \nleft ventricular cavity is moderately dilated. There is severe \nregional left ventricular systolic dysfunction c/w multivessel \nCAD. Tissue Doppler imaging suggests an increased left \nventricular filling pressure (PCWP>18mmHg). Doppler parameters \nare most consistent with Grade III/IV (severe) left ventricular \ndiastolic dysfunction. Right ventricular chamber size and free \nwall motion are normal. The aortic valve leaflets are moderately \nthickened. The mitral valve appears structurally normal with \ntrivial mitral regurgitation. There is no mitral valve prolapse. \nMild to moderate (___) mitral regurgitation is seen. The \npulmonary artery systolic pressure could not be determined. \nThere is no pericardial effusion. \nIMPRESSION: \n1) Severe regional left ventricular systolic dysfunction c/w \nmultivessel CAD (predominant mid LAD infarct).\n2) Restrictive LV diastolic filling with measured elevated \nLVEDP. \n\nTEE (___):\nMild spontaneous echo contrast is seen in the body of the left \natrium. No mass/thrombus is seen in the left atrium or left \natrial appendage. No spontaneous echo contrast is seen in the \nleft atrial appendage. The left atrial appendage emptying \nvelocity is depressed (<0.2m/s). No spontaneous echo contrast or \nthrombus is seen in the body of the right atrium or the right \natrial appendage. No atrial septal defect is seen by 2D or color \nDoppler. Overall left ventricular systolic function is severely \ndepressed (LVEF ~20 %). There are complex (>4mm) atheroma in the \naortic arch and descending thoracic aorta. The aortic valve \nleaflets are moderately thickened. No masses or vegetations are \nseen on the aortic valve. No aortic regurgitation is seen. The \nmitral valve leaflets are structurally normal. No mass or \nvegetation is seen on the mitral valve. Mild (1+) mitral \nregurgitation is seen. There is no pericardial effusion. \n\nIMPRESSION: No left atrial or left atrial appendage thrombus. \nMild SEC in the LA without thrombus. Low left atrial appendage \nvelocity.\n\nPROCEDURES\n==============================\nCath report (___): \nCoronary Anatomy\nDominance: Right\n* Left Main Coronary Artery\nThe LMCA is without significant disease.\n\n* Left Anterior Descending\nThere is a 100% stenosis in the Proximal LAD with bridging \ncollaterals revealing <20mm length of occlusion. The lesion has \na TIMI flow of 0 and has mild calcification noted. An \nintervention was performed on the Proximal LAD with a final \nstenosis of 0%. There were no lesion complications. The ___ \ndiagonal is with diffuse proximal disease to 90% in a long 2.0mm \nvessel.\n\n* Circumflex\nThe Circumflex is with mild luminal irregularities.\n\n* Right Coronary Artery\nThe RCA is with ___ diffuse mid.\nThere are right-to-left collaterals to the LAD beyond the \nocclusion.\n\nDCCV (___):\nIMPRESSION:\nSuccessful electrical cardioversion of atrial fibrillation to\nsinus rhythm.\n___ year old gentleman with history of hypothyroidism, \nhypertension, osteoarthritis, presenting with progressive \ndyspnea on exertion, found to have new onset CHF with EF of 20% \nlikely from CAD. Underwent successful LAD stenting. \n\n# Acute heart failure with reduced ejection fraction (20%)/CAD/ \nIschemic Cardiomyopathy : Patient presented with evidence of \nheart failure with BNP 6,213, orthopnea, PND, pulm \nedema/bilateral lower extremity edema. No history of heart \nfailure in the past with last echo in ___ showing EF >55%. New \necho showing LVEF 20% with regional wall motional abnormalities \nin the LAD territory. He underwent LHC which revealed \nnon-obstructive disease in the RCA and LCx and a 100% sub-total \nocclusion in the proximal LAD with bridging collaterals. This \nlesion was crossed fairly easily with a wire and a 2.75x33mm \ndrug-eluting stent was placed with an excellent angiographic \nresult. He was started on Plavix 75mg daily in addition to \naspirin 81mg daily. The patient initially diuresed with IV Lasix \nand also started on lisinopril and spironolactone. He became \nhypovolemic and developed ___, therefore diuretics, ACEi, MRA, \nand beta-blocker were all held. Metoprolol succinate was resumed \nand uptitrated to 25mg daily but the lisinopril and \nspironolactone were held to allow ongoing renal recovery. \nDiuretics continued to be held on discharge as he remained \neuvolemic despite >48 hours without any diuretics and was still \nrecovering from ___. It is possible that he may not need \ndiuretics at all now that he has been revascularized. At his \nfollow up appointment, please consider restarting his lisinopril \nand possibly spironolactone. His discharge weight was 87.7 kg \nand discharge creatinine 1.4.\n\n# Coronary Artery Disease: Please see details of the LHC above. \nAfter DES to the LAD, he was initially started on dual \nanti-platelet therapy with aspirin and clopidogrel. After going \ninto afib, he was started on rivaroxaban and clopidogrel was \ncontinued and aspirin stopped, based on the results of the \nrecent PIONEER trial. He was started on high-dose statin with \natorvastatin 80mg daily. \n\n#New onset Atrial Fibrillation: \nOn ___, the patient went into atrial fibrillation with \nventricular rates in ___ at rest. The ventricluar rate \nincreased to 120s-130s with ambulation. He was started on \nrivaroxaban 20mg daily for anticoagulation. Patient underwent \nsuccessful TEE/DCCV on ___ with restoration sinus rhythm. \nPatient will be discharged home on rivaroxaban 20mg QPM and \nmetoprolol 25mg XL daily. \n\n# Acute kidney injury: Baseline cr 1.0. Developed ___ (Cr to \n2.2) toward end of hospitalization secondary to prerenal \nazotemia and overdiuresis. Treated with small bolus of IVF and \ndiuretics held as above. Discharge creatinine was 1.4.\n\n# Hypertension: Patient was normotensive during admission. \nIndapamide was stopped; spironolactone and lisinopril were \nstarted in the setting of heart failure, then discontinued after \nepisode of hypotension on ___. \n\n# Hypothyroidism: TSH within normal limits this admission. \nLevothyroxine 125 mcg PO daily continued.\n \n# BPH: Doxazosin 4 mg PO QHS was discontinued and patient was \nstarted on tamsulosin 0.4 mg QHS given low/normotensive BPs and \nthe need for ACEI.\n \n# Microcytic anemia: At baseline. Chronic. ___ be a thalassemia \nas Iron studies normal.'}}
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{'final_diagnoses': ['Heart failure with reduced ejection fraction (EF 20%)', 'Coronary artery disease s/p PCI', 'Acute kidney injury', 'Hypernatremia', 'Atrial Fibrillation', 'HTN', 'Hypothyroidism'], 'procedures': ['Left heart catheterization and PCI on ___', 'Cardioversion on ___'], 'visit_summary': '___ year old gentleman with history of hypothyroidism, \nhypertension, osteoarthritis, presenting with progressive \ndyspnea on exertion, found to have new onset CHF with EF of 20% \nlikely from CAD. Underwent successful LAD stenting. \n\n# Acute heart failure with reduced ejection fraction (20%)/CAD/ \nIschemic Cardiomyopathy : Patient presented with evidence of \nheart failure with BNP 6,213, orthopnea, PND, pulm \nedema/bilateral lower extremity edema. No history of heart \nfailure in the past with last echo in ___ showing EF >55%. New \necho showing LVEF 20% with regional wall motional abnormalities \nin the LAD territory. He underwent LHC which revealed \nnon-obstructive disease in the RCA and LCx and a 100% sub-total \nocclusion in the proximal LAD with bridging collaterals. This \nlesion was crossed fairly easily with a wire and a 2.75x33mm \ndrug-eluting stent was placed with an excellent angiographic \nresult. He was started on Plavix 75mg daily in addition to \naspirin 81mg daily. The patient initially diuresed with IV Lasix \nand also started on lisinopril and spironolactone. He became \nhypovolemic and developed ___, therefore diuretics, ACEi, MRA, \nand beta-blocker were all held. Metoprolol succinate was resumed \nand uptitrated to 25mg daily but the lisinopril and \nspironolactone were held to allow ongoing renal recovery. \nDiuretics continued to be held on discharge as he remained \neuvolemic despite >48 hours without any diuretics and was still \nrecovering from ___. It is possible that he may not need \ndiuretics at all now that he has been revascularized. At his \nfollow up appointment, please consider restarting his lisinopril \nand possibly spironolactone. His discharge weight was 87.7 kg \nand discharge creatinine 1.4.\n\n# Coronary Artery Disease: Please see details of the LHC above. \nAfter DES to the LAD, he was initially started on dual \nanti-platelet therapy with aspirin and clopidogrel. After going \ninto afib, he was started on rivaroxaban and clopidogrel was \ncontinued and aspirin stopped, based on the results of the \nrecent PIONEER trial. He was started on high-dose statin with \natorvastatin 80mg daily. \n\n#New onset Atrial Fibrillation: \nOn ___, the patient went into atrial fibrillation with \nventricular rates in ___ at rest. The ventricluar rate \nincreased to 120s-130s with ambulation. He was started on \nrivaroxaban 20mg daily for anticoagulation. Patient underwent \nsuccessful TEE/DCCV on ___ with restoration sinus rhythm. \nPatient will be discharged home on rivaroxaban 20mg QPM and \nmetoprolol 25mg XL daily. \n\n# Acute kidney injury: Baseline cr 1.0. Developed ___ (Cr to \n2.2) toward end of hospitalization secondary to prerenal \nazotemia and overdiuresis. Treated with small bolus of IVF and \ndiuretics held as above. Discharge creatinine was 1.4.\n\n# Hypertension: Patient was normotensive during admission. \nIndapamide was stopped; spironolactone and lisinopril were \nstarted in the setting of heart failure, then discontinued after \nepisode of hypotension on ___. \n\n# Hypothyroidism: TSH within normal limits this admission. \nLevothyroxine 125 mcg PO daily continued.\n \n# BPH: Doxazosin 4 mg PO QHS was discontinued and patient was \nstarted on tamsulosin 0.4 mg QHS given low/normotensive BPs and \nthe need for ACEI.\n \n# Microcytic anemia: At baseline. Chronic. ___ be a thalassemia \nas Iron studies normal.', 'medications_prescribed': ['Atorvastatin 80 mg PO QPM \nRX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0', 'Rivaroxaban 20 mg PO DINNER \nRX *rivaroxaban [Xarelto] 20 mg 1 tablet(s) by mouth with dinner \nDisp #*30 Tablet Refills:*0', 'Tamsulosin 0.4 mg PO QHS \nRX *tamsulosin 0.4 mg 1 capsule(s) by mouth at night Disp #*30 \nCapsule Refills:*0', 'Acetaminophen 650 mg PO BID', 'Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID', 'Calcium 600 + D(3) (calcium carbonate-vitamin D3) unknown \noral BID', 'Calcium 600 + D(3) (calcium carbonate-vitamin D3) unknown \noral BID', 'cranberry unknown oral QAM', 'Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID', 'Ferrous Sulfate 325 mg PO DAILY', 'Levothyroxine Sodium 125 mcg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 63, 'gender': 'M', 'symptoms': 'Dypsnea, cough', 'medical_history': ['-HIV x ___ years (CD4 572 31% Vl UD ___. History of PCP.', '-Hepatitis B: positive core antibody, cleared infection', '-Hepatitis C: last HCV VL 6 million on ___', '-COPD - last PFTs in ___: FEV1/FVC 77% of predicted, FEV1 = 71% \nof predicted', '-s/p MVA with residual neck/back pain, numbness in fingers', '-Spinal Stenosis - chronic back pain and peripheral neuropathy', '-Depression', '-s/p celiac trunk patch angioplasty and division of median\narcuate ligament syndrome in ___', '-H/o nephrolithiasis', '-Bilateral Hydroceles and Uroceles', '-Gastritis (EGD in ___', '-History of heroin and cocaine abuse'], 'family_history': 'Father: brain aneurysm\nMother: lung cancer\nBrother: ___\nBrother: died of drug overdose', 'present_illness': 'The patient is a ___ y/o gentleman with a PMH of HIV (CD4 572 31% \nVl UD on ___, Hep C with cirrhosis, COPD, chronic pain on \nmethadone/narcotics, h/o celiac artery stenosis s/p median \narcuate ligament release and angioplasty ___ recently admitted \n___ with CAP and COPD exacerbation now presenting with SOB \nand wheezing for "a few" days accompanied by persistant wet \ncough but without sputum production or fever. Has been using \nhome inhaler and albuterol nebs with no relief. Was hospitalized \nfor similar symptoms in ___, and ultimately CXR revealed \nright-sided penumonia for which the patient took a course of \nLevaquin. No recent sick contacts. \n. \nIn the ED, initial vitals were T 98.0 HR 63 BP165/122 RR24 \n92-96%RA. He had diffuse wheezes on exam with unremarkable CXR. \nHe was given albuterol and ipratropium nebs x 3, \nmethyprednisolone 125mg IV, and azithromycin 500mg with \nimprovement in minimal improvement in symptoms. He also received \nphenergan for nausea and toradol. Blood cx sent. VS prior to \ntransfer: 65 120/64 14 99%2.5L. \n. \n(+) Per HPI \n(-) Denies fever or chills. Denies headache, sinus tenderness, \nrhinorrhea or congestion. Some right-sided chest pain with \ninspiration. No change in pain with position. Nausea began this \nAM, but no vomiting, diarrhea, or abdominal pain.', 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Doxazosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPREDNISolone Sodium Succ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H: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': '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Phenazopyridine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', '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': 'ONCE:PRN', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': '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': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', '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': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Doxazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Adenosine', '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': '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': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q5MIN:PRN', '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': '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q30MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', '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': '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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', 'route': 'IV', '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': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': '1X', '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': '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': '1X', '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': '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '18', 'valuenum': 18.0, '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': '292', 'valuenum': 292.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, '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': '294', 'valuenum': 294.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '13', 'valuenum': 13.0, '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': '11.4', 'valuenum': 11.4, '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': '17', 'valuenum': 17.0, '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': '8.8', 'valuenum': 8.8, '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': 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': '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': '2.0', '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': '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, 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'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, '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': '32.7', 'valuenum': 32.7, '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': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, 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'ref_range_upper': None, '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '310', 'valuenum': 310.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '129', 'valuenum': 129.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.49', 'valuenum': 7.49, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '142', 'valuenum': 142.0, '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': 3.3, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40.7', 'valuenum': 40.7, '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': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '181', 'valuenum': 181.0, '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': '4.54', 'valuenum': 4.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.6', 'valuenum': 42.6, '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': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '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': 0.5, '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': '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': '306', 'valuenum': 306.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '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': '146', 'valuenum': 146.0, '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': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW CALCULATION AND 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': '9.2', 'valuenum': 9.2, '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': 87.0, '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': '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': 169.0, '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': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '306', 'valuenum': 306.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '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': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.03, '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': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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}, {'value': '1.48', 'valuenum': 1.48, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, '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': '13.2', 'valuenum': 13.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '9.5', 'valuenum': 9.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '73.3', 'valuenum': 73.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '189', 'valuenum': 189.0, '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': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.13', 'valuenum': 0.13, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.93', 'valuenum': 0.93, 'valueuom': 'K/uL', 'ref_range_lower': 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'___'}, {'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': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '29.4', 'valuenum': 29.4, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '166', 'valuenum': 166.0, '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': '4.39', 'valuenum': 4.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, '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': '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': 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': '19', 'valuenum': 19.0, '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': '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': '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '7', 'valuenum': 7.0, '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': '314', 'valuenum': 314.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '13', 'valuenum': 13.0, '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': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, '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': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.42', 'valuenum': 4.42, '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': '43.9', 'valuenum': 43.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New calculation and 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': '9.2', 'valuenum': 9.2, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 154.0, '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': '10', 'valuenum': 10.0, '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': '2.4', 'valuenum': 2.4, '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': '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '305', 'valuenum': 305.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '9.2', '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': '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 (eGFR) is likely between 61 and 74 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': 152.0, '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': '2.4', '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': '4.5', 'valuenum': 4.5, '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '41.7', 'valuenum': 41.7, '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': '29.3', 'valuenum': 29.3, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.57', 'valuenum': 4.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '6.0', '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': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '>182*.'}, {'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': '#/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': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'DkAmb*.'}, {'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': '14', 'valuenum': 14.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '4', 'valuenum': 4.0, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, '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': '7.50', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, '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': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<20.'}, {'value': '84', 'valuenum': 84.0, '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': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '822', 'valuenum': 822.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 53.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Desirable pH 2.0-5.0: Interpret results accordingly.'}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 239.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 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'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.6, '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': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '9.0', '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': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 180.0, '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': '2.6', 'valuenum': 2.6, '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.63', 'valuenum': 0.63, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '16', 'valuenum': 16.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '179', 'valuenum': 179.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.51', 'valuenum': 4.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, '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': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 173.0, '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': '1', 'valuenum': 1.0, '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': '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': '4.7', 'valuenum': 4.7, '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': '39', 'valuenum': 39.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, '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': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '177', 'valuenum': 177.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '42.4', 'valuenum': 42.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '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': 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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'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': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': 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': 'RARE*.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '38.2', 'valuenum': 38.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, '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': '33.2', 'valuenum': 33.2, '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': '155', 'valuenum': 155.0, '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': '4.16', 'valuenum': 4.16, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, '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': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '8.4', 'valuenum': 8.4, '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': 164.0, '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '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': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '10', 'valuenum': 10.0, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 23.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '71', 'valuenum': 71.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and Reference range as of ___.'}, {'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': '20', 'valuenum': 20.0, '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': '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': '0.9', '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/1.73m2, . 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': 172.0, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, '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': '139', 'valuenum': 139.0, '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': '37.1', 'valuenum': 37.1, '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': '30.0', 'valuenum': 30.0, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '160', 'valuenum': 160.0, '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': '4.06', 'valuenum': 4.06, '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': '40.8', 'valuenum': 40.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': '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': 0.0, 'ref_range_upper': 0.0, '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': 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': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.31', 'valuenum': 1.31, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '1+*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': 'NORMAL.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'OCCASIONAL*.'}, {'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': '12.3', 'valuenum': 12.3, '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': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.12', 'valuenum': 0.12, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.16', 'valuenum': 9.16, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '8.6', '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': '0.9', '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': 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': '16', 'valuenum': 16.0, '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': '4.5', 'valuenum': 4.5, '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': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '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': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New calculation and Reference range as of ___.'}, {'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': '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': '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': '___', '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': '48', 'valuenum': 48.0, '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', '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': '22', 'valuenum': 22.0, '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': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '39.9', 'valuenum': 39.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': 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': '6.5', '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': '1.014', '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': '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': '6', 'valuenum': 6.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 117.0, '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': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '22', 'valuenum': 22.0, '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': '36.9', 'valuenum': 36.9, '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': '29.5', 'valuenum': 29.5, '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': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.14', 'valuenum': 4.14, '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': '39.8', 'valuenum': 39.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '9.2', 'valuenum': 9.2, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '40', 'valuenum': 40.0, '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': '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': '137', 'valuenum': 137.0, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '231', 'valuenum': 231.0, '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': '4.27', 'valuenum': 4.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '41.3', 'valuenum': 41.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New calculation and 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': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 137.0, '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', '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': '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '23', 'valuenum': 23.0, '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': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', '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': '33.6', 'valuenum': 33.6, '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': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.25', 'valuenum': 4.25, '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': '41.3', 'valuenum': 41.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.0', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, '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': '90', 'valuenum': 90.0, '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': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.23', 'valuenum': 4.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, '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': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 24.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 159.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '211', 'valuenum': 211.0, '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': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '42.4', 'valuenum': 42.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New calculation and 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': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, '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 0.8,. estimated GFR (eGFR) is likely >75 mL/min/1.73m2, . 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': 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': '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': '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': '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': '18', 'valuenum': 18.0, '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': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, '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': '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': '91', 'valuenum': 91.0, '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': 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': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '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': 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 (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': 116.0, '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': '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': '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': '4.4', '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': '18', 'valuenum': 18.0, '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': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': 'New calculation and 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': '9.2', 'valuenum': 9.2, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.9', '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': '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': '16', 'valuenum': 16.0, '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': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', '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': '33.4', 'valuenum': 33.4, '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': '186', 'valuenum': 186.0, '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': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T=96.3, BP=135/84, HR=72, RR=20, O2 sat= 98 on 2L \nGENERAL: In mild distress secondary to R-sided chest discomfort \nand cough. Alert, oriented. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. Conjunctiva were pink, no pallor \nor cyanosis of the oral mucosa. No xanthalesma. \nNECK: Supple \nCARDIAC: RR, normal S1, S2. II/VI systolic murmur heard best at \nright sternal boarder. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Mild \naccessory muscle use. Pronounced expiratory wheezes diffusely. \nABDOMEN: Hypoactive bowl sounds. Soft, NTND. \nEXTREMITIES: warm, no edema \nSKIN: No stasis dermatitis.', 'diagnoses': [{'icd_code': 'I611', 'desc': 'Nontraumatic intracerebral hemorrhage in hemisphere, cortical'}, {'icd_code': 'J9600', 'desc': 'Acute respiratory failure, unspecified whether with hypoxia or hypercapnia'}, {'icd_code': 'R402113', 'desc': 'Coma scale, eyes open, never, at hospital admission'}, {'icd_code': 'G936', 'desc': 'Cerebral edema'}, {'icd_code': 'G92', 'desc': 'Toxic encephalopathy'}, {'icd_code': 'G8194', 'desc': 'Hemiplegia, unspecified affecting left nondominant side'}, {'icd_code': 'E873', 'desc': 'Alkalosis'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'I471', 'desc': 'Supraventricular tachycardia'}, {'icd_code': 'R414', 'desc': 'Neurologic neglect syndrome'}, {'icd_code': 'R402213', 'desc': 'Coma scale, best verbal response, none, at hospital admission'}, {'icd_code': 'R29810', 'desc': 'Facial weakness'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'G932', 'desc': 'Benign intracranial hypertension'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'B965', 'desc': 'Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'B957', 'desc': 'Other staphylococcus as the cause of diseases classified elsewhere'}, {'icd_code': 'R402353', 'desc': 'Coma scale, best motor response, localizes pain, at hospital admission'}, {'icd_code': 'R739', 'desc': 'Hyperglycemia, unspecified'}, {'icd_code': 'R633', 'desc': 'Feeding difficulties'}, {'icd_code': 'H5010', 'desc': 'Unspecified exotropia'}, {'icd_code': 'R319', 'desc': 'Hematuria, unspecified'}, {'icd_code': 'R21', 'desc': 'Rash and other nonspecific skin eruption'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'T380X5A', 'desc': 'Adverse effect of glucocorticoids and synthetic analogues, initial encounter'}, {'icd_code': 'N401', 'desc': 'Benign prostatic hyperplasia with lower urinary tract symptoms'}, {'icd_code': 'R338', 'desc': 'Other retention of urine'}], 'summary': "Admission labs:\n___ 11:35AM BLOOD WBC-6.6 RBC-3.79* Hgb-14.4 Hct-43.9 \nMCV-116* MCH-38.0* MCHC-32.8 RDW-14.0 Plt ___\n___ 11:35AM BLOOD Glucose-83 UreaN-12 Creat-0.6 Na-138 \nK-4.2 Cl-104 HCO3-25 AnGap-13\n___ 11:41AM BLOOD Lactate-1.3\n.\nCXR ___: No acute cardiopulmonary process.\nCXR ___: As compared to the previous radiograph, there is no \nrelevant \nchange. Minimal right basal atelectasis. No pleural effusion. No \nevidence \nof pneumonia. Normal size of the cardiac silhouette. Normal \nhilar and \nmediastinal contours. No evidence of pneumothorax. .\n.\nCTA Chest ___: 1. No evidence of pulmonary embolism. \n2. Bibasal segmental and subsegmental mild areas of secretions \nwith \nsubsequent linear atelectasis that potentially may be \nsuperinfected. \nAdditional area of ground glass opacity in the apex of the right \nupper lobe that also might represent infectious process. \n3. Left adrenal hypodense lesion, consistent with benign \nfinding. \n.\nDischarge labs:\n___ 07:00AM BLOOD WBC-6.7 RBC-3.36* Hgb-12.9* Hct-39.2* \nMCV-117* MCH-38.4* MCHC-32.9 RDW-14.3 Plt ___\n___ 07:00AM BLOOD Glucose-87 UreaN-13 Creat-0.6 Na-139 \nK-3.9 Cl-103 HCO3-27 AnGap-13\n___ 07:00AM BLOOD Calcium-8.9 Phos-3.1 Mg-2\nM with COPD, HIV, and Hep C recently treated for CAP \npresents with ___ history of SOB and wheezing, minimal cough, \nbut no sputum production or fever. \n.\n#. SOB/Cough: Patient was begun on treatment for a COPD \nexacerbation. Albuterol nebs q 4 hrs ATC with q2 hours PRN. \nIpratroprium nebs q 6 hrs ATC. He got one dose of azithromycin \n500mg in the ED, subsequently he continued on 250mg daily for a \nplanned ___t that dose. He got a total of 2 doses of \n125mg IV methyprednisone. While lung exam was improving, \ndifffuse wheezes were still heard, so pt was started on po \nprednisone on HD 3. He got 2 days of 60mg po prednisone, and \nwill be discharged on 40mg daily for 3 days, follwed by 3 days \nof 20mg each, giving a total 10 day course of steroids. Patient \nwas begun on low-dose Ativan for the duration of his steroid \ncourse for anxiety ___ prednisone, which has happened in the \npast. He will be precribed an tiotropium inhaler to be used \ndaily in addition to his home Advair and albuterol at least \nuntil his symptoms resolve. Patient has been scheduled for PFTs \nand an appoitment in the pulmonary clinic in 1 week. The \nimportance of seeing a pulmonologist was emphasized to the \npatient. \nPt complained of right-sided CP with deep inspiration and \nrecently was treated for a right-sided pneumonia in ___. No \ninfiltrate noted on CXR in ED, and repeat xray on HD2 only \nshowed a small area of RLL atelectasis that has been \nintermittently noted on previous chest studies. Urine legionella \nantigen negative. While suspicion for PE was low given patient's \nfunctional status and lack of recent surgery, CTA was done to \nr/o PE as a cause of his R-sided chest pain. CTA showed no \nevidence of PE, nor any lung process which could be contributing \nto pt's pain. Pain improved at the time of discharge. \nHe was encouraged to continue to be smoke-free. He used a \nnicotine patch during admission and will be d/c with a \nprescription to continue this. \n. \n#. HIV: Continue home HAART regimen. Pt has follow-up scheduled \nwith Dr. ___ in ___. \n.\n#. Hx of substance abuse: Continue outpatient methodone dose. \n.\n#. Chronic back pain: Continue home oxycontin with oxycodone for \nbreakthrough. The patient's L-spine MRI with sedation that was \nscheduled for ___ was re-scheduled for ___. \n.\n#. Neuropathy: Contiune home gabapentin. \n.\n# Depression: Continue home citalopram. \n. \n# CODE: full code, confirmed with patient"}}
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{'final_diagnoses': ['chronic obstructive pulmonary disease \nexacerbation', 'Tobacco abuse', 'human immunodeficiency \nvirus', 'Chronic pain'], 'procedures': ['none'], 'visit_summary': "M with COPD, HIV, and Hep C recently treated for CAP \npresents with ___ history of SOB and wheezing, minimal cough, \nbut no sputum production or fever. \n.\n#. SOB/Cough: Patient was begun on treatment for a COPD \nexacerbation. Albuterol nebs q 4 hrs ATC with q2 hours PRN. \nIpratroprium nebs q 6 hrs ATC. He got one dose of azithromycin \n500mg in the ED, subsequently he continued on 250mg daily for a \nplanned ___t that dose. He got a total of 2 doses of \n125mg IV methyprednisone. While lung exam was improving, \ndifffuse wheezes were still heard, so pt was started on po \nprednisone on HD 3. He got 2 days of 60mg po prednisone, and \nwill be discharged on 40mg daily for 3 days, follwed by 3 days \nof 20mg each, giving a total 10 day course of steroids. Patient \nwas begun on low-dose Ativan for the duration of his steroid \ncourse for anxiety ___ prednisone, which has happened in the \npast. He will be precribed an tiotropium inhaler to be used \ndaily in addition to his home Advair and albuterol at least \nuntil his symptoms resolve. Patient has been scheduled for PFTs \nand an appoitment in the pulmonary clinic in 1 week. The \nimportance of seeing a pulmonologist was emphasized to the \npatient. \nPt complained of right-sided CP with deep inspiration and \nrecently was treated for a right-sided pneumonia in ___. No \ninfiltrate noted on CXR in ED, and repeat xray on HD2 only \nshowed a small area of RLL atelectasis that has been \nintermittently noted on previous chest studies. Urine legionella \nantigen negative. While suspicion for PE was low given patient's \nfunctional status and lack of recent surgery, CTA was done to \nr/o PE as a cause of his R-sided chest pain. CTA showed no \nevidence of PE, nor any lung process which could be contributing \nto pt's pain. Pain improved at the time of discharge. \nHe was encouraged to continue to be smoke-free. He used a \nnicotine patch during admission and will be d/c with a \nprescription to continue this. \n. \n#. HIV: Continue home HAART regimen. Pt has follow-up scheduled \nwith Dr. ___ in ___. \n.\n#. Hx of substance abuse: Continue outpatient methodone dose. \n.\n#. Chronic back pain: Continue home oxycontin with oxycodone for \nbreakthrough. The patient's L-spine MRI with sedation that was \nscheduled for ___ was re-scheduled for ___. \n.\n#. Neuropathy: Contiune home gabapentin. \n.\n# Depression: Continue home citalopram. \n. \n# CODE: full code, confirmed with patient", 'medications_prescribed': ['Promethazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for nausea.', 'Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'Efavirenz 600 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Lamivudine-Zidovudine 150-300 mg Tablet Sig: One (1) Tablet \nPO BID (2 times a day).', 'Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3 \ntimes a day).', 'Tenofovir Disoproxil Fumarate 300 mg Tablet Sig: One (1) \nTablet PO DAILY (Daily).', 'Methadone 10 mg Tablet Sig: Fifteen (15) Tablet PO DAILY \n(Daily).', 'Nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily) for 14 days.\nDisp:*14 Patch 24 hr(s)* Refills:*0*', 'Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) \nas needed for insomina.', 'Azithromycin 250 mg Tablet Sig: One (1) Tablet PO Q24H \n(every 24 hours) for 1 doses: Take this pill the morning after \ndischarge to finish your course. .\nDisp:*1 Tablet(s)* Refills:*0*', 'Prednisone 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily) \nfor 6 days: Take 2 tabs for 3 days (___), then take \n1 tab for 3 days (___).\nDisp:*9 Tablet(s)* Refills:*0*', 'Oxycodone-Acetaminophen ___ mg Tablet Sig: One (1) Tablet \nPO Q6H (every 6 hours) as needed for Pain.', 'Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: One (1) \nTablet Sustained Release 12 hr PO Q12H (every 12 hours) for 7 \ndays.\nDisp:*14 Tablet Sustained Release 12 hr(s)* Refills:*0*', 'Lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO once a day as \nneeded for anxiety for 6 days.\nDisp:*6 Tablet(s)* Refills:*0*', 'Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \n___ puffs Inhalation every ___ hours as needed for shortness of \nbreath or wheezing.', 'Advair Diskus 100-50 mcg/Dose Disk with Device Sig: One (1) \npuff Inhalation twice a day.', 'Tiotropium Bromide 18 mcg Capsule, w/Inhalation Device Sig: \nOne (1) puff Inhalation once a day.\nDisp:*1 inhaler* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['1. Hypertension', '2. Hyperlipidemia', '3. CAD by cath at ___ in ___ ', '4. IDDM- on insulin pump', '5. COPD', '6. Asthma', '7. GERD', '8. Depression', '9. Tobacco abuse', '10. ___: exploratory back surgery', '___. Two prior left shoulder surgeries', '12. Right TFCC surgery', '___. Polycystic ovary disease at a young age', '___. s/p hysterectomy for endometriosis ', '15. ? Sleep apnea- patient snores very heavily and wakes several\ntimes during the night. Has not had formal sleep study', '16. Kidney cysts'], 'family_history': 'Mother with borderline DM, two MIs. Father CABG in ___. Older \nbrother with quintuple CABG when ___, passed away. Younger \nbrother with 2 or 3 PCI placed in ___. Uncle who "dropped dead," \nthought to be secondary to cardiac disease/ACS. ', 'present_illness': '___ h/o CAD s/p coronary angiogram ___ (in ___, no \nintervention), coronary angiogram ___ that revealed 60%mid \nLAD stenosis and 80% distal LAD stenosis, admitted to CCU after \nplanned cardiac catheterization and PCI of LAD complicated by \nhypotension, small distal dissection requiring IABP placement \nand dopamine gtt. \n\nPatient reports first undergoing cardiac catheterization in \n___ in ___ for fleeting episodes of chest pain and \nshortness of breath. Per patient, no interventions were \nperformed at that time and chest pain was at attributed to \nasthma exacerbations. She was advised to start clopidogrel but \ndeferred at that time. She subsequently experienced multiple \nasthma and COPD exacerbations over the years but noted nature of \nthis chest discomfort changed starting earlier this year. Chest \npain was now more of a pressure in left chest and ears, \ntightness in throat, lasted about 5 min at a time, and was \noccasionally associated with shortness of breath and \ndiaphoresis. Chest pain improved with subligingual \nnitroglycerine. Noted a marked increase in her dyspnea on \nexertion in last few months and can now only exercise for 10 min \nfrom her baseline walking 3.5 miles. She denied change in \northopnea or PND, noting that she has slept using ___ pillows \nand waking up at night for "many years." Denies pedal edema. \n\nShe consequently underwent cardiac catheterization in ___ for \nthis chest pain at ___. \nCatheterization revealed 60%mid LAD stenosis and 80% distal LAD \nstenosis. No intervention was performed and medical management \nwas initiated. Patient reports trial of many different \nmedications, including initiation of plavix, metoprolol which \nshe did not tolerate due to her asthma/COPD. Due to persistent \nchest pain episodes occurring ___ times per a day, she presented \ntoday for elective cardiac catheterization. \n\nPatient was premedicated for contrast allergy with: \n___ ___: prednisone 40mg, Benadryl 50mg, Zantac 150mg\n___ AM: prednisone 40mg, Zantac 150mg\nDuring catheterization, a stent was placed in the mid-LAD and in \nthe distal LAD, with good result but with a small distal \ndissection without luminal irregularities. Patient experienced \nmarked chest tightness in throat and nausea with balloon \nexpansion and subsequently became hypotensive, necessitating \nplacement of IABP and dopamine gtt. IABP was initially noted to \nhave migrated distally and was thus removed and replaced. \n\nUpon arrival to the CCU, patient reported marked improvement in \nchest pain now just slight feeling of discomfort and with no \nshortness of breath. Denies any new numbness or tingling apart \nfrom her chronic diabetic neuropathy. \n\nROS notable for h/o +BRBPR thought to be due to hemorrhoids \nthough none recently, constipation, chronic cough productive of \nclear sputum, intermittent "black spots" in L eye due to "small \nretinal tear" following bilateral cataract surgery. She denied \nfever, chills, nausea, vomiting, abdominal pain, dysuria, \ndiarrhea. ', 'medications': [{'medication': 'Furosemide', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', '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': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', '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': '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': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Isoproterenol', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nitroglycerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'GuaiFENesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (250/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}, {'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': 'Isoproterenol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': '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': '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': 'Q6H: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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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': 'Ramipril', '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', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', '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', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram', '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', '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': 'BID: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': 'Isoproterenol', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '1.010', '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, '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': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, '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': '17', 'valuenum': 17.0, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, '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': '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': 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 = >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': 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': '___', 'valuenum': 1371.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 852.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '3', 'valuenum': 3.0, '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': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '196', 'valuenum': 196.0, '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': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.6', 'valuenum': 45.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, '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': '106', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.9', 'valuenum': 12.9, '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': '1.4', 'valuenum': 1.4, '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '280', 'valuenum': 280.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 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None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 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16.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, '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': '31.2', 'valuenum': 31.2, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '161', 'valuenum': 161.0, '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': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.5', 'valuenum': 45.5, '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': 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': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.7', 'valuenum': 45.7, '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': '16.2', 'valuenum': 16.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '2.8', 'valuenum': 2.8, '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': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.98', 'valuenum': 0.98, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, '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': '32.1', 'valuenum': 32.1, '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': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '9.2', 'valuenum': 9.2, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74.9', 'valuenum': 74.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, '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': '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': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '0.70', 'valuenum': 0.7, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.67', 'valuenum': 5.67, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '45.5', 'valuenum': 45.5, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': 0.5, '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': '7', 'valuenum': 7.0, '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': '2.0', '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION: \nVS: 97.6 76 114/68 15 92% 2L NC \nWeight: ___ \nTele: sinus rhythm \nGEN: Pleasant, alert and oriented. \nHEENT: Sclera anicteric, MMM. \nCV: RRR, no murmurs, rubs or gallops \nLUNGS: Intermittent expiratory high pitched wheeze \nABD: +BS, soft, no TTP. L abdomen with insulin pump. \nEXT: No pedal edema, warm and well perfused. ___ and DP pulses \ndopplerable bilaterally. L groin pulse palpable. R groin with \nline in place, dressing clean, dry and intact. \nSKIN: No rashes appreciated\nNEURO: Grossly intact. \n\nDISCHARGE PHYSICAL EXAM:\n VS: 97.9 135/73 (122-135/60-70) 74 (72-74) 18 96%RA, lowest O2 \nsat 89% while ambulating \n Weight: 80.0 kg \n Exam: \nGEN: Pleasant, alert and oriented. \nHEENT: Sclera anicteric, MMM. \nCV: RRR, no murmurs, rubs or gallops \nLUNGS: Intermittent expiratory high pitched wheeze \nABD: +BS, soft, no TTP. L abdomen with insulin pump. \nEXT: No pedal edema, warm and well perfused.\nSKIN: No rashes appreciated\nNEURO: Grossly intact. ', 'diagnoses': [{'icd_code': 'I080', 'desc': 'Rheumatic disorders of both mitral and aortic valves'}, {'icd_code': 'J810', 'desc': 'Acute pulmonary edema'}, {'icd_code': 'I442', 'desc': 'Atrioventricular block, complete'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z8522', 'desc': 'Personal history of malignant neoplasm of nasal cavities, middle ear, and accessory sinuses'}, {'icd_code': 'Z8546', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z96652', 'desc': 'Presence of left artificial knee joint'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I499', 'desc': 'Cardiac arrhythmia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'I272', 'desc': 'Other secondary pulmonary hypertension'}], 'summary': "ADMISSION LABS:\n\n___ 01:00PM BLOOD WBC-19.9*# RBC-4.52 Hgb-13.6 Hct-40.9 \nMCV-91 MCH-30.1 MCHC-33.3 RDW-13.2 RDWSD-43.5 Plt ___\n___ 01:00PM BLOOD Neuts-92.1* Lymphs-5.4* Monos-1.1* \nEos-0.0* Baso-0.4 Im ___ AbsNeut-18.34*# AbsLymp-1.08* \nAbsMono-0.22 AbsEos-0.00* AbsBaso-0.07\n___ 02:15PM BLOOD ___ PTT-51.2* ___\n___ 02:15PM BLOOD Glucose-283* UreaN-21* Creat-0.8 Na-137 \nK-4.4 Cl-101 HCO3-23 AnGap-17\n___ 02:15PM BLOOD ALT-17 AST-18 LD(LDH)-182 AlkPhos-109* \nTotBili-0.4\n___ 02:15PM BLOOD Calcium-9.1 Phos-3.0 Mg-1.9\n___ 09:10AM BLOOD cTropnT-<0.01\n\nDISCHARGE LABS:\n\n___ 07:10AM BLOOD WBC-9.4 RBC-3.99 Hgb-12.2 Hct-37.2 MCV-93 \nMCH-30.6 MCHC-32.8 RDW-13.1 RDWSD-44.6 Plt ___\n___ 07:10AM BLOOD Glucose-182* UreaN-19 Creat-0.8 Na-139 \nK-4.2 Cl-101 HCO3-28 AnGap-14\n___ 07:10AM BLOOD Calcium-9.3 Phos-3.5 Mg-2.2\n\nCardiac Cath ___:\nImpressions:\n1. Single vessel coronary artery disease\n2. Successful PCI of this mid LAD\n\nTTE ___:\nThe left atrium and right atrium are normal in cavity size. No \natrial septal defect is seen by 2D or color Doppler. The \nestimated right atrial pressure is ___ mmHg. Left ventricular \nwall thickness, cavity size, and global systolic function are \nnormal (LVEF>55%). Due to suboptimal technical quality, a focal \nwall motion abnormality cannot be fully excluded. The estimated \ncardiac index is normal (>=2.5L/min/m2). Transmitral and tissue \nDoppler imaging suggests normal diastolic function, and a normal \nleft ventricular filling pressure (PCWP<12mmHg). Right \nventricular chamber size and free wall motion are normal. The \ndiameters of aorta at the sinus, ascending and arch levels are \nnormal. The aortic valve is not well seen. There is no aortic \nvalve stenosis. No aortic regurgitation is seen. The mitral \nvalve appears structurally normal with trivial mitral \nregurgitation. The pulmonary artery systolic pressure could not \nbe determined. There is an anterior space which most likely \nrepresents a prominent fat pad. \n\nIMPRESSION: Suboptimal image quality. Normal biventricular \ncavity sizes with preserved regional and global biventricular \nsystolic function. No pericardial effusion. \n\nCXR ___\nIN COMPARISON WITH THE STUDY ___, THERE ARE SUBSTANTIALLY \nLOWER LUNG \nVOLUMES. THE IABP HAS BEEN REMOVED. CARDIAC SILHOUETTE REMAINS \nWITHIN NORMAL LIMITS. INDISTINCTNESS OF ENGORGED PULMONARY \nVESSELS SUGGESTS SOME ELEVATED PULMONARY VENOUS PRESSURE. \nINCREASED OPACIFICATION AT THE LEFT BASE SILHOUETTING THE \nHEMIDIAPHRAGM IS CONSISTENT WITH PLEURAL FLUID AND \nCOMPRESSIVE ATELECTASIS. \n___ h/o CAD s/p coronary angiogram ___ (in ___, no \nintervention), coronary angiogram ___ that revealed 60% \nmid-LAD stenosis and 80% distal LAD stenosis, admitted to CCU \nafter planned cardiac catheterization and PCI of LAD complicated \nby hypotension, small distal dissection requiring IABP placement \nand dopamine gtt.\n\nACTIVE MEDICAL ISSUES: \n#) Coronary artery disease: CAD ___ 60% mid LAD stenosis and \n80% distal LAD stenosis. Pt underwent cardiac cath on ___, \ns/p stent x2 on mid and distal LAD complicated by hypotension \nand small distal dissection without luminal irregularities \nrequiring IABP and dopamine gtt. Pt received prasugrel load in \ncath lab in place of her home plavix. Pt was admitted to the CCU \nwhere IABP was weaned and removed. Dopamine gtt weaned off as \nwell. Pt was continued on ASA 81 and Prasugrel 10 mg PO DAILY. \nPt unable to tolerate statins due to myalgias, and will continue \nevolocumab 140 mg/mL subcutaneous Q2Weeks. Pt unable to tolerate \nbeta blocker due to COPD/asthma. Pt unable to tolerate \nlisinopril due to cough, and she was restarted on losartan at \nhalf home dose \n\n#) Chest pain: Pt experienced intermittent ___ L sided chest \npain throughout hospital stay. EKG with some T wave flattening \nbut no other acute changes. Troponin T<0.01 on arrival and was \ntrended to peak 0.16, CK-MB wnl. Pt continued to experience \nnon-angina given occurring at rest without EKG changes which was \nfelt to be less likely cardiac. She was discharged off her home \nRanolazine ER 500 mg PO BID as her pain was not felt to be \nangina. \n\n#) Hypoxia: Pt was noted to desat to 83% on room air with \nambulation on ___ while working with physical therapy. Etiology \nfelt to likely be multifactorial from COPD, atelectasis, and \nsmall amount of fluid overload seen on CXR. Pt was diuresed with \n10 IV Lasix and now improved with improved O2 with ambulation \n___ to 89% and 96% at rest on room air.\n \nCHRONIC MEDICAL ISSUES:\n#) Diabetes mellitus: Pt's home insulin pump was held while \ninpatient. She was continued on 20u lantus with dinner and SSI \nHumalog while inpatient. \n\n#) Hypertension: Pt's home anti-htn medications originally held \ngiven hypotension per above. She was restarted on Losartan \nPotassium 50 mg PO QHS (half home dose). She was discharged off \nhome Diltiazem Extended-Release 120 mg PO DAILY\n \n#) Hyperlipidemia: Pt's home evolocumab 140 mg/mL subcutaneous \nQ2Weeks not given while inpatient \n \n#) Depression: Pt was continued home Citalopram 40 mg PO/NG \nDAILY and home BuPROPion (Sustained Release) 300 mg PO QAM \n\n#) Anxiety: Pt was continued on LORazepam 0.5 mg PO/NG Q4H:PRN \nanxiety \n\n#) COPD: Pt continued on home albuterol sulfate 90 mcg/actuation \ninhalation Q4H:PRN SOB. Pt's home breo ellipta QD ran out, and \nshe was started formulary equivalent of Fluticasone-Salmeterol \nDiskus (250/50).\n \n#) GERD: Pt was continued on Omeprazole 40 mg PO DAILY \n\nTRANSITIONAL ISSUES:\n[] ASA and Prasugrel started; please continue for at least one \nyear\n[] Home diltiazem held and losartan dose halved (100mg -> 50 mg) \non discharge given lower blood pressures; please recheck as an \noutpatient and uptitrate anti-hypertensives as needed\n[] Patient with non anginal chest pain. Renexa held on discharge\n[] Celecoxib 200 mg oral DAILY stopped given CAD"}}
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{'final_diagnoses': ['UNSTABLE ANGINA', 'DISTAL CORONARY ARTERY DISSECTION'], 'procedures': ['Left Heart Cardiac Catherization', 'Intraaortic Balloon Pump'], 'visit_summary': "___ h/o CAD s/p coronary angiogram ___ (in ___, no \nintervention), coronary angiogram ___ that revealed 60% \nmid-LAD stenosis and 80% distal LAD stenosis, admitted to CCU \nafter planned cardiac catheterization and PCI of LAD complicated \nby hypotension, small distal dissection requiring IABP placement \nand dopamine gtt.\n\nACTIVE MEDICAL ISSUES: \n#) Coronary artery disease: CAD ___ 60% mid LAD stenosis and \n80% distal LAD stenosis. Pt underwent cardiac cath on ___, \ns/p stent x2 on mid and distal LAD complicated by hypotension \nand small distal dissection without luminal irregularities \nrequiring IABP and dopamine gtt. Pt received prasugrel load in \ncath lab in place of her home plavix. Pt was admitted to the CCU \nwhere IABP was weaned and removed. Dopamine gtt weaned off as \nwell. Pt was continued on ASA 81 and Prasugrel 10 mg PO DAILY. \nPt unable to tolerate statins due to myalgias, and will continue \nevolocumab 140 mg/mL subcutaneous Q2Weeks. Pt unable to tolerate \nbeta blocker due to COPD/asthma. Pt unable to tolerate \nlisinopril due to cough, and she was restarted on losartan at \nhalf home dose \n\n#) Chest pain: Pt experienced intermittent ___ L sided chest \npain throughout hospital stay. EKG with some T wave flattening \nbut no other acute changes. Troponin T<0.01 on arrival and was \ntrended to peak 0.16, CK-MB wnl. Pt continued to experience \nnon-angina given occurring at rest without EKG changes which was \nfelt to be less likely cardiac. She was discharged off her home \nRanolazine ER 500 mg PO BID as her pain was not felt to be \nangina. \n\n#) Hypoxia: Pt was noted to desat to 83% on room air with \nambulation on ___ while working with physical therapy. Etiology \nfelt to likely be multifactorial from COPD, atelectasis, and \nsmall amount of fluid overload seen on CXR. Pt was diuresed with \n10 IV Lasix and now improved with improved O2 with ambulation \n___ to 89% and 96% at rest on room air.\n \nCHRONIC MEDICAL ISSUES:\n#) Diabetes mellitus: Pt's home insulin pump was held while \ninpatient. She was continued on 20u lantus with dinner and SSI \nHumalog while inpatient. \n\n#) Hypertension: Pt's home anti-htn medications originally held \ngiven hypotension per above. She was restarted on Losartan \nPotassium 50 mg PO QHS (half home dose). She was discharged off \nhome Diltiazem Extended-Release 120 mg PO DAILY\n \n#) Hyperlipidemia: Pt's home evolocumab 140 mg/mL subcutaneous \nQ2Weeks not given while inpatient \n \n#) Depression: Pt was continued home Citalopram 40 mg PO/NG \nDAILY and home BuPROPion (Sustained Release) 300 mg PO QAM \n\n#) Anxiety: Pt was continued on LORazepam 0.5 mg PO/NG Q4H:PRN \nanxiety \n\n#) COPD: Pt continued on home albuterol sulfate 90 mcg/actuation \ninhalation Q4H:PRN SOB. Pt's home breo ellipta QD ran out, and \nshe was started formulary equivalent of Fluticasone-Salmeterol \nDiskus (250/50).\n \n#) GERD: Pt was continued on Omeprazole 40 mg PO DAILY \n\nTRANSITIONAL ISSUES:\n[] ASA and Prasugrel started; please continue for at least one \nyear\n[] Home diltiazem held and losartan dose halved (100mg -> 50 mg) \non discharge given lower blood pressures; please recheck as an \noutpatient and uptitrate anti-hypertensives as needed\n[] Patient with non anginal chest pain. Renexa held on discharge\n[] Celecoxib 200 mg oral DAILY stopped given CAD", 'medications_prescribed': ['1. Aspirin 81 mg PO QPM ', '2. Breo Ellipta (fluticasone-vilanterol) 200-25 mcg/dose \ninhalation DAILY ', '3. BuPROPion (Sustained Release) 300 mg PO QAM ', '4. Citalopram 40 mg PO DAILY ', '5. Incruse Ellipta (umeclidinium) 62.5 mcg/actuation inhalation \nDAILY ', '6. Omeprazole 40 mg PO DAILY ', '7. Insulin Pump SC (Self Administering Medication)Insulin \nLispro (Humalog)\nTarget glucose: 80-180', '8. Prasugrel 10 mg PO DAILY \nRX *prasugrel [Effient] 10 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0', '9. Losartan Potassium 50 mg PO QHS \nRX *losartan 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', '10. Acetaminophen w/Codeine 1 TAB PO Q8H:PRN pain ', '11. albuterol sulfate 90 mcg/actuation inhalation Q4H:PRN SOB ', '12. ALPRAZolam 0.25 mg PO BID:PRN acute anxiety ', '13. evolocumab 140 mg/mL subcutaneous Q2Weeks ', '14. Zolpidem Tartrate 10 mg PO QHS:PRN insomnia ', '15. varenicline 1 mg oral BID ', '16. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'M', 'symptoms': 'Febrile neutropenia', 'medical_history': ['ONCOLOGIC HISTORY\n* ___ diagnosed with ovarian cancer, treated with TAH with BSO \n\nand chemotherapy', '* ___ developed rectal bleeding, mass found on colonoscopy \nand diagnosed with rectal cancer. Treated with XRT, infusional \n___ followed by surgical resection which demonstrated no \nresidual disease. Received 4 more cycles of ___ and leucovorin', '* ___ noticed several months of fatigue, now with shortness \nof breath. Seen by PCP and noted to be anemic with hemoglobin of \napproximately 8. Referred back to her oncologist Dr. ___', '* ___ bone marrow biopsy showing trilineage dysplasia with \napproximately 50% blasts on the aspirate and sheets of blasts \nseen on the core biopsy.', '* ___ received ___ blood transfusion, 2 units PRBC', '* ___ admitted to ___, bone marrow biopsy confirms \nleukemia, normal cytogenetics, FLT3 negative, NPM positive', "* ___ induction chemotherapy with 7+3 (daunorubicin 90 mg/m2\ndays 1,2,3 and cytarabine 100 mg/m2 days ___ complicated by\nSweet's syndrome", '* ___ began consolidation with HiDAC, ___ cycle complicated \nby fever, thought related to Ara-C, tolerated final dose with\nsteroids', '* ___, received ___ (and last planned) cycle of HiDAC', 'Ovarian cancer', 'Rectal cancer', 'Chronic diarrhea', 's/p TAH with BSO', 's/p bowel resection', 's/p cholecystectomy 1990s', 's/p hernia repair'], 'family_history': '(per OMR) Mother is living with history of ovarian cancer, \nmacular degeneration and cardiac problems. Father is living with \n___ disease and a history of DVT. She has 1 brother and \n3 sisters, all of whom are healthy', 'present_illness': 'Mrs. ___ is a ___ year old female with AML, now C4D16 of \nhiDAC, who presents with a temperature of 100.1 at home and an \nANC of 112. She was seen in clinic yesterday for a routine visit \nand was noted to be neutropenic. She had a fever following her \nplt transfusion, but she was monitored and defervesced. The \ndecision was made to send her home but she was advised to \nmonitor her temperature closely and to call for any fevers. She \nwas taking ciprofloxacin for prophylaxis. Her Tmax last night \nwas 99.3, but today, her temperature rose from 99.5 in the \nmorning to 100.1 at 4pm. She called her NP who referred her to \nthe ER for evaluation. She has no localizing symptoms of \ninfection and feels well. In the ER, her VS were T 99.6, BP \n163/75, HR 114, RR 20, sats 100% on RA. Her HR came down to 96 \nin the ER with some IVF. Labs were drawn from her R Hickman \ncatheter, including blood cultures and a lactate. She also had a \nCXR and urine sent for UA and culture. She was given a dose of \nmeropenem (as she has a cefepime allergy) and was admitted to \n___. On arrival here, she is reading a book and feels \ncomfortable. She denies any localizing symptoms of infection, \nother than a "weird" feeling in the left side of her throat when \nshe swallows. No enlarged lymph nodes, no dysphagia, and no \nother mouth sores.', 'medications': [{'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': 'Lisinopril', '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': 'Docusate Sodium', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': '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', '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': 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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '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': '0.4', 'valuenum': 0.4, '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': '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 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 228.0, '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': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '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': '40.0', 'valuenum': 40.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '0.6', 'valuenum': 0.6, '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': '47.2', 'valuenum': 47.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.4', 'valuenum': 17.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.0', 'valuenum': 37.0, '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': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59.1', 'valuenum': 59.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '270', 'valuenum': 270.0, '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': '5.13', 'valuenum': 5.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.6', 'valuenum': 43.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '35.1', 'valuenum': 35.1, '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': '211', 'valuenum': 211.0, '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': '4.70', 'valuenum': 4.7, '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': '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': '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': '102', 'valuenum': 102.0, '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': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 55.0, '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': '2', 'valuenum': 2.0, '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': 200.0, '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': '3.8', '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 275.0, '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': 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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam:\n \nT 99.2, BP 120/82, HR 90, RR 16, sats 100% on RA\nGEN: Well appearing middle aged female in NAD, reading a book in \nbed. \nHEENT: NCAT. Sclera anicteric. EOMI. OP clear, no exudates or \nerythema. No mouth sores, no thrush. \nNECK: Supple, no appreciable cervical, supraclavicular or \ninfraclavicular LAD. \nCHEST: R sided CVL w/o any surrounding erythema, tenderness or \npus. \nCV: RR, normal S1, S2. No m/r/g. \nLUNGS: CTAB, no crackles, wheezes, rhonchi. \nABD: Soft, NTND. + BS throughout. No masses, no HSM. \nEXT: No edema, no rashes. 2+ ___ pulses bilaterally. \n \nDischarge Physical Exam:\n \nTmax 99.4, Tcurrent 97.6, BP 126/70, HR 67, RR 18, SO2 99% on RA \n\nGEN: Well appearing middle aged female in NAD.\nHEENT: PERRL Sclera anicteric. EOMI. OP clear, no exudates or \nerythema. No mouth sores, no thrush. \nNECK: Supple, no appreciable cervical, supraclavicular or \ninfraclavicular LAD. \nCHEST: R sided CVL w/o any surrounding erythema, tenderness or \npus. \nCV: RR, normal S1, S2. No m/r/g. \nLUNGS: CTAB, no crackles, wheezes, rhonchi. \nABD: Soft, NTND. + BS throughout. No masses, no HSM. \nEXT: No edema, no rashes. 2+ ___ pulses bilaterally.', 'diagnoses': [{'icd_code': '78659', 'desc': 'Other chest pain'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '51889', 'desc': 'Other diseases of lung, not elsewhere classified'}, {'icd_code': '2559', 'desc': 'Unspecified disorder of adrenal glands'}, {'icd_code': '5739', 'desc': 'Unspecified disorder of liver'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'V1581', 'desc': 'Personal history of noncompliance with medical treatment, presenting hazards to health'}], 'summary': "Labs:\n \nWBC 0.2, Hgb 8.1, Hct 22.3, MCV 81, plts 29K \nN:56 Band:0 ___ M:0 E:2 Bas:0 \n\n140 102 9 AGap=13 \n-------------< 115 \n3.5 29 0.6 \n \nLactate: 1.4\nUA negative\n \nLFTs (from ___: ALT: 25 AST: 17 AP: 103 Tbili: 1.2 LDH: 211 \n\n \nImaging:\nCXR: no evidence of infiltrates or effusions.\n \n___ CT Chest\nIMPRESSION: \nInnumerable punctate centrilobular nodules and \nperibronchovascular ground-glass opacities are new from ___, most compatible with diffuse infectious bronchiolitis. \n \nMICRO:\n- All blood cultures NGTD.\n- All Urine cultures negative\n- Beta glucan negative\n- Aspergillus galactomannan antigen negative\n- Viral resp screen negative\n \nDischarge Labs:\n \n___ 06:00AM BLOOD WBC-3.1* RBC-2.94* Hgb-8.6* Hct-24.6* \nMCV-84 MCH-29.4 MCHC-35.1* RDW-16.6* Plt ___\n___ 06:00AM BLOOD Neuts-45* Bands-3 Lymphs-8* Monos-40* \nEos-0 Baso-1 ___ Metas-1* Myelos-2* NRBC-1*\n___ 06:00AM BLOOD Hypochr-OCCASIONAL Anisocy-2+ \nPoiklo-OCCASIONAL Macrocy-1+ Microcy-1+ Polychr-1+ Tear \nDr-OCCASIONAL\n___ 06:00AM BLOOD Plt Smr-LOW Plt ___\n___ 06:00AM BLOOD ___ ___\n___ 06:00AM BLOOD Glucose-95 UreaN-5* Creat-0.5 Na-144 \nK-3.7 Cl-104 HCO3-30 AnGap-14\n___ 06:00AM BLOOD estGFR-Using this\n___ 06:00AM BLOOD Calcium-8.8 Phos-3.8 Mg-2.\n___ year old woman with AML presented at the nadir of cycle 4 of \nhiDAC with febrile neutropenia. Blood and urine cultures were \nnegative, CXR negative and no localizing symptoms.\n \nDiagnoses:\n \n# Febrile neutropenia: Never had localizing symptoms during her \nstay. She was empirically treated with vancomycin, meropenem, \nmicafungin and voriconazole (cefepime could not be given due to \nallergy) during this admission. She required several \ntransfusions of PRBC's for low hct while her counts were \nreturning. Acetaminophen was used to treat her fever sparingly. \nThe only indication of a source was the CT scan which indicated \ninfectious bronchiolitis. Because of this the micafungin was \nreplaced with voriconazole for better aspergillus coverage. \nStarting around ___ her counts started to return and she was no \nlonger neutropenic by definition. On ___ she defervesced. On \n___ her IV Antibiotics were stopped and she was started on PO \nLevofloxacin. On ___ she was discharged with a 5 day course of \nlevofloxacin. Upon discharge her ___ count was 1581, hct 24.6, \nWBC 3.1 and plt count 134. She received 1 final unit of blood \nprior to leaving to ensure her hct was stable enough to hold \nuntil her marrow has recovered enough.\n \n# AML: C4D25 of hiDAC, With all WBC's returning at this time. \nPer patient no chemotherapy planned at this time. She will \nfollow up with her primary oncologist regarding further \ntreatment plan as an outpatient.\n\nTransitional Issues\n- Her blood cultures will need to be followed up by her primary \noncologist"}}
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{'final_diagnoses': ['Febrile neutropenia - no infectious source identified', 'Acute myelogenous leukemia'], 'procedures': ['None'], 'visit_summary': "___ year old woman with AML presented at the nadir of cycle 4 of \nhiDAC with febrile neutropenia. Blood and urine cultures were \nnegative, CXR negative and no localizing symptoms.\n \nDiagnoses:\n \n# Febrile neutropenia: Never had localizing symptoms during her \nstay. She was empirically treated with vancomycin, meropenem, \nmicafungin and voriconazole (cefepime could not be given due to \nallergy) during this admission. She required several \ntransfusions of PRBC's for low hct while her counts were \nreturning. Acetaminophen was used to treat her fever sparingly. \nThe only indication of a source was the CT scan which indicated \ninfectious bronchiolitis. Because of this the micafungin was \nreplaced with voriconazole for better aspergillus coverage. \nStarting around ___ her counts started to return and she was no \nlonger neutropenic by definition. On ___ she defervesced. On \n___ her IV Antibiotics were stopped and she was started on PO \nLevofloxacin. On ___ she was discharged with a 5 day course of \nlevofloxacin. Upon discharge her ___ count was 1581, hct 24.6, \nWBC 3.1 and plt count 134. She received 1 final unit of blood \nprior to leaving to ensure her hct was stable enough to hold \nuntil her marrow has recovered enough.\n \n# AML: C4D25 of hiDAC, With all WBC's returning at this time. \nPer patient no chemotherapy planned at this time. She will \nfollow up with her primary oncologist regarding further \ntreatment plan as an outpatient.\n\nTransitional Issues\n- Her blood cultures will need to be followed up by her primary \noncologist", 'medications_prescribed': ['1. acyclovir 400 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours).', '2. lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO at bedtime as \nneeded for anxiety, insomnia.', '3. levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day \nfor 5 days.\nDisp:*5 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 88, 'gender': 'M', 'symptoms': 'Chest Pain', 'medical_history': ['___ disease', 'Polymyalgia rheumatica/inflammatory arthritis', 'nonalcoholic steatohepatitis', 'lumbar spinal stenosis', 'osteoarthritis', 'hypertension', 'hyperlipidemia', 'history of retinal detachment, with resultant blindness in the \nright eye. He has had the left retina surgically repaired twice \nand underwent some type of corneal scraping procedure recently', 'obstructive sleep apnea, untreated', 'chronic lower extremity edema'], 'family_history': 'Remarkable for a history of retinal detachment in 3 family \nmembers. No family history of coronary artery disease. No known \nfamily history of ___ Disease, dementia, or other \nneurologic illnesses.', 'present_illness': '___ yo man with h/o hypertension and hyperlipidemia who presented \nwith chest pain starting around noon on ___. The pain was in \nthe ___ his chest, with no radiation, and he had no \nshortness of breath. He did feel kind of clammy and then \ndiaphoretic. He took ASA 81 mg and took diclofenac for the pain \nas well. He also had similar pain one night PTA following \n___ food that went away spontaneously after 30 minutes. At \nbaseline, he uses a walker and wheel chair and is S/P recent \nleft eye operation, and hence has little to provoke angina in \nevery day life.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Midodrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Guaifenesin-Dextromethorphan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Simvastatin', '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Escitalopram Oxalate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'sevelamer HYDROCHLORIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '5.4', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.3, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '106', 'valuenum': 106.0, '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': '3.73', 'valuenum': 3.73, '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': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '8.1', 'valuenum': 8.1, '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': '6.6', 'valuenum': 6.6, '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': '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, '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': '60', 'valuenum': 60.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'GENERAL: Elderly Caucasian man in NAD. Oriented x3. Mood, affect \nappropriate.\nVS: T=96.3 BP=113/92 HR=73 RR=18 O2 sat=96/2L \nHEENT: NCAT. Sclera anicteric. EOMI. Opacified right pupil with \nrelative ptosis.\nCARDIAC: RR, normal S1, S2. grade III/XI holosystolic murmur \nheard best at the tricuspid area. No S3 or S4.\nLUNGS: Crackles at the bases R>>L, breath sounds quiet \nthroughout.\nABDOMEN: Soft, NTND.\nCATH SITE: Hematoma on right S/P catheterization. No bruit.\nSKIN: Bilateral leg edema with papular lesions.\nPULSES: Dopplerable', 'diagnoses': [{'icd_code': '80502', 'desc': 'Closed fracture of second cervical vertebra'}, {'icd_code': '5856', 'desc': 'End stage renal disease'}, {'icd_code': '40391', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '8930', 'desc': 'Open wound of toe(s), without mention of complication'}, {'icd_code': '87342', 'desc': 'Open wound of forehead, without mention of complication'}, {'icd_code': '87320', 'desc': 'Open wound of nose, unspecified site, without mention of complication'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': 'E8842'}, {'icd_code': '7862', 'desc': 'Cough'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': '28521', 'desc': 'Anemia in chronic kidney disease'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': 'V433'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': 'V4511', 'desc': 'Renal dialysis status'}, {'icd_code': 'V4975', 'desc': 'Below knee amputation status'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}], 'summary': '___ 03:00AM WBC-17.6*# RBC-4.29* HGB-11.8* HCT-36.1* \nMCV-84 MCH-27.5 MCHC-32.6 RDW-14.7\n___ 03:00AM NEUTS-78.6* LYMPHS-16.8* MONOS-3.0 EOS-1.3 \nBASOS-0.4\n___ 03:00AM PLT COUNT-495*\n___ 03:00AM ___ PTT-30.1 ___\n\n___ 11:20AM WBC-17.4* \n___ 05:10AM WBC-19.9* \n___ 09:20AM WBC-20.6* \n___ 05:05AM WBC-17.5* \n\n___ 03:00AM GLUCOSE-148* UREA N-13 CREAT-0.9 SODIUM-141 \nPOTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-26 ANION GAP-15\n\n___ 03:00AM CK(CPK)-29* CK-MB-NotDone \ncTropnT-0.07*\n___ 11:20AM CK(CPK)-185* CK-MB-26* MB Indx-14.1* \ncTropnT-0.48*\n___ 05:10AM CK(CPK)-77 CK-MB-NotDone \ncTropnT-0.35*\n___ 05:05AM CK(CPK)-35* CK-MB-NotDone \ncTropnT-0.48*\n\n___ 05:10AM Calcium-8.7 Phos-3.3 Mg-1.8 Cholest-126\n___ 05:10AM Triglyc-180* HDL-26 CHOL/HD-4.8 LDLcalc-64\n\n___ 03:00AM proBNP-___*\nED Course:\nIn the ED, he was found to have ST-Elevations in his precordial \nleads, new from prior EKGs and q-waves in V1-V3. He was given \nASA, Plavix, and started on Integrelin and heparin.\n\nGiven concern for an acute ST elevation MI, Mr ___ went \ndirectly to catheterization laboratory where a 90% long, \nirregular, chronic appearing stenosis in the LAD was treated \nwith a bare metal stent. There was also a moderate stenosis in \nthe LCx and mild stenosis in the RCA. He remained \nhemodynamically stable throughout procedure and was transported \nto the ___ 3 for further care.\n\nHospital Course by Problem:\n\nCAD - Patient underwent cardiac catheterization as described \nabove. Given his anterior Q waves with ST elevation (suggestive \nof aneurysm) and depressed LVEF on echocardiogram out of \nproportion to his biomarker rise, it was felt that most likely \nhis anterior Q wave MI was remote, having occurred at some point \nin the last ___ years since his prior tracing, with a new \ninfarction (with perhaps 1 mm transient increase in anterior ST \nelevations), with presenting troponin-T of 0.07 with subsequent \npeak CK 185, peak MB 26, and peak troponin-T 0.48. As he is s/p \nstenting of his LAD lesion with a BMS, he was started on aspirin \n325 mg daily, Plavix 75 mg daily, and a 12 hour infusion of \nIntegrilin, as well as increased dose of statin and continued \nACE-I. His beta-blocker was changed from atenolol to metoprolol \nfor easier dose titration and because of his newly documented LV \nsystolic dysfunction. He had no recurrence of his presenting \nchest pain, although he did report tenderness of his \ncostochondral-sternal junctions and ribs during auscultation \nwith a stethoscope on his chest. During the course of his \nhospital stay, a pericardial friction rub was noted (but only on \none occasion). His diclofenac was held given the increased risk \nof cardiac rupture with NSAIDs, and he was treated with higher \ndose ASA for several days, although he never reported pleuritic \nchest pain.\n\nRhythm - About 2 days after presentation, Mr. ___ had what \nappeared to be an accelerated idioventricular rhythm (slightly \nirregular wide complex non-tachycardic rhythm) with inconsistent \nunderlying slower P waves with apparent atrio-ventricular \ndissociation. The tracings were reviewed informally with the \nElectrophysiology Service, who felt it was consistent with a \nreperfusion arrhythmia and of no immediate concern.\n\nPump - His NT-pro-BNP was grossly elevated at 2862 on admission, \nand he had ___ B-lines and pleural effusions on CXR, raising \nconcern for acute diastolic heart failure. An echocardiogram was \nperformed which revealed an LVEF of 35%, LV systolic dysfunction \nwith near akinesis of distal half of the anterior septum and \nanterior walls. This suggested prior left ventricular systolic \nheart failure with superimposed exacerbation of diastolic heart \nfailure. He had poor respiratory effort on auscultation of his \nlung fields, with occasional reals. His Lasix was increased to \n80 mg daily, and his ACE-I and metoprolol were continued (with \ngoal of switching to the heart failure regimen of metoprolol \nsuccinate when discharged to home). His PPI was changed to an H2 \nblocker to avoid negative interaction with Plavix.\n\nRLL consolidation - After his cardiac catheterization, a CXR \nrevealed a RLL consolidation. This, coupled with an elevated \nWBC, raised concern for pneumonia. At that time, the patient \nreported no respiratory symptoms of cough or rhinorrhea. With \nincreased diuresis, his crackles improved greatly. His WBC count \n___ to a peak of 20.5 on ___ and started trending downward \nthereafter. His baseline appears to be elevated (___,) so it \nis possible that this is post-MI leukocytosis. A follow-up CXR \nshowed improvement in the RLL, but worsening of the effusion and \ninfiltrate on the left lower lobe. Towards the end of his \nadmission, he reported a right sternal border sensation of chest \ncongestion that he stated had been present for several days. As \nhis WBC was still elevated, he was begun on a 10 day course of \nLevofloxacin (his last day of antibiotics will be ___.\n\nPenile swelling - patients wife reported recent asymmetric \nswelling of penis, not scrotum, not glans. Urology consultation \nwas requested.\n\nHypertension - This was easily controlled on metoprolol 50 mg of \nBID and his home dose of ACE inhibitor.\n\nPolymyalgia Rheumatica/Pain Control - Diclofenac had to be \nstopped as discussed above, we started ASA 325 QID for several \ndays.\n\nMental Status Changes - Early during his admission, he received \nmorphine sulfate for pain control, followed by delirium and \nconfusion, for which he received haloperidol. The next morning, \nhe was lethargic, disoriented, with worsened slurring of his \nspeech. Head CT did not show an acute bleed, and his Integrilin \nwas stopped. The following day, he was much more interactive and \nfully oriented to person, place, and reason for his admission. \nThe mental status changes were attributed to morphine and \nhaloperidol.\n\nRecent eye surgery - His eye drop regimen was streamlined by Dr. \n___ to Cosopt BID in the R eye, Polysporin Opthalmic Left \neye BID, and vigamox left Eye QID and Dr. ___ a fellow to \nexamine him who gave the patient instructions for follow-up.\n\n___ disease - He was mildly symptomatic with pill \nrolling tremor and cog wheeling, he was continued on his home \nSinemet.\n\nNutrition - Nutrition consultation felt that adding some Boost \nsupplement would improve his protein intake.'}}
|
{'final_diagnoses': ['Acute anterior myocardial infarction with transient worsening \nof anterior ST elevations, likely superimposed on prior anterior \nQ wave myocardial infarction with chronic ST elevations, treated \nwith deployment of a bare metal stent in the left anterior \ndescending artery', 'Coronary artery disease', 'Acute on chronic left ventricular systolic and diastolic \nheart failure', 'Acute post-infarct pericarditis', 'Accelerated idioventricular rhythm', 'Hypertension', 'Hyperlipidemia', '___ Disease', 'Polymyalgia rheumatica with musculoskeletal chest pain', 'Penile lesion', 'Lower extremity edema', 'Bilateral lower lobe infiltrates and leukocytosis consistent \nwith pneumonia', 'Left>right pleural effusion', 'Medication-induced delirium and confusion'], 'procedures': ['Cardiac Catheterization and bare metal stent implantation'], 'visit_summary': 'ED Course:\nIn the ED, he was found to have ST-Elevations in his precordial \nleads, new from prior EKGs and q-waves in V1-V3. He was given \nASA, Plavix, and started on Integrelin and heparin.\n\nGiven concern for an acute ST elevation MI, Mr ___ went \ndirectly to catheterization laboratory where a 90% long, \nirregular, chronic appearing stenosis in the LAD was treated \nwith a bare metal stent. There was also a moderate stenosis in \nthe LCx and mild stenosis in the RCA. He remained \nhemodynamically stable throughout procedure and was transported \nto the ___ 3 for further care.\n\nHospital Course by Problem:\n\nCAD - Patient underwent cardiac catheterization as described \nabove. Given his anterior Q waves with ST elevation (suggestive \nof aneurysm) and depressed LVEF on echocardiogram out of \nproportion to his biomarker rise, it was felt that most likely \nhis anterior Q wave MI was remote, having occurred at some point \nin the last ___ years since his prior tracing, with a new \ninfarction (with perhaps 1 mm transient increase in anterior ST \nelevations), with presenting troponin-T of 0.07 with subsequent \npeak CK 185, peak MB 26, and peak troponin-T 0.48. As he is s/p \nstenting of his LAD lesion with a BMS, he was started on aspirin \n325 mg daily, Plavix 75 mg daily, and a 12 hour infusion of \nIntegrilin, as well as increased dose of statin and continued \nACE-I. His beta-blocker was changed from atenolol to metoprolol \nfor easier dose titration and because of his newly documented LV \nsystolic dysfunction. He had no recurrence of his presenting \nchest pain, although he did report tenderness of his \ncostochondral-sternal junctions and ribs during auscultation \nwith a stethoscope on his chest. During the course of his \nhospital stay, a pericardial friction rub was noted (but only on \none occasion). His diclofenac was held given the increased risk \nof cardiac rupture with NSAIDs, and he was treated with higher \ndose ASA for several days, although he never reported pleuritic \nchest pain.\n\nRhythm - About 2 days after presentation, Mr. ___ had what \nappeared to be an accelerated idioventricular rhythm (slightly \nirregular wide complex non-tachycardic rhythm) with inconsistent \nunderlying slower P waves with apparent atrio-ventricular \ndissociation. The tracings were reviewed informally with the \nElectrophysiology Service, who felt it was consistent with a \nreperfusion arrhythmia and of no immediate concern.\n\nPump - His NT-pro-BNP was grossly elevated at 2862 on admission, \nand he had ___ B-lines and pleural effusions on CXR, raising \nconcern for acute diastolic heart failure. An echocardiogram was \nperformed which revealed an LVEF of 35%, LV systolic dysfunction \nwith near akinesis of distal half of the anterior septum and \nanterior walls. This suggested prior left ventricular systolic \nheart failure with superimposed exacerbation of diastolic heart \nfailure. He had poor respiratory effort on auscultation of his \nlung fields, with occasional reals. His Lasix was increased to \n80 mg daily, and his ACE-I and metoprolol were continued (with \ngoal of switching to the heart failure regimen of metoprolol \nsuccinate when discharged to home). His PPI was changed to an H2 \nblocker to avoid negative interaction with Plavix.\n\nRLL consolidation - After his cardiac catheterization, a CXR \nrevealed a RLL consolidation. This, coupled with an elevated \nWBC, raised concern for pneumonia. At that time, the patient \nreported no respiratory symptoms of cough or rhinorrhea. With \nincreased diuresis, his crackles improved greatly. His WBC count \n___ to a peak of 20.5 on ___ and started trending downward \nthereafter. His baseline appears to be elevated (___,) so it \nis possible that this is post-MI leukocytosis. A follow-up CXR \nshowed improvement in the RLL, but worsening of the effusion and \ninfiltrate on the left lower lobe. Towards the end of his \nadmission, he reported a right sternal border sensation of chest \ncongestion that he stated had been present for several days. As \nhis WBC was still elevated, he was begun on a 10 day course of \nLevofloxacin (his last day of antibiotics will be ___.\n\nPenile swelling - patients wife reported recent asymmetric \nswelling of penis, not scrotum, not glans. Urology consultation \nwas requested.\n\nHypertension - This was easily controlled on metoprolol 50 mg of \nBID and his home dose of ACE inhibitor.\n\nPolymyalgia Rheumatica/Pain Control - Diclofenac had to be \nstopped as discussed above, we started ASA 325 QID for several \ndays.\n\nMental Status Changes - Early during his admission, he received \nmorphine sulfate for pain control, followed by delirium and \nconfusion, for which he received haloperidol. The next morning, \nhe was lethargic, disoriented, with worsened slurring of his \nspeech. Head CT did not show an acute bleed, and his Integrilin \nwas stopped. The following day, he was much more interactive and \nfully oriented to person, place, and reason for his admission. \nThe mental status changes were attributed to morphine and \nhaloperidol.\n\nRecent eye surgery - His eye drop regimen was streamlined by Dr. \n___ to Cosopt BID in the R eye, Polysporin Opthalmic Left \neye BID, and vigamox left Eye QID and Dr. ___ a fellow to \nexamine him who gave the patient instructions for follow-up.\n\n___ disease - He was mildly symptomatic with pill \nrolling tremor and cog wheeling, he was continued on his home \nSinemet.\n\nNutrition - Nutrition consultation felt that adding some Boost \nsupplement would improve his protein intake.', 'medications_prescribed': ['Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) \nfor 1 months. Disp:*30 Tablet(s)* Refills:*2*', 'Carbidopa-Levodopa ___ mg Tablet Sustained Release Sig: \nOne (1) Tablet PO QHS (once a day (at bedtime)).', 'Carbidopa-Levodopa ___ mg Tablet Sig: One (1) Tablet PO \nQID (4 times a day).', 'Fluoxetine 20 mg Capsule Sig: Three (3) Capsule PO DAILY \n(Daily).', 'Hydrocortisone 2.5 % Cream Sig: One (1) Appl Rectal DAILY \n(Daily) as needed for PRN hemorrhoids.', 'Lisinopril 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday). Disp:*60 Tablet(s)* Refills:*2*', 'Oxycodone-Acetaminophen ___ mg Tablet Sig: One (1) Tablet \nPO Q5H () as needed for pain.', '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.', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily).', 'Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: ___ \nDrops Ophthalmic PRN (as needed) as needed for dry eyes.', 'Triamcinolone Acetonide 0.025 % Cream Sig: One (1) Appl \nTopical DAILY (Daily) as needed for to legs PRN itching.', 'Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl \nTopical TID (3 times a day) as needed for leg lesions.', 'Pravastatin 20 mg Tablet Sig: Four (4) Tablet PO DAILY \n(Daily).\nDisp:*80 Tablet(s)* Refills:*2* [NOTE ADDED IN PROOF: Patient \nshould have been discharged on pravastatin 80 mg daily]', 'Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).', 'Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO TIDAC (3 times a day (before \nmeals)).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*2* [NOTE \nADDED IN PROOF: Patient should have been discharged on ASA 325 \nmg daily]', 'Furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). Disp:*30 Tablet(s)* Refills:*2*', 'Ranitidine HCl 150 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). Disp:*60 Tablet(s)* Refills:*2*', 'Levofloxacin 750 mg Tablet Sig: One (1) Tablet PO once a day \nfor 10 days. Disp:*10 Tablet(s)* Refills:*0*', 'Edema management: Please wrap both legs in ace bandage to \nthe knees to limit swelling. Please elevate legs when patient \nis resting in bed. Patient also has some penile edema and was \nseen by urology at ___ recommendations are to elevate penis \nwhen possible (such as by propping when patient is lying flat).', 'Bacitracin-Polymyxin B 500-10,000 unit/g Ointment Sig: One \n(1) Appl Ophthalmic BID (2 times a day). Disp:*1 unit* \nRefills:*2*', 'Dorzolamide-Timolol ___ % Drops Sig: Two (2) Drop \nOphthalmic BID (2 times a day).', 'Moxifloxacin 0.5 % Drops Sig: One (1) Ophthalmic four times \na day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 20, 'gender': 'F', 'symptoms': 'Chest pain, shortness of breath', 'medical_history': ['Emphysema', 'FDG avid lung nodule, s/p palliative XRT at ___ in ___', 'HFpEF', 'HTN', 'AFib', 'TIA x 2', 'HLD', 'Hypothyroidism', 'Anxiety', 's/p b/l cataract surgery', 'Varicose veins', 'Dizziness ___ diagnosed with BPPV, resolved', 'BSO', 'cholecystecomy', 'appendectomy'], 'family_history': 'Noncontributory.\nMother: with stroke, DM\nPaternal aunt: stroke', 'present_illness': '___ w/ PMHx emphysema, lung cancer s/p palliative radiation at ___, HFpEF, HTN, TIAs, a-fib on Eliquis presented with R sided chest pain and SOB. She says she woke up at 6 AM on the morning of ___ with pain in the R side of her chest that worsened with inspiration. Also reports progressive worsening of shortness of breath and fatigue so she came to ED for further evaluation. \n\nUpon initial evaluation in the ED, the patient had stable vital signs and an unremarkable ECG. She then developed acute onset SOB and desatted to the ___ on RA. She was placed on NRB w/ improvement in her sats. Portable CXR was obtained which showed a large R sided PTX w/ some shifting of the mediastinum c/f tension pneumo. IP was then consulted and placed a pigtail catheter. \n\nIn the ED: \n\n Initial vital signs were notable for:\n - 96.9 92 140/79 16 99% RA \n Labs were notable for: \n - CBC wnl \n - Na 135, K 4.1, BUN 23 \n - Trop neg x1 \n - Lactate 1.5 \n - VBG 7.31/62 \n - ___ 13.7, PTT 29.3, INR 1.3 \n - proBNP 2554 \n Studies performed include: \n - CXR (___) \n - Large right pneumothorax with contralateral shift of the mediastinal structures, raising the possibility of tension pneumothorax. \n - CXR (___) \n - Interval re-expansion of the right lung status post placement of a right-sided chest tube. There is trace residual right apical and basilar pneumothorax. \n - CXR (___) \n - FINDINGS: Right-sided pigtail chest tube is unchanged in position as compared to most recent chest radiograph. Previously noted right pneumothorax is no longer seen.\n Otherwise no change. \n - IMPRESSION: No residual right pneumothorax.\n Right chest tube in place. \n - CT Chest w/o contrast (___) \n 1. Difficult to distinguish between presumed interval growth of a pre-existing right upper lobe pulmonary nodule into a larger mass and its resulting postobstructive atelectasis, noting obstruction of the adjacent right upper lobe posterior segment bronchus. The confluent area of opacification measures approximately 4.8 cm. \n 2. A right middle lobe pulmonary nodule has slightly increased in size and measures 0.7 cm. \n 3. A small right hydropneumothorax is decreased in size since radiographs obtained 1 day prior status-post pigtail pleural drainage catheter placement. \n 4. Ground-glass opacities in the peripheral left upper lobe apicoposterior segment could reflect sequela of aspiration or developing infection. \n 5. Severe centrilobular and paraseptal pulmonary emphysema. \n 6. Severe calcified coronary and aortic atherosclerosis. \n 7. Unchanged main pulmonary artery enlargement suggests pulmonary hypertension. \n - CXR (___) \n - Unchanged appearance of the chest since 1.5 hours prior. The pigtail pleural drainage catheter is unchanged in position. \n\n Patient was given: \n - ___ 08:56 IV Morphine Sulfate 4 mg \n - ___ 10:03 IV Fentanyl Citrate 50 mcg \n - ___ 10:03 PO Acetaminophen 1000 mg \n - ___ 13:12 IV Morphine Sulfate 2 mg \n - ___ 18:35 IV Morphine Sulfate 2 mg \n - ___ 18:35 PO/NG Apixaban 2.5 mg \n - ___ 00:16 IV Morphine Sulfate 2 mg \n - ___ 00:17 PO Pravastatin 40 mg \n - ___ 05:38 IV Morphine Sulfate 2 mg \n\n Consults:\n - IP as above, placed pigtail, PTX improved. \n\nVitals on transfer: T98.0 BP132/69 HR85 RR16 O2sat 91%RA \n\nUpon arrival to the floor, patient was hemodynamically stable. She corroborates the above history. She denies current SOB, chest pain, fevers, chills, abdominal pain, nausea, diaphoresis, orthopnea, vomiting, diarrhea.\n\nREVIEW OF SYSTEMS: Otherwise negative.', 'medications': [{'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Polacrilex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Guaifenesin ER', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE: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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Vivitrol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q4WEEKS', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}, {'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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Sucralfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'naltrexone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', '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': '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': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \n======================\nVITALS: T98.0 BP132/69 HR85 RR16 O2sat 91%RA\nGENERAL: lying in bed in NAD\nHEENT: NC/AT \nNECK: No JVD\nCARDIAC: RRR, nl s1/s2, no mrg\nLUNGS: CTABL, no increased WOB, no decreased breath sounds over R lung fields\nABDOMEN: soft, NT/ND, +BS\nEXTREMITIES: no edema over BLE\nNEUROLOGIC: AOx3\n\nDISCHARGE PHYSICAL EXAM:\n=========================\nVITALS: T 97.7 PO BP 106 / 57 L Lying HR 74 RR 17 93% RA \nGENERAL: pleasant elderly lady, lying in bed in NAD\nHEENT: NC/AT, anicteric sclera, PERRL\nNECK: supple, no lymphadenopathy\nCARDIAC: irregularly irregular, nl s1/s2, no mrg\nLUNGS: CTABL, no increased WOB, slightly decreased breath sounds\nRLL posteriorly\n-- chest tube incision site in right anterio-lateral chest wall, healing well with no induration or erythema\nABDOMEN: soft, NT/ND, +BS\nEXTREMITIES: warm well perfused, 2+ pulses, no edema\nNEUROLOGIC: AOx3, CN ___ grossly intact; no focal neurologic deficits', 'diagnoses': [{'icd_code': '29189', 'desc': 'Other alcohol-induced mental disorders'}, {'icd_code': 'V6284', 'desc': 'Suicidal ideation'}, {'icd_code': '5771', 'desc': 'Chronic pancreatitis'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '78056', 'desc': 'Dysfunctions associated with sleep stages or arousal from sleep'}, {'icd_code': '31400', 'desc': 'Attention deficit disorder without mention of hyperactivity'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '30521', 'desc': 'Cannabis abuse, continuous'}, {'icd_code': '47819', 'desc': 'Other disease of nasal cavity and sinuses'}, {'icd_code': '30981', 'desc': 'Posttraumatic stress disorder'}, {'icd_code': '78906', 'desc': 'Abdominal pain, epigastric'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'V620'}, {'icd_code': 'V1541', 'desc': 'History of physical abuse'}], 'summary': "ADMISSION LABS:\n==============\n___ 08:03AM BLOOD WBC-5.6 RBC-4.18 Hgb-12.9 Hct-39.6 MCV-95 MCH-30.9 MCHC-32.6 RDW-14.4 RDWSD-50.1* Plt ___\n___ 08:03AM BLOOD Neuts-73.3* Lymphs-18.3* Monos-5.9 Eos-1.1 Baso-0.9 Im ___ AbsNeut-4.07 AbsLymp-1.02* AbsMono-0.33 AbsEos-0.06 AbsBaso-0.05\n___ 08:43AM BLOOD ___ PTT-29.3 ___\n___ 08:03AM BLOOD Glucose-116* UreaN-23* Creat-0.9 Na-135 K-7.8* Cl-96 HCO3-26 AnGap-13\n___ 08:03AM BLOOD ALT-<5 AST-63* AlkPhos-40 TotBili-0.5\n___ 08:03AM BLOOD proBNP-2554*\n___ 08:03AM BLOOD cTropnT-<0.01\n___ 08:16AM BLOOD ___ pO2-30* pCO2-62* pH-7.31* calTCO2-33* Base XS-2\n___ 08:16AM BLOOD Lactate-1.5 K-4.1\n\nPERTINENT LABS:\n==============\n___ 06:05AM BLOOD CK-MB-1 cTropnT-<0.01\n___ 03:54PM BLOOD CK-MB-1 cTropnT-<0.01\n___ 06:45AM BLOOD ALT-18 AST-22 LD(LDH)-183 AlkPhos-61 TotBili-0.7\n\nMICROBIOLOGY:\n=============\n___ 8:03 am BLOOD CULTURE\n Blood Culture, Routine (Final ___: NO GROWTH. \n___ 8:08 am BLOOD CULTURE\n Blood Culture, Routine (Final ___: NO GROWTH. \n\nIMAGING:\n========\nCXR (___) \n- IMPRESSION: Large right pneumothorax with contralateral shift of the mediastinal structures, raising the possibility of tension pneumothorax. \n\nCXR (___) \n- IMPRESSION: Interval re-expansion of the right lung status post placement of a right-sided chest tube. There is trace residual right apical and basilar pneumothorax. \n\nCXR (___) \n- IMPRESSION: No residual right pneumothorax. Right chest tube in place.\n\nCT Chest w/o contrast (___) \n- IMPRESSION:\n-- 1. Difficult to distinguish between presumed interval growth of a pre-existing right upper lobe pulmonary nodule into a larger mass and its resulting postobstructive atelectasis, noting obstruction of the adjacent right upper lobe posterior segment bronchus. The confluent area of opacification measures approximately 4.8 cm. \n-- 2. A right middle lobe pulmonary nodule has slightly increased in size and measures 0.7 cm. \n-- 3. A small right hydropneumothorax is decreased in size since radiographs obtained 1 day prior status-post pigtail pleural drainage catheter placement. \n-- 4. Ground-glass opacities in the peripheral left upper lobe apicoposterior segment could reflect sequela of aspiration or developing infection.\n-- 5. Severe centrilobular and paraseptal pulmonary emphysema. \n-- 6. Severe calcified coronary and aortic atherosclerosis. \n-- 7. Unchanged main pulmonary artery enlargement suggests pulmonary hypertension.\n\nRepeat CXRs were conducted daily or more frequently ___, ___\nx2, ___ x2, ___ which showed stability.\n\nDISCHARGE CXR (___): \nIMPRESSION: \n1. Stable subcutaneous emphysema over the right chest wall. \n2. Stable right apical pneumothorax. \n3. Worsening pulmonary edema. \n\n___ Bilateral ___\n- IMPRESSION: No evidence of deep venous thrombosis in the right or left lower extremity veins.\nPATIENT SUMMARY:\n====================\nMs. ___ is a ___ year old woman with PMH of severe emphysema, lung cancer s/p palliative XRT, HFpEF, HTN, TIAs, a-fib on Eliquis who presented with R sided chest pain and dyspnea and was found to have a large R sided pneumothorax. A pigtail catheter was placed by IP with re-expansion of the lung. Patient then underwent talc pleurodesis to prevent recurrence. Course complicated by development of UTI which was treated with PO macrobid (continued through ___. \n\nACUTE ISSUES: \n============= \n#Spontaneous Pneumothorax\n#Emphysema\nAs above, Ms. ___ presented with acute R sided chest pain, SOB, and hypoxemia and was found to have large R sided PTX. It was felt this was secondary to her underlying severe emphysema. Interventional Pulmonology placed a pigtail catheter with complete re-expansion of the lung, then eventually performed a talc pleurodesis via thoracoscopy ___. Daily CXRs were performed to assess interval change, which demonstrated stability. Pre-procedure, her DOAC was held but restarted uneventfully ___. Her pain was controlled with tylenol and oxycodone 2.5mg q4hr:PRN (NSAIDs avoided due to interference with anti-inflammatory response required for successful pleurodesis -- IVF also avoided for this reason). Follow-up with interventional pulmonology arranged prior to discharge. \n\n#Atrial fibrillation with rapid ventricular response\nCHADS2-VASc 7. During her hospitalization, Ms. ___ developed new-onset pleuritic chest pain with tachycardia. ECG notable for atrial fibrillation with rapid ventricular response. ECG with new TWI but cardiac enzymes persistently negative, so ACS felt to be unlikely. Some concern for PE as trigger given held anticoagulation prior to procedure, but LENIs negative and patient without worsening hypoxemia. Ultimately attributed to pain post-pleurodesis and resolved with treatment of pain. Home diltiazem continued. Home apixaban initially held for pleurodesis, then re-started post-procedure.\n\n#Lung Nodule, malignant\nPer review of records here and at ___, Ms. ___ has had multiple pulmonary nodules seen on CT chest since ___, with one FDG-avid spiculated nodule. Has received palliative radiation at ___, but no definitive biopsy in concordance with patient's wishes. On CT here, possible progression of nodule to mass. Further conversations with the patient confirmed that she did not want biopsy. \n\n#Urinary Tract Infection\nPatient is followed in ___ clinic and has history of recurrent UTIs, although per chart review may also be chronically colonized with E.Coli. She has been taking prophylactic methenamine +Vitamin C at home. On ___, she developed urinary frequency and dysuria, with UA showing multiple WBCs, ___ positive with bacteria. She was started on a 5 day course of Macrobid, and prophylactic methenamine/Vit C was held. She will finish her course of Macrobid ___, after which she will resume taking methenamine + Vit C.\n\nCHRONIC & RESOLVED ISSUES: \n============================ \n#HFpEF:\nAppeared euvolemic on admission. Continued home furosemide 20mg daily and diltiazem. Home Lisinopril discontinued due to soft blood pressures. Discharge weight: 129.9lbs. \n\nTRANSITIONAL ISSUES:\n====================\n[] Discharge weight: 129.9 lbs. \n[] Please ensure patient does not receive anti-inflammatory medications for several weeks post-pleurodesis.\n[] Discharged on 5 day course of Macrobid (___) for empiric treatment of UTI, urine culture pending at time of discharge. \n[] Methenamine-Ascorbic Acid was held on discharge due to starting Macrobid 5 day course. Patient can restart methamine-ascorbic acid on ___ after macrobid course is complete.\n[] Lisinopril was discontinued this hospitalization due to relatively low blood pressures. Follow-up pressure and consider re-starting if needed\n[] Ensure ongoing goals of care discussions and follow-up regarding enlarging pulmonary mass \n\n#CODE: DNR/DNI (confirmed); ok to reverse for procedures\n#CONTACT: ___ \n Relationship: Daughter / HCP\n Phone number: ___"}}
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{'final_diagnoses': ['Spontaneous pneumothorax', 'Emphysema', 'Urinary tract infection', 'Malignant lung nodule', 'Afib', 'HFpEF', 'Hypothyroidism', 'Recurrent UTIs (on prophylactic methenamine-vitC)'], 'procedures': ['Pigtail Catheter Placement', 'Thoracoscopy guided Talc Pleurodesis'], 'visit_summary': "PATIENT SUMMARY:\n====================\nMs. ___ is a ___ year old woman with PMH of severe emphysema, lung cancer s/p palliative XRT, HFpEF, HTN, TIAs, a-fib on Eliquis who presented with R sided chest pain and dyspnea and was found to have a large R sided pneumothorax. A pigtail catheter was placed by IP with re-expansion of the lung. Patient then underwent talc pleurodesis to prevent recurrence. Course complicated by development of UTI which was treated with PO macrobid (continued through ___. \n\nACUTE ISSUES: \n============= \n#Spontaneous Pneumothorax\n#Emphysema\nAs above, Ms. ___ presented with acute R sided chest pain, SOB, and hypoxemia and was found to have large R sided PTX. It was felt this was secondary to her underlying severe emphysema. Interventional Pulmonology placed a pigtail catheter with complete re-expansion of the lung, then eventually performed a talc pleurodesis via thoracoscopy ___. Daily CXRs were performed to assess interval change, which demonstrated stability. Pre-procedure, her DOAC was held but restarted uneventfully ___. Her pain was controlled with tylenol and oxycodone 2.5mg q4hr:PRN (NSAIDs avoided due to interference with anti-inflammatory response required for successful pleurodesis -- IVF also avoided for this reason). Follow-up with interventional pulmonology arranged prior to discharge. \n\n#Atrial fibrillation with rapid ventricular response\nCHADS2-VASc 7. During her hospitalization, Ms. ___ developed new-onset pleuritic chest pain with tachycardia. ECG notable for atrial fibrillation with rapid ventricular response. ECG with new TWI but cardiac enzymes persistently negative, so ACS felt to be unlikely. Some concern for PE as trigger given held anticoagulation prior to procedure, but LENIs negative and patient without worsening hypoxemia. Ultimately attributed to pain post-pleurodesis and resolved with treatment of pain. Home diltiazem continued. Home apixaban initially held for pleurodesis, then re-started post-procedure.\n\n#Lung Nodule, malignant\nPer review of records here and at ___, Ms. ___ has had multiple pulmonary nodules seen on CT chest since ___, with one FDG-avid spiculated nodule. Has received palliative radiation at ___, but no definitive biopsy in concordance with patient's wishes. On CT here, possible progression of nodule to mass. Further conversations with the patient confirmed that she did not want biopsy. \n\n#Urinary Tract Infection\nPatient is followed in ___ clinic and has history of recurrent UTIs, although per chart review may also be chronically colonized with E.Coli. She has been taking prophylactic methenamine +Vitamin C at home. On ___, she developed urinary frequency and dysuria, with UA showing multiple WBCs, ___ positive with bacteria. She was started on a 5 day course of Macrobid, and prophylactic methenamine/Vit C was held. She will finish her course of Macrobid ___, after which she will resume taking methenamine + Vit C.\n\nCHRONIC & RESOLVED ISSUES: \n============================ \n#HFpEF:\nAppeared euvolemic on admission. Continued home furosemide 20mg daily and diltiazem. Home Lisinopril discontinued due to soft blood pressures. Discharge weight: 129.9lbs. \n\nTRANSITIONAL ISSUES:\n====================\n[] Discharge weight: 129.9 lbs. \n[] Please ensure patient does not receive anti-inflammatory medications for several weeks post-pleurodesis.\n[] Discharged on 5 day course of Macrobid (___) for empiric treatment of UTI, urine culture pending at time of discharge. \n[] Methenamine-Ascorbic Acid was held on discharge due to starting Macrobid 5 day course. Patient can restart methamine-ascorbic acid on ___ after macrobid course is complete.\n[] Lisinopril was discontinued this hospitalization due to relatively low blood pressures. Follow-up pressure and consider re-starting if needed\n[] Ensure ongoing goals of care discussions and follow-up regarding enlarging pulmonary mass \n\n#CODE: DNR/DNI (confirmed); ok to reverse for procedures\n#CONTACT: ___ \n Relationship: Daughter / HCP\n Phone number: ___", 'medications_prescribed': ['Acetaminophen 1000 mg PO TID \nRX *acetaminophen [Acetaminophen Extra Strength] 500 mg 2 tablet(s) by mouth three times a day Disp #*90 Tablet Refills:*0', 'Nitrofurantoin Monohyd (MacroBID) 100 mg PO Q12H Duration: 5 Days \ndo not take methenamine + vitamin C with this medication. \nRX *nitrofurantoin monohyd/m-cryst [Macrobid] 100 mg 1 capsule(s) by mouth twice daily Disp #*9 Capsule Refills:*0', 'Apixaban 2.5 mg PO BID', 'Calcium Carbonate 500 mg PO DAILY', 'Diltiazem Extended-Release 360 mg PO DAILY', 'Docusate Sodium 100 mg PO DAILY:PRN Constipation - First Line', 'Furosemide 20 mg PO DAILY', 'Levothyroxine Sodium 50 mcg PO QAM', 'Oxybutynin XL (*NF*) 5 mg Other DAILY', 'Pravastatin 40 mg PO QPM', 'Vitamin D 400 UNIT PO DAILY', 'HELD- Ascorbic Acid ___ mg PO BID This medication was held. Do not restart Ascorbic Acid until you complete your course of antibiotics', 'HELD- methenamine hippurate 1 gram oral BID This medication was held. Do not restart methenamine hippurate until finishing your antibiotics for your UTI']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'M', 'symptoms': 'Right Sided Weakness, inability to speak', 'medical_history': ['None'], 'family_history': 'Uncle with an MI in his ___', 'present_illness': 'This is a ___ yo RH Caucasian woman with no significant medical \nhistory who presents transferred from ___. Per \nfamily report, patient was at her usual state of health this \nmorning. Approximately around 8am she called on her daughter \n(she was still at home) feeling unwell. She reportedly looked \npale and subsequently "collapsed" in the couch, becoming \nunresponsive, although the exact nature of this unresponsiveness \nremains unclear. The neighbors called EMS. The circumstances are \nnot well described, but it is known that the patient was \nbradycardic, normotensive and was not reliably following \ncommands, though she was awake. She was noted to move the R side \nsignificantly less than the L. Upon arrival at ___ \nsome motor function recovery on the R side was noted. She was \nintubated for airway protection. Tele-Stroke advised \nadministration of IVtPA based on symptoms and grossly dense L \nMCA in CT scan. tPA administered at 10:00am.\n\nUpon arrival in our ED, BP in the 100-110s, HR in the high ___. \nGlobally aphasic, not following any commands. R gaze preference, \nbut not forced deviation. Although on low dose propofol \ncontinuous infusion (___) patient alert, opening \neyes spontaneously. Pupils equal, reactive to light bilaterally \n(3-->2mm). Moves L side readily. Some spontaneous movement of \nthe R arm in the horizontal plane. Very minimal spontaneous \nmovement of the R leg, though the latter fluctuated \nsignificantly throuhgout her ED stay. Withdraws to noxious \nstimuli on the R and L. \n\nCT scan with hypodensity in the L MCA territory, more prominent \nin the superior division subterritory. CTA with occlusion of the \nL ICA distal to the carotid bifurcation- flame-shaped tapered \npattern in the reconstructions characteristic of dissection. \nBased on ___ scan there is persistent clot in the entire L MCA \n(seen in M1 as well as proximal M2 segments). Very minimal flow \nin some distal L MCA branches. Perfusion scan with reduced blood \nvolume/ blood flow and increased MTT across the entire L MCA \nterritory. \n\nInterventions in the ED: Patient was given 2L of NS as IV bolus, \npressure remained in the 110s (this caused significant diuresis \napp 500cc/hr for ___. Subsequently 150cc/hr of NS. Sedation \nwas changed from Propofol to midazolam (propofol lowering \npressure). We considered the option of mechanical clot \nretrieval, but given the extent of thrombosis and already \nestablished extensive hypodensity in the L hemisphere bespeaking \nextensive area of already infarcted tissue, it was felt that the \nrisks would outweigh the benefits.\n\nEtiology of dissection unclear- no obvious provoking event / \ntrauma. Patient runs approx 40mins ___ times/week last time app \n1 week ago. Occasional very light weight lifting. No recent \nstrenuous exertion. She works as a ___. No hx of \nsmoking. She reportedly started OCPs 1.5 weeks ago. No family hx \nof strokes. No family or personal hx of connective tissue \ndisorders.', 'medications': [{'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Multivitamins W/minerals', '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', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', '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': 'Diazepam - CIWA protocol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '44.0', 'valuenum': 44.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, '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': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '182', 'valuenum': 182.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.65', 'valuenum': 4.65, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, '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': '56.6', 'valuenum': 56.6, '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': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '339', 'valuenum': 339.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, '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': 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': '15', 'valuenum': 15.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', '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': 0.0, 'ref_range_upper': 1.5, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '6', 'valuenum': 6.0, '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': '358', 'valuenum': 358.0, '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': '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.7', 'valuenum': 46.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '32.1', 'valuenum': 32.1, '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': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.97', 'valuenum': 4.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55.6', 'valuenum': 55.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'log10 IU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '32', 'valuenum': 32.0, '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', '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': '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': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'POSITIVE*.'}, {'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': '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': '3.7', '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': 3.5, '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.277', 'valuenum': 0.277, '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': '0.967', 'valuenum': 0.967, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.28', 'valuenum': 18.28, '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': '14', 'valuenum': 14.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43.7', 'valuenum': 43.7, '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': '29.8', 'valuenum': 29.8, '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': '93', 'valuenum': 93.0, '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.70', 'valuenum': 4.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, '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': '54.4', 'valuenum': 54.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '93', 'valuenum': 93.0, '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': 10.0, 'ref_range_upper': 18.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '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': '___', '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': '28', 'valuenum': 28.0, '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2131', 'valuenum': 2131.0, 'valueuom': 'mg/dL', 'ref_range_lower': 700.0, 'ref_range_upper': 1600.0, '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': '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': 3.5, '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.173', 'valuenum': 0.173, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, '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': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'POS*. Presumptive (unconfirmed) positive. If clinically indicated recommend confirmation by alternate method. To be used only for medical (ie, treatment) purposes.. 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': 'abnormal', 'priority': 'STAT', 'comments': 'POS*. Presumptive (unconfirmed) positive. If clinically indicated recommend confirmation by alternate method. To be used only for medical (ie, treatment) purposes..'}, {'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': '47', 'valuenum': 47.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-479', 'valuenum': -479.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '519', 'valuenum': 519.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-250', 'valuenum': -250.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-65', 'valuenum': -65.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-354', 'valuenum': -354.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': "Vitals: T:98 P: 80 R: 20 BP:134/78 SaO2:100% intubated\nGeneral: Sedated, intubated.\nHEENT: NC/AT, MMM.\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: Lungs CTA bilaterally \nCardiac: RRR, nl. S1S2 \nAbdomen: soft, NT/ND.\nExtremities: No edema or deformities.\nSkin: no rashes or lesions noted.\n\nNeurologic:\nIntubated and sedated. Off propofol for examination. Eyes \nclosed, not opening to pain stimuli, give a grimace that looks \nsymmetric, but obscured by ET tube and holder. did not test gag \nor cough now. PERRL, VOR intact. No blink to threat but + \ncorneals b/l with no clear asymmetry. Is localizing with both \nhands to pain, limited exam as not following commands now but \nseems at least ___ mstrength in both upper extremities. Reflexes \nin UE are brisk and symmetric no clear difference in tone. In \nthe lower extremities withdraws the left leg much more brisker \nthen the right, Reflexes are once again brisk and symmetric. The \ntoe on the right is up going.\n\n** Discharge examination: Improved cognition, with some \nappropriate answers. Wernicke's aphasia remains present. \nResponds to most commands. Gross Left hemiparesis persists.", 'diagnoses': [{'icd_code': 'I200', 'desc': 'Unstable angina'}, {'icd_code': 'I5023', 'desc': 'Acute on chronic systolic (congestive) heart failure'}, {'icd_code': 'I110', 'desc': 'Hypertensive heart disease with heart failure'}, {'icd_code': 'Z590', 'desc': 'Homelessness'}, {'icd_code': 'Z5321', 'desc': 'Procedure and treatment not carried out due to patient leaving prior to being seen by health care provider'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}, {'icd_code': 'K7469', 'desc': 'Other cirrhosis of liver'}, {'icd_code': 'B1920', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': 'F14129', 'desc': 'Cocaine abuse with intoxication, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'R161', 'desc': 'Splenomegaly, not elsewhere classified'}, {'icd_code': 'I340', 'desc': 'Nonrheumatic mitral (valve) insufficiency'}], 'summary': '___ ECHO IMPRESSION: The left atrium is normal in size. \nNo atrial septal defect or patent foramen ovale is seen by 2D, \ncolor Doppler or saline contrast (single injection). Left \nventricular wall thickness, cavity size, and global systolic \nfunction are normal (LVEF 65%). Right ventricular chamber size \nand free wall motion are normal. The number of aortic valve \nleaflets cannot be determined. The mitral valve appears \nstructurally normal with trivial mitral regurgitation \n(borderline mitral valve prolapse may be present). The estimated \npulmonary artery systolic pressure is normal. There is no \npericardial effusion. \n\n___ CTA Head/Neck IMPRESSION: \n1. Tapering occlusion of the left cervical internal carotid \nartery. MRI/MRA is recommended for further assessment of \ndissection. \n2. Lack of flow in the left middle cerebral artery with a \nmatched perfusional defect on CTP. \n\n___ MRI Head IMPRESSION: Extensive area of restricted \ndiffusion identified in the left cerebral hemisphere, vascular \nterritory of the left middle cerebral artery, related with an \nevolving ischemic event, causing effacement of the sulci and \nnarrowing of the lateral ventricle as described above with no \nfrank evidence of hemorrhagic transformation. There is \nocclusion of the left internal carotid artery, previously \ndemonstrated by CTA. \n\n___ MRI Head IMPRESSION: \n1. Extensive edema from a left MCA infarction with continued \nmass effect on the left lateral ventricle and increased bulging \nof the brain through the hemicraniectomy defect. \n2. Decreased pneumocephalus with no evidence of new hemorrhage.\n___ F w/left extracranial carotid dissection with resulting\nthrombosis of the left ICA and MCA, and extensive left MCA\ninfarct s/p IV TPA ___ and decompressive hemicraniectomy on \n___. \n\nICU course: \n___: Transferred to ___ for large left ICA and MCA stroke, \ns/p tPA at 10am at OSH. Echo normal, negative bubble study. Exam \nremained stable. \n___: Withdrawal only on R side, not following commands. Harder \nto arouse after CT; plan to stay intubated, repeat scan 6pm. \nStarted mannitol: first bolused, then q6h. Family meeting update \nwith neurology. A-line, L SC CVL placed. Repeat NCHCT 6pm with \nincreased cerebral edema, concern for mild transtentorial and \nuncal herniation. After discussion between neurology and \nneurosurgery, increased mannitol to 25 q6h. Plan for repeat scan \n0400, likely hemicraniectomy in AM. \n___: Somewhat less spontaneously interactive overnight, 0400 \nNCHCT with persistent subfalcine herniation - otherwise \nunchanged. To OR for L crani. L a-line in OR. 3% NS with Q4 Na \ncontinued 2 h post-op. hydral for sbp > 140. post-op head CT. \nRUE duplex for diminished pulses (remained dopplerable), \nswelling, coolness. CXR per neuro for infectious w/u. \nImprovement in exam after surgery. NGT exchanged for dobhoff. \n___: more awake, L gaze preference, R pupil > L. Extubated in \nthe morning, tube feeds started (goal 55), ___ consulted. \nSputum cx with strep pneumo/coag + staph. Urine cx no growth \n___: Purposeful movements, R pupil > L, reactive. More alert, \nputs on glasses. A1c, lipid panel for stroke w/u; repeat NCHCT \nper neuro. Called out to step-down. Awaiting helmet. \n\nNeurology Ward course:\n# Infectious Disease: Sputum culture showed moderate growth of \npneumococcus and sparse growth of MSSA on ___. Patient was \ntreated with a 7-day course of cefazolin. Patient was \nasymptomatic and afebrile throughout her hospital stay.\n\n# Neurology: Patient had right hemiparesis and global aphasia \n(not able to speak but able to sing "happy birthday") at time of \nadmission to the ward. She has developed spastic hyperreflexia \non her right side. Patient started on aspirin 81 mg on ___. \nThe patient\'s aphasia has been improving since her admission to \nthe ward, and has notably been consistent with Wernicke\'s \naphasia; fluent, responds appropriately to some but not most \nverbal commands, with some appropriate "yes / no" answers. \n\nTransitions of care:\n- Follow up has been scheduled with Neurosurgery, Neurology, and \nfor repeat CT imaging of the head.\n- The patient has been counseled to wear her helmet with any \nactivity, which will be conveyed to rehabilitation.'}}
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{'final_diagnoses': ['Malignant Left MCA Infarct', 'Left ICA dissection'], 'procedures': ['Hemicraniectomy'], 'visit_summary': '___ F w/left extracranial carotid dissection with resulting\nthrombosis of the left ICA and MCA, and extensive left MCA\ninfarct s/p IV TPA ___ and decompressive hemicraniectomy on \n___. \n\nICU course: \n___: Transferred to ___ for large left ICA and MCA stroke, \ns/p tPA at 10am at OSH. Echo normal, negative bubble study. Exam \nremained stable. \n___: Withdrawal only on R side, not following commands. Harder \nto arouse after CT; plan to stay intubated, repeat scan 6pm. \nStarted mannitol: first bolused, then q6h. Family meeting update \nwith neurology. A-line, L SC CVL placed. Repeat NCHCT 6pm with \nincreased cerebral edema, concern for mild transtentorial and \nuncal herniation. After discussion between neurology and \nneurosurgery, increased mannitol to 25 q6h. Plan for repeat scan \n0400, likely hemicraniectomy in AM. \n___: Somewhat less spontaneously interactive overnight, 0400 \nNCHCT with persistent subfalcine herniation - otherwise \nunchanged. To OR for L crani. L a-line in OR. 3% NS with Q4 Na \ncontinued 2 h post-op. hydral for sbp > 140. post-op head CT. \nRUE duplex for diminished pulses (remained dopplerable), \nswelling, coolness. CXR per neuro for infectious w/u. \nImprovement in exam after surgery. NGT exchanged for dobhoff. \n___: more awake, L gaze preference, R pupil > L. Extubated in \nthe morning, tube feeds started (goal 55), ___ consulted. \nSputum cx with strep pneumo/coag + staph. Urine cx no growth \n___: Purposeful movements, R pupil > L, reactive. More alert, \nputs on glasses. A1c, lipid panel for stroke w/u; repeat NCHCT \nper neuro. Called out to step-down. Awaiting helmet. \n\nNeurology Ward course:\n# Infectious Disease: Sputum culture showed moderate growth of \npneumococcus and sparse growth of MSSA on ___. Patient was \ntreated with a 7-day course of cefazolin. Patient was \nasymptomatic and afebrile throughout her hospital stay.\n\n# Neurology: Patient had right hemiparesis and global aphasia \n(not able to speak but able to sing "happy birthday") at time of \nadmission to the ward. She has developed spastic hyperreflexia \non her right side. Patient started on aspirin 81 mg on ___. \nThe patient\'s aphasia has been improving since her admission to \nthe ward, and has notably been consistent with Wernicke\'s \naphasia; fluent, responds appropriately to some but not most \nverbal commands, with some appropriate "yes / no" answers. \n\nTransitions of care:\n- Follow up has been scheduled with Neurosurgery, Neurology, and \nfor repeat CT imaging of the head.\n- The patient has been counseled to wear her helmet with any \nactivity, which will be conveyed to rehabilitation.', 'medications_prescribed': ['1. Bisacodyl ___AILY:PRN constipation', '2. Docusate Sodium (Liquid) 100 mg PO DAILY:PRN constipation', '3. Heparin 5000 UNIT SC TID', '4. Senna 1 TAB PO BID', '5. Acetaminophen 325-650 mg PO Q6H:PRN pain or temp>100.4', '6. Famotidine 20 mg PO Q12H', '7. Ondansetron 4 mg IV Q8H:PRN nausea', '8. Sodium Chloride 0.9% Flush 3 mL IV Q8H:PRN line flush', '9. Fluoxetine 20 mg PO DAILY', '10. Aspirin 81 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 50, 'gender': 'F', 'symptoms': 'Elevated Creatinine', 'medical_history': ['1. Granulomatosis with polyangitis\nDiagnosed in ___ when she presented with cough, congestion, \nhemoptysis. ANCA+. Followed by Dr. ___ rheumatology \n(now at ___). Developed a flare ___ with gum and nasal \nmembrane ulceration, intermittent epistaxis, and sinus \ncongestion. Was put back on methotrexate and prednisone with \nimprovement and was taken off. Had another flare in ___ \nrequiring reinitiation of methotrexate and prednisone.', '2. Osteopenia. Diagnosed in ___. On Evista and Fosamax in the \npast, started aledronate in ___ when on prednisone. ', '3. GERD. Well controlled currently. ', '4. Hypertension. ', '5. Several basal cell carcinomas and actinic keratoses ', '6. Subglottic stenosis. Underwent a laryngoscopic procedure for \nthis with balloon dilation by Dr. ___ ___ and \ndeveloped a post-op pneumothorax/pneumomediastinum.'], 'family_history': 'Mother ___ ___ HYPERTENSION \nCAROTID STENOSIS ___ \nDIABETES MELLITUS \nMYOCARDIAL INFARCTION ___ \nFather ___ ___ CORONARY ARTERY DISEASE ___ \nBrother Living ___ DIABETES MELLITUS \nOBESE \nNONMELANOMA skin cancer \nBrother Living ___ NONMELANOMA skin cancers \nBrother Living ___ NONMELANOMA skin cancer \nBrother Living ___ NONMELANOMA skin cancers \nSister Living ___ ASTHMA', 'present_illness': '___ PMH Granulomatosis w/ Polyangiitis (dx in ___ recently \nadmitted ___ for ___ (unclear etiology, d/c Cr 1.5) and \nnow returns for ___ and was admitted to medicine for further \nevaluation and management.\n \nOn ___ admission, pt presented w/ Cr of 1.7, up from \nbaseline of 1.1. She was given 500mg IV solumedrol on ___ and \n___. Renal biopsy was performed on ___ and was significant for \nweakly positive IgA of 1+ which could be consistent with an IgA \nnephropathy. She had no fibrinoid necrosis or crescents \nsuggestive of an ANCA vasculitis. Creatinine had improved to 1.5 \non day of discharge. The cause of her ___ remained unclear. \nFollowing discussion with her outpatient nephrologist, she was \ndischarged on 30mg of prednisone x5days, w/ plans to taper as \nper outpatient rheumatologist. Pt also noted to be hypercalcemic \non that admission which normalized to ~9 by time of discharge. \n\nSince then, pt\'s prednisone was weaned to 15mg daily, and was \ncontinued on MTX. She was instructed not to take bactrim. She \nthen traveled to ___ a week ago and was extremely tired, \nrequiring several days of prolonged rest, a/w poor PO intake. \nShe then developed a "cold" on her trip, along w/ her husband, \nbut noted that she produced phlegm and blood clots. Similar \nclots were produced w/ her initial wegeners presentation, but \nthis time self-resolved and thought it was ___ humidity. She \nthen had outpt appt where her Cr was checked and found to be \n2.8, so referred to ED for admission. \nOn ROS, denies CP, SOB, abdominal pain, urinary sx, fevers, \nchills, diarrhea, nausea. \n\nIn the ED initial vitals were: 97.7 72 99/49 16 98%. Labs were \nsignificant for plt 446, BNP ~4800, ___, Phos 5.9, Na129, K \n5.2, BUN/Cr 50/3.0, CRP 46, ALT 41, UA w/ spec gr 1.013, Tr \nprotein, 5WBC, Na 36, Osm 306. Renal U/S showed no evidence of \nhydronephrosis. Punctate hyperechoic foci in the right kidney \nmay represent tiny stones or milk of calcium. CXR showed no e/o \ninfection. \n\nPatient was given 1L NS and was admitted to medicine. On the \nfloor, pt noted that she felt tired, and was extremely worried \nthat her Cr is worsening. ', 'medications': [{'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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 via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS: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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', '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': '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '160', 'valuenum': 160.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.7', 'valuenum': 44.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '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': 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': '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': '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': '4', 'valuenum': 4.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, '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': '12', 'valuenum': 12.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 79.0, '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': '3.5', 'valuenum': 3.5, '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': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam:\nVitals - 98.4, BP123/58, P67, R18, O296RA, Wt60.8 \nGENERAL: NAD, pleasant, lying in bed, NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, \ndry MM, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, systolic murmur at sternal border \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, slightly tender in epigastric \nregion, no rebound/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:\nVitals - 98.3, BP ___, P50s, R18, O2 92RA \nGENERAL: NAD, pleasant, lying in bed, NAD \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, pink conjunctiva, \ndry MM, good dentition \nNECK: nontender supple neck, no LAD, no JVD \nCARDIAC: RRR, systolic murmur at sternal border \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, slightly tender in epigastric \nregion, no rebound/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 \nMEDS/LABS: see attached ', 'diagnoses': [{'icd_code': 'N10', 'desc': 'Acute pyelonephritis'}, {'icd_code': 'G35', 'desc': 'Multiple sclerosis'}, {'icd_code': 'B9620', 'desc': 'Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z8589', 'desc': 'Personal history of malignant neoplasm of other organs and systems'}, {'icd_code': 'R195', 'desc': 'Other fecal abnormalities'}], 'summary': 'Admission Labs:\n\n___ 02:55PM URINE HOURS-RANDOM\n___ 09:15AM GLUCOSE-88 UREA N-49* CREAT-2.7* SODIUM-136 \nPOTASSIUM-3.9 CHLORIDE-100 TOTAL CO2-25 ANION GAP-15\n___ 09:15AM ALT(SGPT)-31 AST(SGOT)-27 ALK PHOS-42 TOT \nBILI-0.3\n___ 09:15AM CALCIUM-12.1* PHOSPHATE-3.4# MAGNESIUM-1.6\n___ 09:15AM PTH-22\n___ 09:15AM WBC-7.2 RBC-3.05* HGB-9.8* HCT-29.0* MCV-95 \nMCH-32.2* MCHC-33.8 RDW-18.1*\n___ 09:15AM PLT COUNT-296\n___ 09:15AM ___ PTT-20.7* ___\n___ 11:30PM URINE HOURS-RANDOM CREAT-85 SODIUM-36 \nPOTASSIUM-39 CHLORIDE-29\n___ 11:30PM URINE OSMOLAL-306\n___ 11:30PM URINE COLOR-Yellow APPEAR-Hazy SP ___\n___ 11:30PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 11:30PM URINE RBC-3* WBC-5 BACTERIA-NONE YEAST-NONE \nEPI-<1\n___ 11:30PM URINE HYALINE-1*\n___ 11:30PM URINE MUCOUS-RARE\n___ 06:30PM GLUCOSE-183* UREA N-50* CREAT-3.0* \nSODIUM-129* POTASSIUM-5.2* CHLORIDE-91* TOTAL CO2-24 ANION \nGAP-19\n___ 06:30PM ALT(SGPT)-41* AST(SGOT)-29 ALK PHOS-58 TOT \nBILI-0.4\n___ 06:30PM LIPASE-51\n___ 06:30PM proBNP-4893*\n___ 06:30PM ALBUMIN-4.0 CALCIUM-15.6* PHOSPHATE-5.9*# \nMAGNESIUM-1.9\n___ 06:30PM CRP-46.8*\n___ 06:30PM WBC-9.3 RBC-3.79* HGB-12.3 HCT-35.9* MCV-95 \nMCH-32.5* MCHC-34.2 RDW-17.9*\n___ 06:30PM NEUTS-93.0* LYMPHS-5.1* MONOS-1.5* EOS-0.4 \nBASOS-0.1\n___ 06:30PM PLT COUNT-446*\n\nMicrobiology:\nBCX ___\nUCX ___\n\nImaging:\nRenal U/S ___\nNo evidence of hydronephrosis. Punctate hyperechoic foci in the \nright kidney may represent tiny stones or milk of calcium. \n\nCXR ___\nNo acute cardipulmonary process \n\nEKG ___: Sinus at 62bpm, normal intervals, no significant ST \nchanges, unchanged from baseline. \n\nCT Chest ___\n-Newly developed ground-glass opacities and septal thickening. \n-Differential diagnosis would include pulmonary edema, \nparenchymal hemorrhage or drug toxicity. \n-Multiple unchanged pulmonary nodules. \n-Bilateral pleural effusions that might be in favor of cardiac \norigin of the ground-glass opacities \n-Pulmonary arteries dilatation \n-Interval increase in mediastinal lymphadenopathy, potentially \nreactive. \n-Reassessment in not more than 3 months with chest CT is \nrecommended. \n\nDischarge Labs:\nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct \n___ 07:10 5.6 2.76* 8.6* 27.2* 99* 31.2 31.6 18.2* 182 \n\nRENAL & GLUCOSE Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 07:10 ___ 138 3.9 105 18* 19 \nHEMATOLOGIC calTIBC Hapto Ferritn TRF \n___ 07:20 279* \nADDED CHEM @ 10:33AM \n___ 08:00 211* 247* 1098* 162* \nTHYROID PTH \n___ 15:31 19 \nIMMUNOLOGY ___ CRP \n___ 18:30 46.8*1 \nPROTEIN AND IMMUNOELECTROPHORESIS PEP IgG IgA IgM IFE \n___ 15:15 HYPOGAMMAG1 168* 12* 11* NO MONOCLO2 \nOTHER URINE CHEMISTRY U-PEP Osmolal \n___ 14:55 NO PROTEIN1 \n___ PMH Granulomatosis w/ Polyangiitis (GPA) since ___ \nrecently admitted ___ for ___ (unclear etiology, d/c Cr \n1.5) and now returns for ___ and was admitted to medicine for \nfurther evaluation and management \n\nActive issues:\n\n#Acute kidney injury: Pt presented with Cr of 3.0 (baseline of \n1.0-1.1), hypercalcemia to 15.6, and renal US in ED showing \npunctate intrarenal calcifications. She was treated with \nsupportive care including IVFs and cessation of home HCTZ, \nlisinopril, and Ca & vitD supplementation and her Ca normalized \nby ___. Cr fell to 1.7 by discharge on ___. Nephrology \nand rheumatology were consulted given concern for ___ ___ \nmicroscopic polyangiitis flare (CRP 46 with recent hemoptysis) \nthough this was ultimately considered unlikely given improvement \nin Cr. Nephrology ultimately felt that ___ was precipitated by \nhypercalcemia and volume depletion. \n\n#Hypercalcemia: Pt presented with hypercalcemia as discussed \nabove. Workup included normal PTH and Vit D. UPEP/SPEP were \nordered given triad of anemia, ___, and hypercalcemia and \nreturned negative for multiple myeloma. Chest CT on ___ \nshowed no evidence of malignancy. Ca rapidly normalized over \nensuing days with concurrent improvement in renal function; \nhypercalcemia now presumed to have arisen secondary to home \nHCTZ/lisinopril/Ca and Vit D supplementation in setting of \nhypovolemia.\n\n#Anemia: Pt had normal Hb/Hct (12.2/36.5) at admission however \nthen developed anemia with Hb falling to low of 8 over ensuing \ndays. Hb/Hct was 8.6/27.2 at disgharge with MCV 99. Iron studies \nwere notable for low TIBC and transferrin, normal iron, and \nelevated ferritin at 1098 suggesting inflammatory state though \nno evidence of anemia of chronic disease (given normal iron and \nacute onset). Haptoglobin was also elevated (high of 279) with \nnormal total, direct, and indirect bili reassuring for no \nhemolysis. She had no evidence of acute bleed and remained \nhemodynamically stable. Anemia was considered consistent with \ninflammatory state given GPA history though macrocytosis workup \nmay be needed as outpatient.\n\n#Hypogammaglobulinemia: Protein and immunoelectrophoresis \nperformed for multiple myeloma workup on ___ incidentally \nshowed hypogammaglobulinemia with IgG 168, IgA 12 IgM 11. \nRheumatology consulted and was concerned for common variable \nimmunodeficiency or other immunodeficiency disorder. She was \nstarted on Bactrim SS 1 tab PO daily for opportunistic \ninfections and scheduled for follow-up at ___ Allergy and \nInflammation clinic to recheck Ig levels in 2 weeks.\n\n# Leukocytosis with left shift: Pt had leukocytosis to 13.9 on \nthe day prior to admission in ___ clinic then \nleft shift (93% polys) in the ED. Given immunosuppression \n(prednisone and hypogammaglobulinemia) there was concern for \nacute infection. CXR/UA in ED and chest CT ___ negative for \ninfection, and no symptoms suggestive of alternate process. \nBlood and urine cultures were sent and remained negative. She \nwas mildly hypotensive but afebrile throughout her admission and \nconcern for infection was low given lack of localizing symptoms.\n\n#Granulomatosis w/ polyangiitis with c/f flare: Pt was diagnosed \nwith GPA in ___ with history of upper airway, gum, joint space, \nand nasal membrane involvement and ___ flares since diagnosis. \nAs note rheum had initial concern for flare given CRP 46 and \nrecent hemoptysis and fatigue. ENT performed a flexible scope at \nbedside and saw no granulomas/concerning lesions to biopsy in \nnasopharynx or oropharynx. Based on this result a flare was \nconsidered unlikely. She was maintained on prednisone 15mg daily \n(presently on taper managed by outpatient rheum at ___) and no \nmethotrexate.\n\nChronic issues:\n\n# Hypertension: Patient has history of hypertension, most recent \nvalue in OMR sheet 171/55 in ___, though pressures \nremained normal to low this admission. Home HCTZ and lisinopril \nwere held in setting of ___. \n\n# GERD: Pt continued on home omeprazole with no symptoms.\n\n# Osteopenia: Pt continued on home alendronate, calcium and \nvitamin D held.'}}
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{'final_diagnoses': ['1. Acute Kidney Injury', '2. Granulomatosis with Polyangiitis', '3. Hypercalcemia', '4. Anemia', '5. Hypogammaglobulinemia', '6. Hypertension', '7. GERD', '8. Osteopenia'], 'procedures': ['Flexible Laryngoscopy ___'], 'visit_summary': '___ PMH Granulomatosis w/ Polyangiitis (GPA) since ___ \nrecently admitted ___ for ___ (unclear etiology, d/c Cr \n1.5) and now returns for ___ and was admitted to medicine for \nfurther evaluation and management \n\nActive issues:\n\n#Acute kidney injury: Pt presented with Cr of 3.0 (baseline of \n1.0-1.1), hypercalcemia to 15.6, and renal US in ED showing \npunctate intrarenal calcifications. She was treated with \nsupportive care including IVFs and cessation of home HCTZ, \nlisinopril, and Ca & vitD supplementation and her Ca normalized \nby ___. Cr fell to 1.7 by discharge on ___. Nephrology \nand rheumatology were consulted given concern for ___ ___ \nmicroscopic polyangiitis flare (CRP 46 with recent hemoptysis) \nthough this was ultimately considered unlikely given improvement \nin Cr. Nephrology ultimately felt that ___ was precipitated by \nhypercalcemia and volume depletion. \n\n#Hypercalcemia: Pt presented with hypercalcemia as discussed \nabove. Workup included normal PTH and Vit D. UPEP/SPEP were \nordered given triad of anemia, ___, and hypercalcemia and \nreturned negative for multiple myeloma. Chest CT on ___ \nshowed no evidence of malignancy. Ca rapidly normalized over \nensuing days with concurrent improvement in renal function; \nhypercalcemia now presumed to have arisen secondary to home \nHCTZ/lisinopril/Ca and Vit D supplementation in setting of \nhypovolemia.\n\n#Anemia: Pt had normal Hb/Hct (12.2/36.5) at admission however \nthen developed anemia with Hb falling to low of 8 over ensuing \ndays. Hb/Hct was 8.6/27.2 at disgharge with MCV 99. Iron studies \nwere notable for low TIBC and transferrin, normal iron, and \nelevated ferritin at 1098 suggesting inflammatory state though \nno evidence of anemia of chronic disease (given normal iron and \nacute onset). Haptoglobin was also elevated (high of 279) with \nnormal total, direct, and indirect bili reassuring for no \nhemolysis. She had no evidence of acute bleed and remained \nhemodynamically stable. Anemia was considered consistent with \ninflammatory state given GPA history though macrocytosis workup \nmay be needed as outpatient.\n\n#Hypogammaglobulinemia: Protein and immunoelectrophoresis \nperformed for multiple myeloma workup on ___ incidentally \nshowed hypogammaglobulinemia with IgG 168, IgA 12 IgM 11. \nRheumatology consulted and was concerned for common variable \nimmunodeficiency or other immunodeficiency disorder. She was \nstarted on Bactrim SS 1 tab PO daily for opportunistic \ninfections and scheduled for follow-up at ___ Allergy and \nInflammation clinic to recheck Ig levels in 2 weeks.\n\n# Leukocytosis with left shift: Pt had leukocytosis to 13.9 on \nthe day prior to admission in ___ clinic then \nleft shift (93% polys) in the ED. Given immunosuppression \n(prednisone and hypogammaglobulinemia) there was concern for \nacute infection. CXR/UA in ED and chest CT ___ negative for \ninfection, and no symptoms suggestive of alternate process. \nBlood and urine cultures were sent and remained negative. She \nwas mildly hypotensive but afebrile throughout her admission and \nconcern for infection was low given lack of localizing symptoms.\n\n#Granulomatosis w/ polyangiitis with c/f flare: Pt was diagnosed \nwith GPA in ___ with history of upper airway, gum, joint space, \nand nasal membrane involvement and ___ flares since diagnosis. \nAs note rheum had initial concern for flare given CRP 46 and \nrecent hemoptysis and fatigue. ENT performed a flexible scope at \nbedside and saw no granulomas/concerning lesions to biopsy in \nnasopharynx or oropharynx. Based on this result a flare was \nconsidered unlikely. She was maintained on prednisone 15mg daily \n(presently on taper managed by outpatient rheum at ___) and no \nmethotrexate.\n\nChronic issues:\n\n# Hypertension: Patient has history of hypertension, most recent \nvalue in OMR sheet 171/55 in ___, though pressures \nremained normal to low this admission. Home HCTZ and lisinopril \nwere held in setting of ___. \n\n# GERD: Pt continued on home omeprazole with no symptoms.\n\n# Osteopenia: Pt continued on home alendronate, calcium and \nvitamin D held.', 'medications_prescribed': ['1. Alendronate Sodium 70 mg PO QTHUR ', '2. Fish Oil (Omega 3) 1000 mg PO DAILY ', '3. Omeprazole 20 mg PO DAILY ', '4. PredniSONE 15 mg PO DAILY ', '5. Simvastatin 40 mg PO DAILY ', '6. Sodium Chloride Nasal ___ SPRY NU TID:PRN dryness \nRX *sodium chloride 0.65 % ___ spray intranasal TID: PRN Disp \n#*1 Spray Refills:*0', '7. Sulfameth/Trimethoprim SS 1 TAB PO DAILY \nRX *sulfamethoxazole-trimethoprim 400 mg-80 mg 1 tablet(s) by \nmouth daily Disp #*30 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 34, 'gender': 'M', 'symptoms': 'Cerebral aneurysm', 'medical_history': ['HTN', 'Urinary retention'], 'family_history': 'Family history is notable for his father, who died of aneurysmal\nsubarachnoid hemorrhage. He was cared for in ___.', 'present_illness': '___ man with a history of an unruptured anterior \ncommunicating artery aneurysm\nfirst diagnosed in ___. His father has a history of death due\nto aneurysmal subarachnoid hemorrhage. MRI scan was performed \nof his back after an injury in ___, imaging was carried out \nthrough the cranial circulation, given his family history or \naneurysm.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H: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': 'Influenza Virus 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', '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': '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': '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/NG', 'frequency': 'Q4H: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': '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': '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': '39.0', 'valuenum': 39.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', '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': '___', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '___', 'valuenum': 1.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'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': '8.4', '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': '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': 121.0, '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': '3.3', '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': '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': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, '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': '87', 'valuenum': 87.0, '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': 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': '4.57', 'valuenum': 4.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '13.3', 'valuenum': 13.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, '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': '86', 'valuenum': 86.0, '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': 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': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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}, {'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': '___', 'valuenum': 4.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': 'ROUTINE', 'comments': '___'}, {'value': '3.7', 'valuenum': 3.7, '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': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'ON DISCHARGE\n============\nAOx3, fluent speech\nLeft eyelid swollen shut but examiner able to open it for exam\nPERRLA\nCNII-XII intact\nMotor: \nno drift\n___ strength in all muscle groups\nSensation intact to light touch\nIncision c/d/i sutures', 'diagnoses': [{'icd_code': '81342', 'desc': 'Other closed fractures of distal end of radius (alone)'}, {'icd_code': '82525', 'desc': 'Closed fracture of metatarsal bone(s)'}, {'icd_code': '8910', 'desc': 'Open wound of knee, leg [except thigh], and ankle, without mention of complication'}, {'icd_code': 'E8120', 'desc': 'Other motor vehicle traffic accident involving collision with motor vehicle injuring driver of motor vehicle other than motorcycle'}], 'summary': 'Please see OMR for pertinent imaging & labs\nOn ___, Mr. ___ presented for elective clipping of AComm \naneurysm. His operative course was uncomplicated; please see OMR \nfor full operative report. Postoperatively, he was monitored in \nPACU where he remained stable prior to transfer to ___. In \n___, his arterial line and foley were removed. His pain was \ncontrolled and he was tolerating a regular diet. On POD#1, he \nwas transferred to the floor in stable condition.\n\nOn POD #2, the day of discharge he was tolerating a regular \ndiet, ambulating without difficulty, afebrile with stable vital \nsigns.'}}
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{'final_diagnoses': ['Cerebral aneurysm'], 'procedures': ['Left Craniotomy for Clipping of Anterior communicating \nartery Aneursym'], 'visit_summary': 'On ___, Mr. ___ presented for elective clipping of AComm \naneurysm. His operative course was uncomplicated; please see OMR \nfor full operative report. Postoperatively, he was monitored in \nPACU where he remained stable prior to transfer to ___. In \n___, his arterial line and foley were removed. His pain was \ncontrolled and he was tolerating a regular diet. On POD#1, he \nwas transferred to the floor in stable condition.\n\nOn POD #2, the day of discharge he was tolerating a regular \ndiet, ambulating without difficulty, afebrile with stable vital \nsigns.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN Pain - Mild', 'Bisacodyl 10 mg PO DAILY', 'Docusate Sodium 100 mg PO BID', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg ___ tablet(s) by mouth every 4 hours Disp \n#*30 Tablet Refills:*0', 'Scopolamine Patch 1 PTCH TD ONCE Duration: 72 Hours', 'Senna 8.6 mg PO BID:PRN constipation', 'amLODIPine 5 mg PO DAILY', 'Atorvastatin 10 mg PO QPM', 'Hydrochlorothiazide 25 mg PO DAILY', 'Sertraline 50 mg PO DAILY', 'Tamsulosin 0.4 mg PO QHS']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 89, 'gender': 'F', 'symptoms': 'Oliguria, LLQ pain', 'medical_history': ['ONCOLOGIC HISTORY: Mr. ___ has a history of metastatic renal\ncancer originally diagnosed in ___ s/p R nephrectomy at that\ntime.', '- ___ - ___ diagnosed; underwent R nephrectomy.', '- ___ - ___ - Anemia and weight loss', '- ___ - Admitted to OSH with episode of LOC. CT abdomen\nshowed masses in the liver, pancreas, L kidney. Bx of liver\nlesion showed metastatic RCC', '- ___ - Cycle 1 Week 1 of high-dose IL2', '- ___ - Cycle 1 Week 2 of high dose IL2 complicated by \nacute\nkidney injury and pulmonary edema', '- ___ - CT abdomen shows progression of disease', '- ___ - Patient enrolled in Phase II biomarker trial of\ntivozinib (C1D1)', '- ___ - CT torso tumor metrics - Stable disease with\ncentral necrosis of the metastatic tumors in liver and pancreas', '- ___ - Stable disease', '- ___ - Stable disease', '- ___ - MRI head - No acute intracranial disease', '- ___ - CT torso - Stable disease', '- ___ - Stable disease', '- ___ - Stable disease', '- ___ - CT torso, stable disease', '- ___ - developed hematuria, held tivozanib, hematuria\nresolved. Urologic w/u negative for bladder tumors or stones,\nlikely source of bleeding the kidney', '- ___ - CT torso: interval increase in solid components of\nthe hepatic metastases may represent tumor ingrowth ', '- ___ - decided to go off study due to hematuria and\nevidence of tumor ingrowth on CT', '- ___ C1D1 on clinical trial ___, which is phase III \ntrial\nof ___, a PD-1 antibody, versus everolimus in patients\nwith metastatic clear-cell renal cell carcinoma who have \nreceived\nprior antiangiogenic therapy. Randomized to PD1 arm. ___ -\n3mg/kg IV every two weeks on D1 and D15.', '- ___ CT TORSO Stable', '- ___ CT TORSO Slight interval enlargement of multiple\nhepatic mets and pancreatic head mets ', '- ___ CT TORSO: 4-mm RUL nodule increased in size. ', '- ___ CT TORSO shows NEW LLL 3mm nodule, other lung nodules\nstable, no new LAD. Pancreatic head mass and hepatic mass \nstable.\nBRAIN MRI showed ___', '- ___ Taken OFF study ___ FTT with anorexia, fatigue and new\nelectrolyte abnormalities including hyponatremia and\nhypercalcemia likely multifactorial in nature related to \npossible\nparaneoplastic phenomenon and hypovolemia.', 'PAST MEDICAL HISTORY: \nHTN\nHypercholesteremia\nCataracts\nBPH\nFocal Seizures first dx ___, on keppra; last SZ ___ last MR \nhead ___ showed no metastatic dz\nHx of kidney stones\nDiabetes: dx ___, on home glargine and humalog SSI'], 'family_history': 'NC', 'present_illness': "___ with metastatic clear cell RCC (liver, pancreas, lung) s/p \nR nephrectomy, IL2, tivozanib, and anti-PD1 antibody though \ncurrently not on treatment secondary to side effects from \nanti-PD1 trial therapy who is home on hospice with recent \nfatigue, anorexia, weight loss, and electrolyte abnormalities. \nToday he presents with acute onset, non-colicky LLQ pain that \nhas been worsening over the past ~48 hrs. He notes the pain to \nbe in the inguinal area with radiation to the L flank. He denies \nfevers, chills, cough, vomiting, though has had nausea. He notes \ndecreased UOP over 48hrs with tea-colored urine but no frank \nblood. His ___ thought he was distended in the abdomen and \nplaced a Foley at home yesterday but he had little output (250mL \nin bag in ED without an interim change). In the ED had urine in \nbag, however had leaking at meatus and burning when leaking. His \nLLQ pain improved s/p Foley placement. He's had only a few \nhundred mLs drainage since getting IVF in the ED. \n He also notes onset of loose stools ___ ___, having \napproximately 4 loose (non-watery) bowel movements without any \nmelena or hematochezia. He reports cramping, but no vomiting, \nsick contacts, or strange food. He takes docusate daily at home. \nHe took an antidiarrheal ___ with improvement, and his last BM \nwas yesterday ___. His abdominal pain has subsided today, \nthough he feels like his abdomen is mildly distended. He has not \nhad recent antibiotics.\n\nHe was recently admitted ___ with profound \nweakness, weight loss, loss of appetite and failure to thrive \nand found to have hyponatremia secondary to decreased PO intake, \nhypercalcemia of malignancy (pamidronate 60mg IV on ___, \nand normal cortisol & thyroid function. He was discharged on \nmethylphenidate and mirtazapine. As recently as ___ at his \nlast oncology visit he had been feeling the 'best [he] has felt \nin ___ years'. He is up and around most of the day and takes \nRitalin and Megace for energy and appetite. \n\nED course\n05:56 97.8 110 159/75 16 100% ___ \n12:19 108 156/90 20 100% ___ \n3L IVF and 150cc of urine since this am 0700\n-16g Foley\n-Tamsulosin\n-Morphine 5mg \n-blood culture\n-ceftriaxone \n-CT scan of the abdomen with oral contrast, to evaluate for any \nobstruction, or any ureter structure.", 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neomycin Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen (Liquid)', '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': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 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', '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': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Neomycin Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Ondansetron', '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/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', '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': 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': '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', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neomycin Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', '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': 'HydrALAzine', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Erythromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H: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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', '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': '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': '1.011', 'valuenum': 1.011, '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': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '32.3', 'valuenum': 32.3, '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': '267', 'valuenum': 267.0, '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': '4.39', 'valuenum': 4.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': 'UNABLE TO REPORT. SPECIMEN CLOTTED.'}, {'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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, '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': '0.7', '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 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': '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': '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': '137', 'valuenum': 137.0, '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': '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': '28.3', 'valuenum': 28.3, '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': 'STAT', 'comments': 'HOLD.'}, {'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': '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': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, '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': '9', 'valuenum': 9.0, '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': '8.2', 'valuenum': 8.2, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.6', 'valuenum': 2.6, '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': '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': '140', 'valuenum': 140.0, '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': '31.7', 'valuenum': 31.7, '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': '27.3', 'valuenum': 27.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, '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': '199', 'valuenum': 199.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', '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': '19', 'valuenum': 19.0, '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': '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': '8.4', 'valuenum': 8.4, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': 3.3, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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', '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': 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': '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, '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': 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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '236', 'valuenum': 236.0, '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': '4.29', 'valuenum': 4.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '32.3', 'valuenum': 32.3, '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': '276', 'valuenum': 276.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.70', 'valuenum': 4.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': 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': 'NEG.'}, {'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': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.011', 'valuenum': 1.011, '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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 173.0, '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': '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '37.8', 'valuenum': 37.8, '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': '27.8', 'valuenum': 27.8, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '349', 'valuenum': 349.0, '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': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '13', 'valuenum': 13.0, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', '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 = >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': 116.0, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM\n--------------\nGENERAL: NAD, awake and alert\nHEENT: anicteric sclera, pink conjunctiva, MMM, poor dentition \nNECK: nontender and supple, no LAD, no JVD \nBACK: no spinal process tenderness, mild L CVA tenderness\nCARDIAC: RRR, nl S1 S2, ___ SEM throughout \nLUNG: CTAB, no rales wheezes or rhonchi, no accessory muscle use\nABDOMEN: +BS, soft, non-tender, moderately distended with \ntympani on percussion, No RT or guarding, no HSM\nEXT: 1+edema in feet; no cyanosis, clubbing\nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact, strength ___ throughout,2+ DTRs \nthroughout, sensation intact to light touch, normal FNF, gait \nintact \nSKIN: warm and well perfused, no excoriations or lesions, no \nrashes \n\nDISCHARGE EXAM\n--------------\n98.2 138/60 HR 99-100s RR 18 Sa02 97% ___\nGENERAL: NAD, awake and alert\nHEENT: anicteric sclera, MMM\nNECK: supple \nBACK: no CVA tenderness b/l\nCARDIAC: RRR, nl S1 S2 \nLUNG: CTAB, no rales wheezes or rhonchi, no accessory muscle use\nABDOMEN: distended, tympany to percussion, +BS, soft, \nnon-tender, moderately distended with tympani on percussion\nEXT: 1+edema in feet; no cyanosis, clubbing \nSKIN: no rashes, no jaundice, no bruising ', 'diagnoses': [{'icd_code': '1533', 'desc': 'Malignant neoplasm of sigmoid colon'}, {'icd_code': '5680', 'desc': 'Peritoneal adhesions (postoperative) (postinfection)'}, {'icd_code': '7962', 'desc': 'Elevated blood pressure reading without diagnosis of hypertension'}, {'icd_code': '6218', 'desc': 'Other specified disorders of uterus, not elsewhere classified'}], 'summary': "___ 06:45AM BLOOD WBC-10.9# RBC-4.62 Hgb-8.5* Hct-32.0* \nMCV-69* MCH-18.4* MCHC-26.6* RDW-19.4* Plt ___\n___ 06:45AM BLOOD Neuts-83.3* Lymphs-10.1* Monos-5.1 \nEos-1.1 Baso-0.4\n___ 06:45AM BLOOD Glucose-134* UreaN-26* Creat-2.7*# \nNa-131* K-3.7 Cl-105 HCO3-17* AnGap-13\n___ 06:45AM BLOOD ALT-9 AST-13 AlkPhos-234* TotBili-0.4\n___ 06:45AM BLOOD Lipase-12\n___ 06:45AM BLOOD Albumin-2.6* Calcium-8.2* Phos-4.2 Mg-1.9\n___ 06:58AM BLOOD Lactate-1.0\n\nDISCHARGE LABS\n--------------\n___ 05:22AM BLOOD WBC-7.0 RBC-3.99* Hgb-7.3* Hct-28.3* \nMCV-71* MCH-18.3* MCHC-25.9* RDW-19.7* Plt ___\n___ 05:22AM BLOOD Glucose-126* UreaN-21* Creat-2.2* Na-139 \nK-4.2 Cl-110* HCO3-18* AnGap-15\n___ 05:22AM BLOOD Calcium-8.7\n\nIMAGING\n-------\nCT A/P w/o contrast\nFINDINGS: \nLUNG BASES: At the right base, there is a 5 mm subpleural \nnodule (2, 14), which is unchanged from the prior exam. The \npreviously identified left basilar sub-4 mm lung nodules are not \ndefinitely identified, likely due to surrounding atelectasis. \nThere is no focal airspace consolidation, pleural effusion, or \npneumothorax. The base of the heart is normal in size. The tip \nof a central venous catheter is noted at the cavoatrial \njunction. Trace \npericardial fluid is within normal physiologic range. \n \nABDOMEN: The liver is heterogeneous with multiple metastases. \nComparison is difficult due to the lack of intravenous contrast, \nthough the hypodense portions of the metastases are grossly \nstable in size. The largest in the left lobe measures 51 mm (2, \n26), and the largest in the right lobe involves the majority of \nthe inferior portion of the right lobe and measures \napproximately 85 mm (2, 39). Within the limitations of this \nnon-contrast exam, no new hepatic metastases are identified. \nThe gallbladder is unremarkable without surrounding stranding. \nThe spleen is slightly enlarged, measuring 14.4 cm. This is \nstable from the prior exam. Again, there is a large mass in the \nhead of the pancreas which measures 51 x 44 mm (2, 47). This is \nunchanged from the prior exam. The proximal pancreatic duct \nremains dilated measuring up to 6 mm (2, 36). No new pancreatic \nmasses are identified. There is no surrounding stranding to \nsuggest active pancreatitis. The right adrenal gland \nis normal. The left adrenal gland is slightly thickened, \nwithout a discrete nodule. This is unchanged from the prior \nexam. \n \nThe patient is status post a right nephrectomy. Multiple \nsurgical clips are present in the resection bed. There is no \nevidence of local tumor recurrence. In the left kidney, there is \na 17 x 11 mm stone in the lower pole collecting system (2, 47). \nThis is grossly stable since the prior exam. Just inferior to \nthis stone are two punctate 1 mm calcifications, also likely \nstones. There is new moderate hydronephrosis of the left upper \nand mid pole collecting systems. No stones are identified in \nthese collecting systems. At the UVJ, there is a 1 mm stone (2, \n83). Just distal to this stone is a second 1 mm stone, also \nlikely in the UVJ (2, 85). As this exam was performed in the \nsupine position, it is difficult to tell if these are \nobstructing at the UVJ or layering at this level in the bladder. \n A 31 mm partially exophytic cyst off the upper pole of the left \nkidney (601B, 44) is unchanged. No new left renal masses are \nidentified. There is minimal perinephric stranding, slightly \nincreased from the prior exam. There is no perinephric fluid \ncollection. \n \nThe stomach is collapsed. Oral contrast extends throughout the \nsmall bowel which is not dilated. There are no focal \ninflammatory changes. There is no evidence of obstruction. \nThere is no free air or free fluid. Within the limitations of \nthis exam, the abdominal vasculature is normal in course and \ncaliber with mild atherosclerotic calcifications. Small \nmesenteric and retroperitoneal lymph nodes do not meet criteria \nfor pathologic enlargement, and are unchanged from the prior \nexam. No periportal lymphadenopathy is identified. \n \nPELVIS: The sigmoid colon and descending colon are mostly \ncollapsed. The transverse and ascending colon have a moderate \nfecal load. There are no surrounding inflammatory changes. \nThere is no evidence of obstruction. The prostate is \nunremarkable. A Foley catheter is noted to be within the \nprostatic portion of the urethra. There is no pelvic or \ninguinal lymphadenopathy. There is no pelvic free fluid. Small \nbilateral fat-containing inguinal hernias are unchanged. \n \nOSSEOUS STRUCTURES: There are no concerning lytic or sclerotic \nosseous \nlesions. Moderate degenerative changes of the spine are \nunchanged. No \nfracture is identified. There is mild diffuse anasarca in the \nsoft tissues. There is no discrete fluid collection. \n \nIMPRESSION: \n1. New moderate left hydronephrosis with increased perinephric \nstranding. A 17 mm stone in the lower pole is grossly stable in \nsize from the prior exam. There are two 1 mm stones at the left \nUVJ, which are new, and likely causing the obstruction. \n2. Grossly unchanged hepatic and pancreatic head metastases. \nUnchanged \npancreatic duct dilation. No evidence of active pancreatitis. \n3. Unchanged mild splenomegaly. \n4. No evidence of a small bowel obstruction. \n5. Foley catheter balloon is inflated in the prostatic urethra, \nrepositioning \nis recommended. \n\n--------\n___ L RENAL US\nFINDINGS: \nThe right kidney is surgically absent. The left kidney is \nenlarged measuring 15.5 cm likely on the basis of compensatory \nhypertrophy. There is a simple cyst in the upper pole. There \nis a 2 cm calculus in the lower pole and a smaller immediately \nadjacent 1 cm calculus. There is moderate hydronephrosis which \nappears unchanged compared to the recent CT. There is no \nevidence of solid renal mass. \n\nThe bladder is completely decompressed with a Foley catheter in \nplace and thus not well evaluated. \n\nIMPRESSION: \nStable moderate left-sided hydronephrosis. Multiple lower pole \ncalculi \nmeasuring up to 2 cm also again noted as seen on CT. \n--------\n___ CT CHEST W/O CONTRAST\nIMPRESSION: \n1. Interval increase of right upper lobe nodule since ___, the \nremainder of the nodules are stable. \n2. New right lower lobe atelectasis, pleural effusion, \nground-glass opacity and venous distension are suggestive of \nmild pulmonary edema. \n3. There is no peripheral central lymphadenopathy. \n___ with metastatic clear cell RCC (liver, pancreas, lung) s/p \nR nephrectomy, IL2, tivozanib, and anti-PD1 antibody though \ncurrently not on treatment secondary to side effects from \nanti-PD1 trial therapy who is home on hospice and presenting \nwith acute onset LLQ pain 24hrs PTA and found to have oliguric \n___ and L UVJ stone.\n\n# Oliguric renal failure: Solitary left kidney after R \nnephrectomy ___. Cr peaked at 2.9, baseline is 1.2-1.4. Likely \nobstructive given pain, hydronephrosis, and L UVJ stone on \nimaging. Oliguria improved with heavy IV fluids. Seen by urology \nin ED who recommended medical trial with consideration for stent \nvs percutaneous nephrostomy. His Foley was discontinued on ___ \nwhen his UOP was adequate and his Cr was downtrending.\n\n# L UVJ stone: Treated with conservative management. Urology did \nnot want to stent. Still had some ongoing pain, but sounded more \nurethral and associated with urge to void than visceral pain \nassociated with stone. Per CT, the Foley placed at home by ___ \nhad balloon inflated in prostatic urethra, which may have \ncontributed to his pain. Unfortunately, we did not see stone \npass in Foley bag in order to analyze it. Likelihood of \nrecurrence given presence of other L renal pelvic stones.\n\n# Metastatic RCC: Metastatic clear cell RCC (liver, pancreas, \nlung) s/p R nephrectomy, IL2, tivozanib, and anti-PD1 antibody \nthough currently not on treatment secondary to side effects from \nanti-PD1 trial therapy. Home on hospice. Had been doing better \nat home per recent ___ clinic notes. He continues to use \nsupportive meds with ritalin and megace which are helpful, \nthough he states he doesn't use Ritalin at home because he feels \nbetter without it. He has regained his\nenergy, appetite, and some weight. There is some consideration \nfor outpatient chemo given his improvement recently.\n\n# Loose stools: Had loose stools PTA. None since admission. \nGiven bowel regimen with opiates.\n\n# Hyponatremia: Has had hyponatremia since ___, thought to be \nsecondary to poor PO intake rather than SIADH. Improved with \nIVF, suggesting that it was due to hypovolemia with appropriate \nADH release.\n\n# Non-elevated anion gap acidosis: HCO3 ~17, likely secondary to \nacute kidney injury. However, he has had low HCO3 since ___ \nwithout significant renal impairment at the time of many of \nthose chemistries. The HCO3 worsened with rising creatinine, and \nthen improved with IVF.\n\n# Pedal edema: Most likely mild hypervolemia in the setting of \n___ with concomittant hypoalbuminemia. Could possibly be related \nto liver dysfunction ___ mets as albumin low, but INR normal \nwhich doesn't support hepatic etiology. No dx of portal HTN. \n\n# Nutrition: Albumin 2.6. Gave TID supplements. Patient does not \nwish to have invasive feeding tubes.\n\n# Microcytic anemia: MCV 69. Hgb ~8.5, stable around baseline. \nHe has always had microcytosis, suggesting a hemoglobinopathy. \nHe did not get work up for this at this time.\n\n# Hx of SZ: Diagnosed ___ in setting of recurrent RCC. Did not \nhave CNS mets. Unclear etiology. On Keppra since then, last \nseizure ___. Continued Keppra.\n\n# Thrombocytosis: Likely reactive."}}
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{'final_diagnoses': ['Oliguric renal failure', 'Left ureteropelvic junction stone', 'Metastatic renal cell carcinoma'], 'procedures': ['NONE'], 'visit_summary': "___ with metastatic clear cell RCC (liver, pancreas, lung) s/p \nR nephrectomy, IL2, tivozanib, and anti-PD1 antibody though \ncurrently not on treatment secondary to side effects from \nanti-PD1 trial therapy who is home on hospice and presenting \nwith acute onset LLQ pain 24hrs PTA and found to have oliguric \n___ and L UVJ stone.\n\n# Oliguric renal failure: Solitary left kidney after R \nnephrectomy ___. Cr peaked at 2.9, baseline is 1.2-1.4. Likely \nobstructive given pain, hydronephrosis, and L UVJ stone on \nimaging. Oliguria improved with heavy IV fluids. Seen by urology \nin ED who recommended medical trial with consideration for stent \nvs percutaneous nephrostomy. His Foley was discontinued on ___ \nwhen his UOP was adequate and his Cr was downtrending.\n\n# L UVJ stone: Treated with conservative management. Urology did \nnot want to stent. Still had some ongoing pain, but sounded more \nurethral and associated with urge to void than visceral pain \nassociated with stone. Per CT, the Foley placed at home by ___ \nhad balloon inflated in prostatic urethra, which may have \ncontributed to his pain. Unfortunately, we did not see stone \npass in Foley bag in order to analyze it. Likelihood of \nrecurrence given presence of other L renal pelvic stones.\n\n# Metastatic RCC: Metastatic clear cell RCC (liver, pancreas, \nlung) s/p R nephrectomy, IL2, tivozanib, and anti-PD1 antibody \nthough currently not on treatment secondary to side effects from \nanti-PD1 trial therapy. Home on hospice. Had been doing better \nat home per recent ___ clinic notes. He continues to use \nsupportive meds with ritalin and megace which are helpful, \nthough he states he doesn't use Ritalin at home because he feels \nbetter without it. He has regained his\nenergy, appetite, and some weight. There is some consideration \nfor outpatient chemo given his improvement recently.\n\n# Loose stools: Had loose stools PTA. None since admission. \nGiven bowel regimen with opiates.\n\n# Hyponatremia: Has had hyponatremia since ___, thought to be \nsecondary to poor PO intake rather than SIADH. Improved with \nIVF, suggesting that it was due to hypovolemia with appropriate \nADH release.\n\n# Non-elevated anion gap acidosis: HCO3 ~17, likely secondary to \nacute kidney injury. However, he has had low HCO3 since ___ \nwithout significant renal impairment at the time of many of \nthose chemistries. The HCO3 worsened with rising creatinine, and \nthen improved with IVF.\n\n# Pedal edema: Most likely mild hypervolemia in the setting of \n___ with concomittant hypoalbuminemia. Could possibly be related \nto liver dysfunction ___ mets as albumin low, but INR normal \nwhich doesn't support hepatic etiology. No dx of portal HTN. \n\n# Nutrition: Albumin 2.6. Gave TID supplements. Patient does not \nwish to have invasive feeding tubes.\n\n# Microcytic anemia: MCV 69. Hgb ~8.5, stable around baseline. \nHe has always had microcytosis, suggesting a hemoglobinopathy. \nHe did not get work up for this at this time.\n\n# Hx of SZ: Diagnosed ___ in setting of recurrent RCC. Did not \nhave CNS mets. Unclear etiology. On Keppra since then, last \nseizure ___. Continued Keppra.\n\n# Thrombocytosis: Likely reactive.", 'medications_prescribed': ['Outpatient Lab Work\nPlease draw chem-7 (with BUN and creatinine) on ___ for \nnephrolithiasis. ICD-9 code 592.0. Please fax results to Dr. \n___: ___ ', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nhold for sedation. \nRX *oxycodone 5 mg 1 capsule(s) by mouth every six (6) hours \nDisp #*20 Tablet Refills:*0', 'Bisacodyl 10 mg PR ONCE Duration: 1 Dose \nRX *bisacodyl [Dulcolax (bisacodyl)] 10 mg 1 suppository(s) \nrectally once Disp #*1 Suppository Refills:*0', 'Acetaminophen 325-650 mg PO Q6H:PRN pain, fever ', 'Docusate Sodium 100 mg PO TID ', 'LeVETiracetam 250 mg PO BID ', 'Loratadine 10 mg PO DAILY ', 'Lorazepam 0.5 mg PO HS:PRN anxiety, sleep ', 'Megestrol Acetate 400 mg PO DAILY ', 'Omeprazole 20 mg PO DAILY ', 'Senna 1 TAB PO BID:PRN constipation ', 'Tamsulosin 0.4 mg PO HS ', 'Glargine 30 Units Breakfast\nInsulin SC Sliding Scale using HUM Insulin', 'Ferrous Sulfate 325 mg PO DAILY ', 'Heparin Flush (10 units/ml) 5 mL IV DAILY and PRN, line \nflush ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 40, 'gender': 'F', 'symptoms': 'Volume overload', 'medical_history': ['- HCV s/p IFN regimen, relapsed', '- Cirrhosis Child B8', '- Colonic adenocarcinoma', '- CAD (s/p ___ ___', '- Esophageal varices s/p banding (last ___', '- GIB', '- TIA vs. CVA', '- Malnutrition', '- IDDM', 'PAST SURGICAL HISTORY', '- Bilateral TIB-FIB fxrs s/p ORIF', '- Parathyroidectomy', '- Appendectomy', '- Tonsillectomy'], 'family_history': 'Mother: possible alcoholic liver disease, but died in her ___ of \na brain aneurysm\nFather: unknown', 'present_illness': "___ with Child Class B8 HCV cirrhosis (c/b portal HN, esophageal \nvarices s/p banding, ascites, HE and malnutrition) failed IFN, \nCAD (s/p ___ ___, TIA vs. CVA, newly diagnosed \nsigmoid colon adenocarcinoma who presents as a transfer from ___ \n___ in ___ with volume overload c/f decompensated \nliver failure.\n \nOn ___ pt called Dr. ___ concerned about \nincreased swelling in his legs. Dr. ___ \nincreasing his Lasix and spironolactone to 80 mg PO and 100 mg \nPO respectively, which he has been taking. One week later Pt's \nPCP noted progressive edema and abdominal distension and so Mr. \n___ presented to ___ where he was admitted and \nunderwent a LVP. \n\nPer pt, Dr. ___ transfer to ___ for further \nmanagement of his colon cancer. He had 1 BM that was reddish \nbrown but says that the subsequent stools he had, especially on \nthe day of admission were all brown. His hgb for the last 3 \ndays, per him has been 10.9 -> 9.6 -> 9.9. He feels well now and \ndenies f/c/CP/SOB/abd pain/n/v. Has softer stools ___ lactulose \nbut not quite diarrhea. No dizziness/lightheadedness.", 'medications': [{'medication': 'Propranolol LA', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H: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': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID: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', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', '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 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': 'Q4H:PRN', '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H: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': '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}]}, 'clinical_findings': {'labs': [{'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '33.8', 'valuenum': 33.8, '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': '223', 'valuenum': 223.0, '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': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '0.5', '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 (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': 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': '1', 'valuenum': 1.0, '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': '3.0', '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': '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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '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': '88', 'valuenum': 88.0, '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': 400.0, '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': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nVS: 98.3 PO 152/78 68 20 97 RA \nGENERAL: well appearing, NAD\nHEENT: NCAT, MMM, EOMI, oropharynx clear\nNECK: supple\nCARDIAC: RRR no m/r/g\nPULMONARY: CTAB no w/r/r\nABDOMEN: soft/NT/ND/normoactive BS \nEXTREMITIES: WWP, 2+ pitting edema to shins\nSKIN: no rashes\nNEUROLOGIC: CN ___ intact, no asterixsis \nPSYCHIATRIC: pleasant, appropriate\n\nDISCHARGE PHYSICAL EXAM: \nVITALS: Temp 98.1, BP 114 / 64, HR 62, RR 18, SpO2 97 RA \n\nGEN: NAD, well appearing\nHEENT: NCAT, EOMI, no scleral icterus\nCV: RRR, radial pulse 2+ b/l\nRESP: breathing comfortably on room air\nGI: appropriately TTP, no R/G/D, BS+ throughout, laparoscopic \nport sites C/D/D\nEXT: WWP, mild 1+ non-pitting edema in the BLE to the distal \ncalf', 'diagnoses': [{'icd_code': 'D251', 'desc': 'Intramural leiomyoma of uterus'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'D250', 'desc': 'Submucous leiomyoma of uterus'}, {'icd_code': 'N736', 'desc': 'Female pelvic peritoneal adhesions (postinfective)'}, {'icd_code': 'R32', 'desc': 'Unspecified urinary incontinence'}], 'summary': "ADMISSION LABS:\n===============\n___ 09:45PM ___ PTT-33.0 ___\n___ 09:45PM PLT COUNT-113*\n___ 09:45PM HYPOCHROM-1+ ANISOCYT-1+ POIKILOCY-2+ \nMACROCYT-1+ MICROCYT-NORMAL POLYCHROM-NORMAL \nSCHISTOCY-OCCASIONAL TEARDROP-OCCASIONAL ACANTHOCY-1+ \nELLIPTOCY-1+\n___ 09:45PM NEUTS-56.6 ___ MONOS-16.7* EOS-4.7 \nBASOS-0.4 NUC RBCS-0.0 IM ___ AbsNeut-2.77 AbsLymp-1.04* \nAbsMono-0.82* AbsEos-0.23 AbsBaso-0.02\n___ 09:45PM WBC-4.9 RBC-UNABLE TO HGB-10.2* HCT-35* \nMCV-UNABLE TO MCH-UNABLE TO MCHC-UNABLE TO RDW-UNABLE TO \nRDWSD-UNABLE TO \n___ 09:45PM calTIBC-312 FERRITIN-125 TRF-240\n___ 09:45PM ALBUMIN-2.6* CALCIUM-7.8* PHOSPHATE-2.0* \nMAGNESIUM-1.6 IRON-56\n___ 09:45PM ALT(SGPT)-77* AST(SGOT)-101* LD(LDH)-275* ALK \nPHOS-149* TOT BILI-1.0\n___ 09:45PM estGFR-Using this\n___ 09:45PM GLUCOSE-322* UREA N-23* CREAT-0.9 SODIUM-132* \nPOTASSIUM-3.5 CHLORIDE-100 TOTAL CO2-24 ANION GAP-12\n\nDISCHARGE/PERTINENT LABS:\n=========================\n___ 09:20AM BLOOD WBC-6.0 RBC-3.14* Hgb-8.9* Hct-26.5* \nMCV-84 MCH-28.3 MCHC-33.6 RDW-23.0* RDWSD-69.2* Plt ___\n___ 04:30AM BLOOD WBC-6.4 RBC-2.92* Hgb-8.3* Hct-24.6* \nMCV-84 MCH-28.4 MCHC-33.7 RDW-23.4* RDWSD-68.8* Plt Ct-95*\n___ 05:51AM BLOOD Hypochr-NORMAL Anisocy-2+ Poiklo-1+ \nMacrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL \nSpheroc-OCCASIONAL Ovalocy-OCCASIONAL Schisto-OCCASIONAL\n___ 07:38AM BLOOD ___ PTT-34.5 ___\n___ 07:38AM BLOOD Glucose-243* UreaN-27* Creat-1.4* Na-133 \nK-4.3 Cl-97 HCO3-27 AnGap-13\n___ 07:38AM BLOOD ALT-24 AST-41* AlkPhos-109 TotBili-0.9\n___ 05:28AM BLOOD proBNP-168\n___ 07:38AM BLOOD Calcium-8.2* Phos-4.0 Mg-1.9\n\nMICROBIOLOGY:\n=============\n___ FLUID - FINAL - NEGATIVE\n___ FLUID GRAM STAIN - FINAL - NEGATIVE\n___ CULTURE - FINAL - NEGATIVE\n___ CULTURE - FINAL - NEGATIVE\n\nIMAGING:\n========\n___ US (COMPLETE STUDY)\n1. There is a small amount of ascites in the perihepatic \nregions and\nbilateral lower quadrants.\n2. Cirrhosis. Cholelithiasis. Large left renal stone \n(previously seen on CT of ___. \n \n___\nThe left atrium is mildly dilated. No atrial septal defect is \nseen by 2D or color Doppler. Left ventricular wall thicknesses \nand cavity size are normal. There is mild regional left \nventricular systolic dysfunction with hypokinesis of the mid and \ndistal septum. The remaining segments contract normally (biplane \nLVEF = 55 %). Right ventricular chamber size and free wall \nmotion are normal. The aortic root is mildly dilated at the \nsinus level. The aortic valve leaflets (3) appear structurally \nnormal with good leaflet excursion and no aortic stenosis. Trace \naortic regurgitation is seen. The mitral valve appears \nstructurally normal with trivial mitral regurgitation. There is \nno mitral valve prolapse. The pulmonary artery systolic pressure \ncould not be determined. There is no pericardial effusion.\n\n___ DOPP ABD/PEL\n1. Patent hepatic vasculature. No evidence of portal vein \nthrombosis.\n2. Cirrhotic appearing liver with sequela of portal hypertension \nincluding moderate ascites and splenomegaly.\n3. Cholelithiasis without biliary dilatation or acute \ncholecystitis.\n4. Staghorn calculus at the left kidney with secondary caliceal \ndilation similar to previous CT examination as detailed above.\n___ with Child Class B, HCV cirrhosis (c/b portal HN, esophageal \nvarices s/p banding, ascites, HE and malnutrition), CAD (s/p ___ \n___ ___, prior TIA, and recently diagnosed untreated \nsigmoid colon adenocarcinoma who presents as a transfer from ___ \n___ in ___ with volume overload i/s/o \ndecompensated liver failure, now s/p active diuresis with 45lbs \nweight loss, now on maintenance diuresis with plan for surgical \nresection of colonic aenocarcinoma.\n\n# Volume overload:\n# HCV Cirrhosis: (c/b portal HN, esophageal varices s/p banding, \nascites, HE and malnutrition)\nPatient reports increased swelling on admission, despite \nincrease in his home diuretics. On exam, patient was very \nseverely fluid overloaded. Per CT, ascites is not considerably \nchanged from ___. US showed patent hepatic vasculature w/ \nno evidence of portal vein thrombosis and moderate ascites. \nPatient received LVP on ___ with 8L removed; given 25g albumin \npost-procedure. No signs of SBP. Ascitic fluid studies negative. \nPatient the started on daily diuresis with Lasix 80mg IV and \nspironolactone 100mg with good diuresis. Abdominal US showed \nsmall volume of residual ascites on ___. In total, patient \nlost 45lbs and his dry weight was determined to be approximately \n211 lbs given rise in creatinine with additional diuresis.\n\n# Distal Sigmoid Adenocarcinoma:\nLocally advanced distal sigmoid adenocarcinoma. Initial plan to \ntreat with curative intent with surgical resection without \nchemotherapy given concern for hepatotoxicity, however deferred \nuntil other medical comorbidities are managed (pt needs to \ncomplete 6 month course of Plavix). Colorectal surgery consulted \nand recommended medical optimization per with plan for \nintervention when stable particularly in terms of volume \noverload (see above). Initial plan for potential TIPS prior to \nsurgery to prevent ascites, but ascites very responsive to \ndiuresis with nearly complete resolution of ascites - no plan \nfor pre-op TIPS.\n\n# GIB/Varices\nHx of esophageal varices s/p banding. Last EGD ___ at OSH.\n- Continued nadolol 20 mg QD\n\n# CAD\nS/p ___ x2 in ___. TTE done this admission shows \npreserved systolic/diastolic function with some septal wall \nhypokinesis.\n- Continued aspirin 81 mg QD\n- Held home Plavix 75 mg QD prior to surgery\n\nChronic Issues \n============== \n# IDDM. Last A1C ___ on ___. \n- Lantus QHS\n- Humalog ISS \n\n# HLD: \n- Continued home atorvastatin 80 mg daily\n\n# Depression: \n- Continued home escitalopram 10 mg QD \n\nFollowing his course on the medical service, Mr. ___ was \ntransferred to the Colorectal Surgery Service. He underwent a \nLaparoscopic Sigmoid Colectomy with Fiducial Placements on \n___. He tolerated the procedure well without complications \n(Please see operative note for further details). After a brief \nand uneventful stay in the PACU, the patient was transferred to \nthe floor for further post-operative management. \n\n Neuro: Pain was well controlled on IV then PO medications\n CV: Vital signs were routinely monitored during the patient's \nlength of stay. He had some mild, asymptomatic hypotension \npost-operatively that responded well to crystalloid and colloid \ninfusion. We were in close contact with Hepatology team \nregarding his tenuous fluid status due to his underlying \ncirrhosis. \n Pulm: The patient was encouraged to ambulate, sit and get out \nof bed, use the incentive spirometer, and had oxygen saturation \nlevels monitored as indicated. \n GI: The patient was initially kept NPO after the procedure. The \npatient was later advanced to and tolerated a regular diet at \ntime of discharge. The Hepatology team was involved in the \nmaintenance of his fluid status; their recommendations were \nappreciated. \n GU: Patient had a Foley catheter that was removed at time of \ndischarge. Urine output was monitored as indicated. He did have \nseveral episodes of urinary retention and a Foley was placed \nprior to his discharge. He will leave with the Foley in place \nand follow up with his PCP/Urology at home for a trial to void. \nHe did have a transient ___ from his baseline Creatinine of 1.0 \nto 1.4. This returned to his baseline with some IVFR. \n ID: The patient's vital signs were monitored for signs of \ninfection and fever. The patient was started on/continued on \nantibiotics as indicated. \n Heme: The patient had blood levels checked post operatively \nduring the hospital course to monitor for signs of bleeding. The \npatient had vital signs, including heart rate and blood \npressure, monitored throughout the hospital stay. \n\nOn ___, the patient was discharged home. At discharge, he \nwas tolerating a regular diet, passing flatus, stooling, \nvoiding, and ambulating independently. He will follow-up in the \nclinic in ___ weeks. This information was communicated to the \npatient directly prior to discharge."}}
|
{'final_diagnoses': ['Hepatitis C cirrhosis', 'Sigmoid Cancer s/p Laparoscopic Sigmoid Colectomy', 'Coronary artery disease', 'Insulin dependent diabetes mellitus'], 'procedures': ['Large Volume Paracentesis on ___', 'Laparoscopic Sigmoid Colectomy with Feducial Placements on ___'], 'visit_summary': "___ with Child Class B, HCV cirrhosis (c/b portal HN, esophageal \nvarices s/p banding, ascites, HE and malnutrition), CAD (s/p ___ \n___ ___, prior TIA, and recently diagnosed untreated \nsigmoid colon adenocarcinoma who presents as a transfer from ___ \n___ in ___ with volume overload i/s/o \ndecompensated liver failure, now s/p active diuresis with 45lbs \nweight loss, now on maintenance diuresis with plan for surgical \nresection of colonic aenocarcinoma.\n\n# Volume overload:\n# HCV Cirrhosis: (c/b portal HN, esophageal varices s/p banding, \nascites, HE and malnutrition)\nPatient reports increased swelling on admission, despite \nincrease in his home diuretics. On exam, patient was very \nseverely fluid overloaded. Per CT, ascites is not considerably \nchanged from ___. US showed patent hepatic vasculature w/ \nno evidence of portal vein thrombosis and moderate ascites. \nPatient received LVP on ___ with 8L removed; given 25g albumin \npost-procedure. No signs of SBP. Ascitic fluid studies negative. \nPatient the started on daily diuresis with Lasix 80mg IV and \nspironolactone 100mg with good diuresis. Abdominal US showed \nsmall volume of residual ascites on ___. In total, patient \nlost 45lbs and his dry weight was determined to be approximately \n211 lbs given rise in creatinine with additional diuresis.\n\n# Distal Sigmoid Adenocarcinoma:\nLocally advanced distal sigmoid adenocarcinoma. Initial plan to \ntreat with curative intent with surgical resection without \nchemotherapy given concern for hepatotoxicity, however deferred \nuntil other medical comorbidities are managed (pt needs to \ncomplete 6 month course of Plavix). Colorectal surgery consulted \nand recommended medical optimization per with plan for \nintervention when stable particularly in terms of volume \noverload (see above). Initial plan for potential TIPS prior to \nsurgery to prevent ascites, but ascites very responsive to \ndiuresis with nearly complete resolution of ascites - no plan \nfor pre-op TIPS.\n\n# GIB/Varices\nHx of esophageal varices s/p banding. Last EGD ___ at OSH.\n- Continued nadolol 20 mg QD\n\n# CAD\nS/p ___ x2 in ___. TTE done this admission shows \npreserved systolic/diastolic function with some septal wall \nhypokinesis.\n- Continued aspirin 81 mg QD\n- Held home Plavix 75 mg QD prior to surgery\n\nChronic Issues \n============== \n# IDDM. Last A1C ___ on ___. \n- Lantus QHS\n- Humalog ISS \n\n# HLD: \n- Continued home atorvastatin 80 mg daily\n\n# Depression: \n- Continued home escitalopram 10 mg QD \n\nFollowing his course on the medical service, Mr. ___ was \ntransferred to the Colorectal Surgery Service. He underwent a \nLaparoscopic Sigmoid Colectomy with Fiducial Placements on \n___. He tolerated the procedure well without complications \n(Please see operative note for further details). After a brief \nand uneventful stay in the PACU, the patient was transferred to \nthe floor for further post-operative management. \n\n Neuro: Pain was well controlled on IV then PO medications\n CV: Vital signs were routinely monitored during the patient's \nlength of stay. He had some mild, asymptomatic hypotension \npost-operatively that responded well to crystalloid and colloid \ninfusion. We were in close contact with Hepatology team \nregarding his tenuous fluid status due to his underlying \ncirrhosis. \n Pulm: The patient was encouraged to ambulate, sit and get out \nof bed, use the incentive spirometer, and had oxygen saturation \nlevels monitored as indicated. \n GI: The patient was initially kept NPO after the procedure. The \npatient was later advanced to and tolerated a regular diet at \ntime of discharge. The Hepatology team was involved in the \nmaintenance of his fluid status; their recommendations were \nappreciated. \n GU: Patient had a Foley catheter that was removed at time of \ndischarge. Urine output was monitored as indicated. He did have \nseveral episodes of urinary retention and a Foley was placed \nprior to his discharge. He will leave with the Foley in place \nand follow up with his PCP/Urology at home for a trial to void. \nHe did have a transient ___ from his baseline Creatinine of 1.0 \nto 1.4. This returned to his baseline with some IVFR. \n ID: The patient's vital signs were monitored for signs of \ninfection and fever. The patient was started on/continued on \nantibiotics as indicated. \n Heme: The patient had blood levels checked post operatively \nduring the hospital course to monitor for signs of bleeding. The \npatient had vital signs, including heart rate and blood \npressure, monitored throughout the hospital stay. \n\nOn ___, the patient was discharged home. At discharge, he \nwas tolerating a regular diet, passing flatus, stooling, \nvoiding, and ambulating independently. He will follow-up in the \nclinic in ___ weeks. This information was communicated to the \npatient directly prior to discharge.", 'medications_prescribed': ['1. Acetaminophen 325 mg PO Q6H:PRN Pain - Mild Duration: 5 Days', '2. OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg 1 tablet(s) by mouth three times a day Disp \n#*35 Tablet Refills:*0', '3. Rifaximin 550 mg PO BID', '4. Glargine 45 Units Bedtime\nHumalog 8 Units Breakfast\nHumalog 8 Units Lunch\nHumalog 8 Units Dinner\nInsulin SC Sliding Scale using HUM Insulin', '5. Aspirin 81 mg PO DAILY', '6. Atorvastatin 80 mg PO QPM', '7. Clopidogrel 75 mg PO DAILY', '8. Escitalopram Oxalate 5 mg PO DAILY', '9. Furosemide 80 mg PO DAILY', '10. Lactulose 15 mL PO DAILY', '11. Nadolol 20 mg PO DAILY', '12. Omeprazole 20 mg PO DAILY', '13. Spironolactone 100 mg PO DAILY', '14. Tamsulosin 0.4 mg PO DAILY', '15.Outpatient Lab Work\nICD-10 code: B18.2 (Chronic Hepatitis C)\n\nOnce weekly Basic Metabolic Panel and Liver Function Test for x2 \nweeks:\nSodium; Potassium; Bicarbonate; Chloride; BUN; Creatinine; \nGlucose; ALT; AST; Alk Phos; Total Bili; ___ (includes INR); PTT; \nCalcium; Phosphate; Magnesium']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'M', 'symptoms': None, 'medical_history': ['None'], 'family_history': 'No known family history of stroke or aneurysm.', 'present_illness': '___ is a ___ year old male who presented to the ED on \n___ as a transfer from an outside facility after \ndeveloping WHOL. Imaging at the outside facility was concerning \nfor extensive SAH, but was negative for any cerebrovascular \nmalformation. The patient was transferred to ___ for \nescalation of care. Neurosurgery was consulted for evaluation \nand management recommendations.', 'medications': [{'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Trandolapril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dorzolamide 2% Ophth. Soln.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OU', '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': 'Cholestyramine', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': '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 via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Triamterene-Hydrochlorothiazide', '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:\n-------------\nDate and Time of Neurosurgical Evaluation: ___ 11:55\n\n___ and ___ Score:\n[ ]Grade I: Asymptomatic, mild headache, slight nuchal rigidity.\n[x]Grade II: Moderate to severe headache, nuchal rigidity, no \nneurologic deficit other than cranial nerve palsy.\n[ ]Grade III: Drowsiness, confusion, mild focal neurologic \ndeficit.\n[ ]Grade IV: Stupor, moderate to severe hemiparesis.\n[ ]Grade V: Coma, decerebrate posturing.\n\nFisher Grade:\n[ ]1 No hemorrhage evident.\n[x]2 SAH less than 1mm thick.\n[ ]3 SAH more than 1mm thick.\n[ ]4 SAH of any thickness with parenchymal extension or IVH.\n\n___ Grading Scale:\n[x]Grade I: GCS 15, no motor deficit.\n[ ]Grade II: GCS ___, no motor deficit.\n[ ]Grade III: GCS ___, with motor deficit.\n[ ]Grade IV: GCS ___, with or without motor deficit.\n[ ]Grade V: GCS ___, with or without motor deficit.\n\nGCS:\n\nAirway:\n[ ]Intubated\n[x]Not intubated\n\nEye Opening: \n[ ]1 Does not open eyes\n[ ]2 Opens eyes to painful stimuli\n[ ]3 Opens eyes to voice\n[x]4 Opens eyes spontaneously\n\nVerbal:\n[ ]1 Makes no sounds\n[ ]2 Incomprehensible sounds\n[ ]3 Inappropriate words\n[ ]4 Confused, disoriented\n[x]5 Oriented\n\nMotor:\n[ ]1 No movement\n[ ]2 Extension to painful stimuli (decerebrate response)\n[ ]3 Abnormal flexion to painful stimuli (decorticate response)\n[ ___ Flexion/withdrawal to painful stimuli\n[ ]5 Localizes to painful stimuli\n[x]6 Obeys commands\n\nTotal: 15\n\nICH Score:\n\nGCS:\n[ ]2 GCS ___\n[ ]1 GCS ___\n[x]0 GCS ___\n\nICH Volume:\n[ ]1 30 mL or greater\n[x]0 Less than 30 mL\n\nIVH:\n[ ]1 Present\n[x]0 Absent\n\nInfratentorial ICH:\n[ ___ Yes\n[x]0 No\n\nAge:\n[ ]1 ___ years old or greater\n[x]0 Less than ___ years old\n\nTotal: 0\n\nVS: T ___, HR 77-80, BP 117-141/60-84, RR 16, O2Sat 99% on room \nair\n\nGeneral: Well-nourished adult male. Appears uncomfortable. \nLaying on stretcher.\nHEENT: Atraumatic.\nNeck: Supple. No meningismus.\nLungs: No respiratory distress.\nExtremities: Warm and well-perfused.\n\nNeurologic:\n\nMental status: Awake and alert. Cooperative with exam. Normal \naffect.\nOrientation: Oriented to person, place, and time.\nLanguage: Speech fluent with good comprehension. No dysarthria \nor paraphasic errors.\n\nCranial Nerves:\n\nI: Not tested.\nII: PERRL, 3-2mm, bilaterally. \nIII, IV, VI: EOMs intact bilaterally without nystagmus.\nV, VII: Facial strength and sensation intact and symmetric.\nVIII: Hearing intact to finger rub bilaterally.\nIX, X: Palatal elevation symmetrical.\nXI: Sternocleidomastoid and trapezius normal bilaterally.\nXII: Tongue midline without fasciculations.\n\nMotor: Normal bulk and tone bilaterally. No abnormal movements, \ntremors. Strength ___ throughout. No drift.\n\nSensation: Grossly intact to light touch.\n\nOn Discharge:\n-------------\nGeneral:\n\nVS: T 98.6F, HR 55, BP 126/81, O2Sat 96% on room air\n\nExam:\n\nOpens Eyes: [x]Spontaneous [ ]To voice [ ]To noxious [ ]None\nOrientation: [x]Person [x]Place [x]Time\nFollows Commands: [ ]Simple [x]Complex [ ]None\nPupils: PERRL\nEOMs: [x]Full [ ]Restricted\nFace Symmetric: [x]Yes [ ]No\nTongue Midline: [x]Yes [ ]No\nDrift: [ ]Yes [x]No\nSpeech Fluent: [x]Yes [ ]No\nComprehension Intact: [x]Yes [ ]No\n\nMotor:\n\n Trap Deltoid Biceps Triceps Grip\nRight 5 5 5 5 5\nLeft 5 5 5 5 5\n\n IP Quad Ham AT ___ ___\nRight 5 5 5 5 5 5\nLeft 5 5 5 5 5 5\n\nSensation: Grossly intact to light touch.\n\nRight Radial Puncture Site:\n- Dressing clean, dry, intact\n- No drainage noted\n- Soft, no hematoma\n- Palpable pulses', 'diagnoses': [{'icd_code': '99813', 'desc': 'Seroma complicating a procedure'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V1083', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}], 'summary': 'Please see OMR for relevant laboratory and imaging results.\n___ year old male found to have extensive SAH.\n\n#SAH\nThe patient was admitted to Neurosurgery to the Neuro ICU on \n___ for further work-up. His SBP was maintained less than \n140 and he was maintained euvolemic. He was started on \nnimodipine to prevent cerebral vasospasm. He was taken for a \ndiagnostic cerebral angiogram on ___, which was negative \nfor any cerebrovascular malformation. The procedure was \nuncomplicated. Please see OMR for further intraprocedural \ndetails. The patient was transferred back to the Neuro ICU \npostprocedurally for close neurologic monitoring where he \nremained neurologically stable. TCD on ___ was negative \nfor cerebral vasospasm. He was eventually transferred out of the \nNeuro ICU to the step down unit. A repeat CT of the head was \nobtained on ___ in the setting of headache, which was \nstable from prior. Additional TCD on ___ showed normal \nvelocities, but was also notable for a diffusely elevated \npulsatility index that was concerning for elevated ICP vs. \nmultifocal distal cerebral vasospasm. Despite this, the patient \nremained neurologically stable. A repeat diagnostic cerebral \nangiogram was obtained on ___, which was again negative \nfor any cerebrovascular malformation. The procedure was \nuncomplicated. Please see OMR for further intraprocedural \ndetails. The patient was transferred back to the step down unit \npostprocedurally for close neurologic monitoring where he \nremained neurologically stable. His nimodipine was discontinued. \nOn ___, the patient continued to be neurologically \nstable. He was afebrile with stable vital signs, mobilizing \nindependently, tolerated a diet, voiding and stooling without \ndifficulty, and his pain was well controlled with oral pain \nmedications. He was discharged home on ___ in stable \ncondition.\n\n#Hyponatremia\nThe patient was hyponatremic and was started on sodium chloride. \nHe was subsequently also started on hypertonic saline and \nfludrocortisone as well. On ___, his hypertonic saline \nwas weaned off. He is being continued on sodium chloride and \nfludrocortisone at discharge with plans to follow-up with his \nPCP.\n\n#Disposition\nThe patient mobilized with the nurse and was determined to be \nindependent. He was discharged home on ___ in stable \ncondition.'}}
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{'final_diagnoses': ['___'], 'procedures': ['Diagnostic cerebral angiogram - Negative for\ncerebrovascular malformation', 'Diagnostic cerebral angiogram - Negative for\ncerebrovascular malformation'], 'visit_summary': '___ year old male found to have extensive SAH.\n\n#SAH\nThe patient was admitted to Neurosurgery to the Neuro ICU on \n___ for further work-up. His SBP was maintained less than \n140 and he was maintained euvolemic. He was started on \nnimodipine to prevent cerebral vasospasm. He was taken for a \ndiagnostic cerebral angiogram on ___, which was negative \nfor any cerebrovascular malformation. The procedure was \nuncomplicated. Please see OMR for further intraprocedural \ndetails. The patient was transferred back to the Neuro ICU \npostprocedurally for close neurologic monitoring where he \nremained neurologically stable. TCD on ___ was negative \nfor cerebral vasospasm. He was eventually transferred out of the \nNeuro ICU to the step down unit. A repeat CT of the head was \nobtained on ___ in the setting of headache, which was \nstable from prior. Additional TCD on ___ showed normal \nvelocities, but was also notable for a diffusely elevated \npulsatility index that was concerning for elevated ICP vs. \nmultifocal distal cerebral vasospasm. Despite this, the patient \nremained neurologically stable. A repeat diagnostic cerebral \nangiogram was obtained on ___, which was again negative \nfor any cerebrovascular malformation. The procedure was \nuncomplicated. Please see OMR for further intraprocedural \ndetails. The patient was transferred back to the step down unit \npostprocedurally for close neurologic monitoring where he \nremained neurologically stable. His nimodipine was discontinued. \nOn ___, the patient continued to be neurologically \nstable. He was afebrile with stable vital signs, mobilizing \nindependently, tolerated a diet, voiding and stooling without \ndifficulty, and his pain was well controlled with oral pain \nmedications. He was discharged home on ___ in stable \ncondition.\n\n#Hyponatremia\nThe patient was hyponatremic and was started on sodium chloride. \nHe was subsequently also started on hypertonic saline and \nfludrocortisone as well. On ___, his hypertonic saline \nwas weaned off. He is being continued on sodium chloride and \nfludrocortisone at discharge with plans to follow-up with his \nPCP.\n\n#Disposition\nThe patient mobilized with the nurse and was determined to be \nindependent. He was discharged home on ___ in stable \ncondition.', 'medications_prescribed': ['Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild \nDo not exceed 4000mg in 24 hours.', 'Docusate Sodium 100 mg PO BID:PRN Constipation - First Line', 'Fludrocortisone Acetate 0.05 mg PO DAILY \nRX *fludrocortisone 0.1 mg 0.5 (One half) tablet(s) by mouth \nonce daily Disp #*4 Tablet Refills:*0', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nDo not drive while taking. \nRX *oxycodone 5 mg ___ tablet(s) by mouth every four (4) hours \nas needed for pain Disp #*60 Tablet Refills:*0', 'Senna 17.2 mg PO QHS:PRN Constipation - Second Line', 'Sodium Chloride 2 gm PO TID \nRX *sodium chloride 1 gram 2 tablet(s) by mouth three times a \nday Disp #*168 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 71, 'gender': 'M', 'symptoms': 'epistaxis', 'medical_history': ['- Ruptured ACOM aneurysm ___ s/p craniotomy for clipping, \ncomplicated by severe neurologic damage', '- s/p trach, s/p PEG ___', '- provoked LLE DVT diagnosed ___ s/p IVC filter ___, \nstarted warfarin ___, not on anticoagulation currently', '- CAD s/p MI, stent ___', '- Hypertension', '- Migraines', '- Hypothyroidism', '-Iron deficiency anemia s/p ferreheme infusions ___ and \n___', '-Thrombocytopenia possibly secondary to ITP', '___ R EVD placement', '___ Craniotomy for Clipping of Aneurysm', '___ Cerebral Diagnostic Angiogram', '___ Cerebral Diagnostic Angiogram', '___ Cerebral Diagnostic Angiogram', '___ Trach/PEG', '___ Right VP shunt, Delta valve', '___ IVC filter', 'Hospitalized ___ for sepsis ___ UTI', 'Hospitalized ___ for fever, elevated lactate, urinary \nretention, source unclear'], 'family_history': 'No family history of aneurysms', 'present_illness': '___ year old man with PMHx notable for Ruptured ACOM aneurysm \n___ s/p craniotomy for clipping complicated by severe \nneurologic damage, DVT s/p IVC filter completed a course of \ncoumadin, CAD, HTN who was transferred from ___ at ___ \nwith two episodes of epistaxis. He had one episode of epistaxis \nin the ER which self resolved, he did not require packing or \npressure. He does have a history of epistaxis/bleeding from \ntracheostomy when previously on Coumadin. There was also a \nsmall amount of blood coming from his tracheostomy. He \nunderwent a CT neck with contrast which did not show evidence of \na trachea-esophageal fistula. His blood pressure was normal in \nthe ED SBPs 120s-130s without treatment. He had an isolated \nfever to 101 once in the ED but was otherwise afebrile.\n\nHe is non-verbal. His family reports that he has been doing \nvery well at rehab, he has been more awake and responsive. No \nreport of nausea, vomiting, shortness of breath. He has been \nhaving mild back pain that his son attributes to him being in \nbed all of the time.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', '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': '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': 'Senna', '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': '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': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', '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': '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': 'PNEUMOcoccal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR8', 'doses_per_24_hrs': None}]}, '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': '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': '28.9', 'valuenum': 28.9, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '320', 'valuenum': 320.0, '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': '4.70', 'valuenum': 4.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '___', '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. HEMOLYZED, SLIGHTLY.'}, {'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}], 'exams': 'Physical Exam:\nVS: T 98.1 HR 84 BP 142/65 RR 20 96% RA\nGen: NAD, resting comfortably in bed\nHEENT: small amount of dried blood in nares, EOMI, PERRLA, MMM, \ntracheostomy site with mild irritation\nCV: RRR nl s1s2 no m/r/g\nResp: CTAB no w/r/r\nAbd: Soft, NT, ND +BS, PEG in place site C/D/I\nExt: no c/c/e\nGU: no foley\nSkin: warm, dry, no rashes, no significant skin breakdown', 'diagnoses': [{'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '4659', 'desc': 'Acute upper respiratory infections of unspecified site'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}], 'summary': '___ 08:45AM GLUCOSE-92 UREA N-35* CREAT-0.6 SODIUM-141 \nPOTASSIUM-3.8 CHLORIDE-102 TOTAL CO2-29 ANION GAP-14\n___ 08:45AM ALT(SGPT)-17 AST(SGOT)-16 LD(LDH)-176 ALK \nPHOS-103 TOT BILI-0.6\n___ 08:45AM WBC-10.3* RBC-3.75* HGB-10.6* HCT-34.2* \nMCV-91 MCH-28.3 MCHC-31.0* RDW-22.6* RDWSD-74.4*\n___ 04:55AM LACTATE-0.9\n___ 11:20PM OTHER BODY FLUID FluAPCR-NEGATIVE \nFluBPCR-NEGATIVE\n___ 10:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30 \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-2* PH-7.0 \nLEUK-NEG\n___ 10:20PM URINE RBC-<1 WBC-<1 BACTERIA-FEW YEAST-NONE \nEPI-0\n___ 07:50PM WBC-12.6*# RBC-3.96* HGB-11.0*# HCT-36.1*# \nMCV-91# MCH-27.8# MCHC-30.5* RDW-22.8* RDWSD-75.2*\n\nCXR ___: \nIMPRESSION: \nNo new focal consolidation, pleural effusion, or pneumothorax. \nLow lung \nvolumes with atelectasis and prominent hila. \n\nCT neck with contrast ___:\nIMPRESSION: \nThe anterior wall of the esophagus directly contacts the \nposterior wall of the trachea from the thoracic inlet to the \ncarina. There is no clear evidence of a tracheoesophageal \nfistula, although, the sensitivity of this test for detection of \na small fistula is limited.\n___ year old man with PMHx notable for Ruptured ACOM aneurysm \n___ s/p craniotomy for clipping complicated by severe \nneurologic damage, DVT s/p IVC filter completed a course of \ncoumadin, CAD, HTN who was transferred from ___ at ___ \nwith two episodes of epistaxis.\n\n#Epistaxis: Self resolved in ER triage, did not require packing \nor pressure. No further bleeding in nearly 24 hours. Blood \ncounts stable. CT neck showed no evidence of tracheo-esophageal \nfistula although CT is unable to assess for small fistulas. Low \nclinical suspicion for fistula. He does have a history of \nepistaxis/bleeding from tracheostomy when previously on Coumadin \nbut currently off therapeutic anticoagulation and just on \nheparin SQ BID. Platelet count stable.\n-Monitor for further bleeding\n-Recommend trialing saline nasal spray to moisten nares\n\n#Tracheostomy irritation: Had irritation at tracheostomy site. \nAppears cannula had been upsized at the SNF and cannula was \nslightly too big causing irritation. Respiratory therapy \nchanged cannula to #8.\n-Continue #8 cannula, monitor site for breakdown or infection.\n-Recommend bacitracin ointment to tracheostomy site until \nirritation improves\n\n#Hypertension: Reported hypertension with SBPs to 180s at SNF. \nBlood pressures in ED and floor entirely normal, highest blood \npressure recorded was 154/89 but mostly SBPs in 120s. \n-Continue home regimen of Doxazosin, HCTZ, metoprolol\n-If BP elevating further at SNF would recommend increasing dose \nof HCTZ to 25 mg\n\n#Heme: iron deficiency anemia, chronic thrombocytopenia, history \nof likely ITP. Blood counts improved from last discharge, has \nreceived iron infusions as outpatient. Platelet count of 90 on \ndischarge which is stable for him, baseline ___. \n-Recommend repeat CBC in 1 week, if anemia or thrombocytopenia \nworsening recommend outpatient hematology referall.\n\n#Isolated fever: Had 1 reported fever in ED to 101.0, afebrile \nat all other checks, temperature on admission to floor 98.1. \nCXR and urinalysis unremarkable. No evidence of skin breakdown. \n No report of increased pain or secretions. Influenza swab \nnegative. Initial WBC was 12.6 improved to 10.3 on repeat. \nOverall suspicion for acute infectious process low. \n-Monitor for further fevers.\n\nChronic issues:\n\n#Constipation: continue home regimen\n\n#Tube feeds: continue home regimen\n\n#Neurology: Aneurysm rupture, VP shunt. Per family mental \nstatus has been doing well recently.\n-continue keppra, rehab as tolerated\n-Avoid sedating medications\n\n#FEN/PPX: tube feeds, heparin SC'}}
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{'final_diagnoses': ['Epistaxis', 'Tracheostomy irritation'], 'procedures': ['None'], 'visit_summary': '___ year old man with PMHx notable for Ruptured ACOM aneurysm \n___ s/p craniotomy for clipping complicated by severe \nneurologic damage, DVT s/p IVC filter completed a course of \ncoumadin, CAD, HTN who was transferred from ___ at ___ \nwith two episodes of epistaxis.\n\n#Epistaxis: Self resolved in ER triage, did not require packing \nor pressure. No further bleeding in nearly 24 hours. Blood \ncounts stable. CT neck showed no evidence of tracheo-esophageal \nfistula although CT is unable to assess for small fistulas. Low \nclinical suspicion for fistula. He does have a history of \nepistaxis/bleeding from tracheostomy when previously on Coumadin \nbut currently off therapeutic anticoagulation and just on \nheparin SQ BID. Platelet count stable.\n-Monitor for further bleeding\n-Recommend trialing saline nasal spray to moisten nares\n\n#Tracheostomy irritation: Had irritation at tracheostomy site. \nAppears cannula had been upsized at the SNF and cannula was \nslightly too big causing irritation. Respiratory therapy \nchanged cannula to #8.\n-Continue #8 cannula, monitor site for breakdown or infection.\n-Recommend bacitracin ointment to tracheostomy site until \nirritation improves\n\n#Hypertension: Reported hypertension with SBPs to 180s at SNF. \nBlood pressures in ED and floor entirely normal, highest blood \npressure recorded was 154/89 but mostly SBPs in 120s. \n-Continue home regimen of Doxazosin, HCTZ, metoprolol\n-If BP elevating further at SNF would recommend increasing dose \nof HCTZ to 25 mg\n\n#Heme: iron deficiency anemia, chronic thrombocytopenia, history \nof likely ITP. Blood counts improved from last discharge, has \nreceived iron infusions as outpatient. Platelet count of 90 on \ndischarge which is stable for him, baseline ___. \n-Recommend repeat CBC in 1 week, if anemia or thrombocytopenia \nworsening recommend outpatient hematology referall.\n\n#Isolated fever: Had 1 reported fever in ED to 101.0, afebrile \nat all other checks, temperature on admission to floor 98.1. \nCXR and urinalysis unremarkable. No evidence of skin breakdown. \n No report of increased pain or secretions. Influenza swab \nnegative. Initial WBC was 12.6 improved to 10.3 on repeat. \nOverall suspicion for acute infectious process low. \n-Monitor for further fevers.\n\nChronic issues:\n\n#Constipation: continue home regimen\n\n#Tube feeds: continue home regimen\n\n#Neurology: Aneurysm rupture, VP shunt. Per family mental \nstatus has been doing well recently.\n-continue keppra, rehab as tolerated\n-Avoid sedating medications\n\n#FEN/PPX: tube feeds, heparin SC', 'medications_prescribed': ['1. Acetaminophen 650 mg PO Q4H:PRN pain', '2. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN SOB/wheezing', '3. Artificial Tears 2 DROP BOTH EYES TID', '4. Bisacodyl ___AILY:PRN constipation', '5. Bisacodyl ___X/WEEK (MO,TH)', '6. Docusate Sodium (Liquid) 100 mg PO BID', '7. Doxazosin 2 mg PO HS', '8. Fleet Enema ___AILY:PRN constipation', '9. Guaifenesin 15 mL PO TID', '10. Heparin 5000 UNIT SC BID', '11. Hydrochlorothiazide 12.5 mg PO DAILY', '12. Ipratropium-Albuterol Neb 1 NEB NEB Q6H', '13. LeVETiracetam Oral Solution 1000 mg PO BID', '14. Levothyroxine Sodium 150 mcg PO DAILY', '15. Lorazepam 0.5 mg PO Q6H:PRN anxiety', '16. Metoprolol Tartrate 12.5 mg PO BID', '17. Miconazole Powder 2% 1 Appl TP BID', '18. Polyethylene Glycol 17 g PO DAILY', '19. Senna 8.6 mg PO BID:PRN constipation', '20. Tamsulosin 0.4 mg PO QHS']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 72, 'gender': 'F', 'symptoms': 'lethargy, malaise, fever and neutropenia', 'medical_history': ['___ as per HPI', 'Multiple Sclerosis - Diagnosed in ___. Multiple resolving \nflares. Multiple lesions detected on MRI. Has been treated with \nalternative medications and acupuncture after having a bad \nexperience with amantadine.', 'Osteoporosis', 'Vitamin D deficiency'], 'family_history': 'Mother: ___ Cancer - Died at age ___ .\nFather: Died in accident at age ___. \nSiblings: No siblings. \nNo other significant illnesses in family.', 'present_illness': '___ with MS and recently diagnosed MDS ___, day ___ ___ cycle \n1 of decitabine (start ___, now admitted from rehab with \nlethargy, hypercalcemia, fever. \n.\n___ was recently admitted from ___ to ___ for cycle 1 of \ndecitabine. During this admission ___ required ICU transfer for \nhypoxemia and hypotension due to aspiration pneumonia. Treated \nwith cefepime and metronidzole. Transferred to rehab at time of \ndischarge. On ___ ___ had low grade fever. Cultures were \nobtained (bloods negative to date; urine with VRE) and ___ was \nstarted on vanco and aztreonam given neutropenia. Vanco changed \nto linezolid when VRE returned. Oncology here was called \nyesterday by family re: lethargy and looking unwell. Today in \nclinic ___ was lethargic. Borderline febrile and neutropenic. \nHypercalcemic to 12.3 uncorrected. In clinic received cefepime \nand daptomycin, also zometa and 1 L IVFs. Admitted now for \nfurther management. \n.\nOn floor, awake but somewhat confused, answers questions with \nsoft speech. Cannot report complaint; does endorse thirst, \ntiredness, shortness of breath, and abdominal pain. ROS \notherwise unable to be obtained.', 'medications': [{'medication': 'Simvastatin', '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', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', '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': '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 1.0}, {'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': 'IV Piggyback', '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 1.0}, {'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': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'irbesartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', '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': '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': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'X1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 5.5, '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': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, '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': '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': '108', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '170', 'valuenum': 170.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': '17.3', 'valuenum': 17.3, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, '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': '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': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 48.0, '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '317', 'valuenum': 317.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.3', 'valuenum': 38.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '13.8', 'valuenum': 13.8, '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': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45.6', 'valuenum': 45.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '15.9', 'valuenum': 15.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '53.3', 'valuenum': 53.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '74.9', 'valuenum': 74.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '17.7', 'valuenum': 17.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75.3', 'valuenum': 75.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.1', 'valuenum': 67.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, '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': 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': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '21.8', 'valuenum': 21.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', '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': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '289', 'valuenum': 289.0, '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': '4.51', 'valuenum': 4.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS: 101.7 125/60, HR116, R36 (my exam) 93%RA\nGen: Thin, elderly, male, tachypneic with fairly shallow \nbreathing pattern. Speech mostly understandable, speaks \nquietly.\nHEENT: Anicteric sclerae, PERRL, oropharynx profoundly dry on \nNeck: No cervical or supraclavicular lymphadenopathy. JVD not \napparent at 30 degrees\nLungs: Rare crackle at L lateral base, otherwise clear.\nHeart: tachy, regular, Nl S1/S2, no MRG appreciated\nAbd: Somewhat quiet bowel sounds, soft, ND, reports diffuse TTP \nbut no rebound or guarding. \nExtremities: warm, no clubbing, bilateral ___ edema (trace) L \nslightly greater than R. R PICC site benign.\nNeuro: Lethargic but answers questions and follows commands. \nComplains of tiredness. Able to flex elbows and lift hands, not \nable to left shoulders off bed. Good shoulder shrug. Cranial \nerves grossly intact. Moves legs non antigravity.', 'diagnoses': [{'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '43813', 'desc': 'Late effects of cerebrovascular disease, dysarthria'}, {'icd_code': '43883', 'desc': 'Other late effects of cerebrovascular disease, facial weakness'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "___ 02:55PM WBC-0.9*# RBC-3.24* HGB-9.6* HCT-26.9* MCV-83 \nMCH-29.5 MCHC-35.6* RDW-15.1\n___ 02:55PM NEUTS-0 BANDS-1 LYMPHS-90* MONOS-5 EOS-0 \nBASOS-0 ATYPS-1* ___ MYELOS-0 BLASTS-3*\n___ 02:55PM PLT SMR-RARE PLT COUNT-15*#\n___ 02:55PM ___ CT-60*\n___ 02:55PM UREA N-23* CREAT-0.6 SODIUM-137 POTASSIUM-3.8 \nCHLORIDE-98 TOTAL CO2-33* ANION GAP-10\n___ 02:55PM ALBUMIN-3.0* CALCIUM-12.3* PHOSPHATE-4.3 \nMAGNESIUM-1.6\n___ 02:55PM ALT(SGPT)-35 AST(SGOT)-36 LD(LDH)-173 ALK \nPHOS-106 TOT BILI-0.6\n.\nMICRO:\n___ 3:30 pm URINE\n**FINAL REPORT ___\nURINE CULTURE (Final ___: \nENTEROCOCCUS FAECIUM. 10,000-100,000 ORGANISMS/ML.. \nSensitivity testing performed by Sensititre. \nYEAST. 10,000-100,000 ORGANISMS/ML..\nSENSITIVITIES: MIC expressed in MCG/ML\n \n_________________________________________________________\n ENTEROCOCCUS FAECIUM\n | \nAMPICILLIN------------ =>16 R\nLINEZOLID------------- 2 S\nTETRACYCLINE---------- =>16 R\nVANCOMYCIN------------ =>128 R\n.\n___ Blood cultures negative\n.\n___ 2:29 pm URINE Source: ___. \n**FINAL REPORT ___\nURINE CULTURE (Final ___: \nYEAST. 10,000-100,000 ORGANISMS/ML.\n.\n___ Blood cultures negative\n.\n___ 12:58 pm PLEURAL FLUID\nGRAM STAIN (Final ___: \nNO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \nNO MICROORGANISMS SEEN. \nThis is a concentrated smear made by cytospin method, please \nrefer to\nhematology for a quantitative white blood cell count. \nFLUID CULTURE (Final ___: NO GROWTH. \nANAEROBIC CULTURE (Final ___: NO GROWTH. \nFUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED. \nACID FAST SMEAR (Final ___: \nNO ACID FAST BACILLI SEEN ON DIRECT SMEAR. \nACID FAST CULTURE (Preliminary): NO MYCOBACTERIA ISOLATED.\n.\n___ Blood cultures negative\n.\nIMAGING:\nCXR ___:\nFINDINGS: There is a large right pleural effusion may be \nminimally decreased comparison to prior study. Right basilar \natelectasis is again noted. Additionally, there is a new subtle \nopacity in the left lower lobe. Otherwise, cardiomediastinal \nsilhouette is stable. Right PICC appears stable with the tip at \nthe lower SVC. \nIMPRESSION: \n1. Increased left basilar opacity. While this may be simple \natelectasis, a developing pneumonia cannot be excluded. \n2. Large right pleural effusion. \n.\n___ ECG: Narrow complex tachycardia at 150 beats per minute. \nShort RP tachycardia. Resetting of the tachycardia by a single \nHis synchronous ventricular premature depolarization. When \ncompared to the tracing of ___ similar supraventricular \ntachycardia is noted. Compared to the previous tracing of \n___ sinus rhythm has been replaced by supraventricular \ntachycardia. \n. \n___ ultrasound BUE: FINDINGS: Duplex evaluation was performed \non the right upper extremity veins. The left subclavian vein \nshows normal flow. Right SCV, IJV, axillary, basilic and \nbrachial veins show normal flow and compressibility. The \ncephalic vein is not compressed and no flow is detected within \nthe cephalic vein. \nIMPRESSION: Thrombosis of the right cephalic vein is seen. This \nis considered a superficial vein. No DVT. \n. \n___ Head CT w/o contrast: IMPRESSION: \n1. No acute intracranial process. \n2. Interval resolution of intraventricular hemorrhage. \n. \n___ pCXR: Large right pleural effusion with adjacent \natelectasis is unchanged. Right PICC tip is in the lower SVC. \nMild vascular congestion has increased. The lower lobe opacities \nare unchanged. There is no pneumothorax \n. \n___ pCXR:Compared to the prior study, there is no significant \ninterval change. Moderate right pleural effusion with associated \nright lower lung volume loss. Excess infiltrate in the right \nlower lobe cannot be totally excluded. \n. \n___ pCXR:FINDINGS: There continues to be obscuration of the \nright hemidiaphragm with increased alveolar infiltrate in the \nright lower lobe. The right effusion is slightly smaller; \nhowever, there is also an area of increased alveolar infiltrate \nin the left lower lung likely representing a small new \ninfiltrate in that region. The right-sided PICC line with tip in \nthe distal SVC is again visualized. \nIMPRESSION: Improved appearance on the right, worsened \nappearance in the left lower lobe. \n. \n___ pCXR: small right pneumothorax after pleurocentesis \n. \n___ pCXR: FINDINGS: Compared to the previous radiograph, \nthere is slightly improved expansion of the right basal lung. In \nunchanged manner, fluid is seen in the pleural space. Slightly \nincreasing areas of atelectasis at the right lung base. No \nevidence of tension. Right PICC line might have been minimally \npulled back. Improved ventilation of the left lung. Unchanged \nappearance of the cardiac silhouette. \n. \n___ BLE ultrasound: IMPRESSION: **Preliminary Report** No \nevidence of DVT, however left peroneal veins (one of the calf \nveins) was \nnot visualized. \n. \n___ pCXR **Preliminary Report**: opacification right thorax \nc/w increased effusion, PTX stable, infiltrates on R that could \nbe c/w atypical pna \n. \n___ pCXR FINDINGS: In comparison with the earlier study of \nthis date, there is little overall change. Substantial pleural \neffusion on the right persists, but has not increased. The \nindistinctness of engorged pulmonary vessels, consistent with \nelevated pulmonary venous pressure, is no worse than on the \nprevious study. The tip of the central catheter is unchanged. \n.\n___ Echo: The left atrium is mildly dilated. Left ventricular \nwall thicknesses and cavity size are normal. Due to suboptimal \ntechnical quality, a focal wall motion abnormality cannot be \nfully excluded. Overall left ventricular systolic function is \nlow normal (LVEF 50-55%). Right ventricular chamber size and \nfree wall motion are normal. The aortic valve leaflets are \nmildly thickened (?#). No aortic regurgitation is seen. The \nmitral valve leaflets are mildly thickened. Moderate (2+) mitral \nregurgitation is seen. The pulmonary artery systolic pressure \ncould not be determined. There is no pericardial effusion. \nIMPRESSION: poor technical quality study. Left ventricular \nfunction is probably low normal, a focal wall motion abnormality \ncannot be fully excluded. Right ventricular size and function \nare normal. Moderate mitral regurgitation. \nCompared with the prior study dated ___ (images review), \nimage quality is worse and there is resting tachycardia. Global \nleft ventricular systolic function is probably low normal. \nPulmmonary pressures could not be determined on the current \nstudy.\n___ with MS and recently diagnosed MDS ___, day ___ ___ cycle \n1 of decitabine (start ___, now admitted from \nrehabilitation with febrile neutropenia, lethargy, and \nhypercalcemia.\n. \n# Febrile neutropenia, bilateral pneumonia, and VRE UTI: The \npatient was found to have a VRE UTI and was treated initially \nwith Daptomycin and Cefepime with steady improvement in his \nfever curve. On the morning of ___ ___ was witnessed to \naspirate and made NPO until a swallowing study could be \nperformed. On the morning of ___ ___ was noted to have \nsignificant erythema of his face after receiving cefepime that \nwas concerning for an allergic reaction. ___ antibiotic coverage \nwas therefore changed to aztreonam for gram negative coverage \nand levoquin for gram positive coverage and coverage of atypical \norganisms. Repeat chest xray on ___ showed improvement of \nright low lobe infiltrate, but development of a new LLL \ninfiltrate concerning for aspiration. ___ developed a recurrent \nright sided effusion that was tapped on ___ and felt \nconsistant with a resolving parapneumonic effusion from his \nprior hospitalization. Although the procedure was complicated by \na small pneumothorax, it remained stable and his repiratory \nstatus steadily improved until the morning of ___. At this \ntime, ___ was noted to be tachypnic with a respiratory rate in \nthe mid-___ with increasing hypoxemia. ___ was briefly started \non bactrim for atypical coverage, but this was stopped due to \nhemodynamic instability with fluid overload evident on clinical \nexam and chest x-ray despite diuresis. A bedside transthoracic \nechocardiogram showed low normal LVEF without worsening of his \nMR. ___ triggered for tachycardia and worsening hypoxemia in the \nlate afternoon that were controlled with metoprolol IV and \nincreasing O2 to ___ by nasal cannula. His clinical status \ncontinued to deteriorate through the early evening hours with \nrespiratory rates in the 40's when ___ elected to be comfort \nmeasures only. His friends and health care proxy gathered at his \nbedside. His antibiotics and phlebotomy were discontinued. ___ \nwas started on a morphine drip and his air hunger and agitation \nwere treated lorezapam IV prn. Secretions were treated with a \nscopolamine patch. ___ expired without distress in the mid \nafternoon of ___. \n.\n# Witnessed aspiration with evidence of a RLL infiltrate and now \nnew LLL pneumonia: The patient's bedside swallow evaluation was \nequivocal. A formal video swallow was unable to be performed due \nto transport issues. ___ was allowed ice chips as a comfort \nmeasure on ___. \n. \n# Hypernatremia: Noted on ___. Corrected slowly with IV free \nwater until the patient's respiratory decompensation on ___. \nLabs were no longer followed when the patient elected comfort \nmeasures only prior to his death. \n. \n# MDS/Pancytopenia. MDS ___ recent decitabine. On ___ & early \n___ ___ received 3 bags of platelets for mucosal bleeding, \nhematuria, and GI bleeding. The patient was started on GCSF on \n___ but this was discontinued on ___ due to increasing \nperipheral blast count. \n. \n# Sacral decubitus ulcer: Noted as present on admission by \nnursing. Seen by wound consult service. \n. \n# VRE UTI and candiduria: Treated with daptomycin. Fluconazole \nstarted for candiduria on urine culture on ___. \n. \n# Pneumothorax: Developed ___ post thorocentesis. Stable by \ninital CXRs and subsequently obscured by recurrent plueral \neffusion on ___. \n. \n# Pleural effusion: Tapped by interventional pulmonary ___. \nConsistant with exudate. Recurrence on pCXR ___. \n. \n# Guaiac positive stool/hematuria/bleeding from oral mucosa: \nDeveloped on ___ and ___. GI bleeding appeared to be lower \nGI and likely due to his thrombocytopenia. No frank blood or \nmelena was observed. Transfused 3 bags platelets on ___ and ___ \nwith resolution of all bleeding. \n. \n# Anemia: New mild lower GI bleeding and hematuria on ___ and \n___ with hematocrit drifting down in addition to MDS. \n___ 4 units PRBCs ___ with stabalization of hemtocrit. \n \n.\n# Tachycardia: Diagnosed previously with AV Nodal Reentry \nTachycardia. Had been on po metoprolol which was held on \nadmission with concern for hypotension. Restarted metoprolol at \nlower dose (12.5 tid) ___ which was changed to IV due to \naspiration on ___ requiring NPO. Monitored on telemetry \nthroughout his hospitalization with 2 to 3 episodes of \nassymptomatic tachycardia to 150's each day. \n.\n# Toxic Metabolic encephalopathy: Present on admission. Resolved \nwith IV hydration and treatment of hypercalcemia and infection. \n.\n# Hypercalcemia. Received Zometa in clinic and IVFs (200ml/hr). \nEtiology was unclear. PTH low, PTHrp low, TSH within normal \nlimits. \n.\n# Pain: Described as total body pain. Treated with a combination \nof morphine and ativan. \n.\n# Anxiety: Continued ativan prn. \n.\n# Hypokalemia: repleted with IV sliding scale. \n.\n# Hypomagnasemia: repleteed IV sliding scale. \n.\n# Multiple sclerosis: Unable to take his po's due to aspiration. \nStable neurologically but debilitated. Seen in informal \nconsultation with neurology who recommended consideration of \nfentenyl patch for pain and marinol if possible to give PR. \n.\n# Nutrition: Seen by nutrition service. Started on TPN on \n___. \n# DNR/DNI on admission and made comfort measures only ___"}}
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{'final_diagnoses': ['expired'], 'procedures': ['Thoracentesis'], 'visit_summary': "___ with MS and recently diagnosed MDS ___, day ___ ___ cycle \n1 of decitabine (start ___, now admitted from \nrehabilitation with febrile neutropenia, lethargy, and \nhypercalcemia.\n. \n# Febrile neutropenia, bilateral pneumonia, and VRE UTI: The \npatient was found to have a VRE UTI and was treated initially \nwith Daptomycin and Cefepime with steady improvement in his \nfever curve. On the morning of ___ ___ was witnessed to \naspirate and made NPO until a swallowing study could be \nperformed. On the morning of ___ ___ was noted to have \nsignificant erythema of his face after receiving cefepime that \nwas concerning for an allergic reaction. ___ antibiotic coverage \nwas therefore changed to aztreonam for gram negative coverage \nand levoquin for gram positive coverage and coverage of atypical \norganisms. Repeat chest xray on ___ showed improvement of \nright low lobe infiltrate, but development of a new LLL \ninfiltrate concerning for aspiration. ___ developed a recurrent \nright sided effusion that was tapped on ___ and felt \nconsistant with a resolving parapneumonic effusion from his \nprior hospitalization. Although the procedure was complicated by \na small pneumothorax, it remained stable and his repiratory \nstatus steadily improved until the morning of ___. At this \ntime, ___ was noted to be tachypnic with a respiratory rate in \nthe mid-___ with increasing hypoxemia. ___ was briefly started \non bactrim for atypical coverage, but this was stopped due to \nhemodynamic instability with fluid overload evident on clinical \nexam and chest x-ray despite diuresis. A bedside transthoracic \nechocardiogram showed low normal LVEF without worsening of his \nMR. ___ triggered for tachycardia and worsening hypoxemia in the \nlate afternoon that were controlled with metoprolol IV and \nincreasing O2 to ___ by nasal cannula. His clinical status \ncontinued to deteriorate through the early evening hours with \nrespiratory rates in the 40's when ___ elected to be comfort \nmeasures only. His friends and health care proxy gathered at his \nbedside. His antibiotics and phlebotomy were discontinued. ___ \nwas started on a morphine drip and his air hunger and agitation \nwere treated lorezapam IV prn. Secretions were treated with a \nscopolamine patch. ___ expired without distress in the mid \nafternoon of ___. \n.\n# Witnessed aspiration with evidence of a RLL infiltrate and now \nnew LLL pneumonia: The patient's bedside swallow evaluation was \nequivocal. A formal video swallow was unable to be performed due \nto transport issues. ___ was allowed ice chips as a comfort \nmeasure on ___. \n. \n# Hypernatremia: Noted on ___. Corrected slowly with IV free \nwater until the patient's respiratory decompensation on ___. \nLabs were no longer followed when the patient elected comfort \nmeasures only prior to his death. \n. \n# MDS/Pancytopenia. MDS ___ recent decitabine. On ___ & early \n___ ___ received 3 bags of platelets for mucosal bleeding, \nhematuria, and GI bleeding. The patient was started on GCSF on \n___ but this was discontinued on ___ due to increasing \nperipheral blast count. \n. \n# Sacral decubitus ulcer: Noted as present on admission by \nnursing. Seen by wound consult service. \n. \n# VRE UTI and candiduria: Treated with daptomycin. Fluconazole \nstarted for candiduria on urine culture on ___. \n. \n# Pneumothorax: Developed ___ post thorocentesis. Stable by \ninital CXRs and subsequently obscured by recurrent plueral \neffusion on ___. \n. \n# Pleural effusion: Tapped by interventional pulmonary ___. \nConsistant with exudate. Recurrence on pCXR ___. \n. \n# Guaiac positive stool/hematuria/bleeding from oral mucosa: \nDeveloped on ___ and ___. GI bleeding appeared to be lower \nGI and likely due to his thrombocytopenia. No frank blood or \nmelena was observed. Transfused 3 bags platelets on ___ and ___ \nwith resolution of all bleeding. \n. \n# Anemia: New mild lower GI bleeding and hematuria on ___ and \n___ with hematocrit drifting down in addition to MDS. \n___ 4 units PRBCs ___ with stabalization of hemtocrit. \n \n.\n# Tachycardia: Diagnosed previously with AV Nodal Reentry \nTachycardia. Had been on po metoprolol which was held on \nadmission with concern for hypotension. Restarted metoprolol at \nlower dose (12.5 tid) ___ which was changed to IV due to \naspiration on ___ requiring NPO. Monitored on telemetry \nthroughout his hospitalization with 2 to 3 episodes of \nassymptomatic tachycardia to 150's each day. \n.\n# Toxic Metabolic encephalopathy: Present on admission. Resolved \nwith IV hydration and treatment of hypercalcemia and infection. \n.\n# Hypercalcemia. Received Zometa in clinic and IVFs (200ml/hr). \nEtiology was unclear. PTH low, PTHrp low, TSH within normal \nlimits. \n.\n# Pain: Described as total body pain. Treated with a combination \nof morphine and ativan. \n.\n# Anxiety: Continued ativan prn. \n.\n# Hypokalemia: repleted with IV sliding scale. \n.\n# Hypomagnasemia: repleteed IV sliding scale. \n.\n# Multiple sclerosis: Unable to take his po's due to aspiration. \nStable neurologically but debilitated. Seen in informal \nconsultation with neurology who recommended consideration of \nfentenyl patch for pain and marinol if possible to give PR. \n.\n# Nutrition: Seen by nutrition service. Started on TPN on \n___. \n# DNR/DNI on admission and made comfort measures only ___", 'medications_prescribed': ['expired']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'F', 'symptoms': 'Ovarian cancer', 'medical_history': ['Hyperlipidemia'], 'family_history': 'Mother with breast cancer, maternal aunt with ovarian cancer. \nFather with heart disease.', 'present_illness': '___ G2P2, postmenopausal female who presented in ___ with \nright upper quadrant pain. She underwent an abdominal \nultrasound, which was notable for right-sided hydronephrosis. \nAround that same time, she started noting increasing urinary \nincontinence as well as nocturia. She underwent a CT urogram to \nevaluate the right-sided hydronephrosis on ___. \nThis showed significant dilation of the right intrarenal \ncollecting system and right ureter to the level of the pelvic \ninlet. There was mass effect from an enlarged uterus causing \nhigh-grade obstruction of the distal right ureter. Inferior to \nthe uterus, the right ureter was felt to be normal in caliber. \nThe left urinary collecting system and left ureter were normal. \nCT of the abdomen showed no enlarged lymph nodes and normal \nbowel and mesentery. In the pelvis, there was felt to be two \nlarge cystic lesions within the uterus measuring 13 cm in \nconglomerate. The ovaries were not definitively demonstrated. As \na followup to the CT scan, a pelvic ultrasound was ordered and \non ___, she underwent a transvaginal ultrasound that \ndemonstrated that both ovaries had been replaced by complex \nsolid and cystic masses. On the right, there was a cystic mass \nmeasuring 9.7 x 9.9 x 9.3cm on the left. There was a \nsimilar-appearing lesion measuring 7.9 x 6.2 x 7.5cm. There was \nno free fluid. The uterus was overall felt to be normal size \nwith one small intramural fibroid. Given these findings and a \nconcern for an ovarian malignancy, she was referred to \nGynecologic Oncology for further evaluation. \n.\nOn questioning, she does note some constipation with incomplete \nevacuation, abdominal pain and again the urinary frequency and \nbloating. She denies any abnormal vaginal bleeding or discharge. \nMenopause was in the ___ and she does continue to experience \noccasional hot flashes. Of note, she also underwent a\ncolonoscopy in ___ that was notable for a somewhat tortuous \nsigmoid colon. There was diverticulosis of the sigmoid colon up \nto the hepatic flexure. There was one polyp that was removed, \nwhich was benign.', 'medications': [{'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': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', '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': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nitrofurantoin Monohyd (MacroBID)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CELECOXIB', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 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': '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': '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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IM', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phosphorus', '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': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', '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': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 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': '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': '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': '-346', 'valuenum': -346.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-594', 'valuenum': -594.0, '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': '-467', 'valuenum': -467.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-265', 'valuenum': -265.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-68', 'valuenum': -68.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-335', 'valuenum': -335.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'FEW*.'}, {'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': '300', 'valuenum': 300.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MOD*.'}, {'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': '7', 'valuenum': 7.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.034', 'valuenum': 1.034, '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': '23', 'valuenum': 23.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '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': '___', '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': '36', 'valuenum': 36.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '66', 'valuenum': 66.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, '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': '40', 'valuenum': 40.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 101.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', '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 (eGFR) is likely between 70 and >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': 163.0, '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': '30', 'valuenum': 30.0, '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': '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': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': 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': '12', 'valuenum': 12.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '-61', 'valuenum': -61.0, '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': '0.39', 'valuenum': 0.39, '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': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, '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': '2.7', 'valuenum': 2.7, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92.6', 'valuenum': 92.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', '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': '12.7', 'valuenum': 12.7, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.30', 'valuenum': 0.3, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.23', 'valuenum': 10.23, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'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': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.0, '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': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, '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': '155', 'valuenum': 155.0, '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': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '___', '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': '34', 'valuenum': 34.0, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 97.0, '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': '168', 'valuenum': 168.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 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': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.1, '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': 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': '0.85', 'valuenum': 0.85, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, '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': 15.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': 'NEGATIVE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FOR INTRA AND EXTRACELLULAR PARASITES. THIN AND THICK SMEARS REVIEWED. IF HIGH CLINICAL SUSPICION OF MALARIA; REPEAT SCREEN EVERY 12-24 HOURS FOR 3 CONSECUTIVE DAYS.'}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '33.3', 'valuenum': 33.3, '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': '95', 'valuenum': 95.0, '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': 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': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': 0.4, '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': '69', 'valuenum': 69.0, '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': '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': '___', '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': 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': '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': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '36.3', 'valuenum': 36.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '143', 'valuenum': 143.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, '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': '41.6', 'valuenum': 41.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, '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': '22', 'valuenum': 22.0, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 133.0, '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': '54', 'valuenum': 54.0, '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': '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': '___', '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': 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': '7', 'valuenum': 7.0, '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': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '35.4', 'valuenum': 35.4, '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': '160', 'valuenum': 160.0, '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': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 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'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': '4', 'valuenum': 4.0, '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '13', 'valuenum': 13.0, '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': '3.9', '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': 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': '18', 'valuenum': 18.0, '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': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 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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': '10.5', 'valuenum': 10.5, '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': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '34.8', 'valuenum': 34.8, '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': '32.9', 'valuenum': 32.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '13.6', 'valuenum': 13.6, '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': 3.9, 'ref_range_upper': 5.2, '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': '49.1', 'valuenum': 49.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '10.1', 'valuenum': 10.1, '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': 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': '25', 'valuenum': 25.0, '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': 0.4, '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 (eGFR) is likely between 70 and >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': 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': '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': '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': '___', 'valuenum': 4.1, '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': '15', 'valuenum': 15.0, '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': '31.7', 'valuenum': 31.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '32.8', 'valuenum': 32.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '174', 'valuenum': 174.0, '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': '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': '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': '48.3', 'valuenum': 48.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 21.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', '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': 0.4, 'ref_range_upper': 1.1, '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': '141', 'valuenum': 141.0, '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': '2.2', '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': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Hemolysis falsely elevates this test. 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': '10', 'valuenum': 10.0, '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': 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': '24', 'valuenum': 24.0, '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': 0.4, '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': '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': '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': '___', 'valuenum': 4.4, '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': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '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', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '179', 'valuenum': 179.0, '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': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM:\nGeneral: Sedated, intubated, appears in no acute distress, able \nto respond to simple questions\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: Supple, JVP not elevated, no LAD \nLungs: Intubated, clear to auscultation bilaterally, no wheezes, \nrales, ronchi \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: Foley in place\nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \n.\nOn day of discharge:\nAfebrile, vitals stable\nNo acute distress\nCV: regular rate and rhythm\nPulm: clear to auscultation bilaterally\nAbd: soft, appropriately tender, nondistended, incision \nclean/dry/intact, no rebound/guarding. ostomy with beefy red \ntissue, draining well.\n___: nontender, nonedematous', 'diagnoses': [{'icd_code': 'C712', 'desc': 'Malignant neoplasm of temporal lobe'}, {'icd_code': 'G9349', 'desc': 'Other encephalopathy'}, {'icd_code': 'I612', 'desc': 'Nontraumatic intracerebral hemorrhage in hemisphere, unspecified'}, {'icd_code': 'G936', 'desc': 'Cerebral edema'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'R4701', 'desc': 'Aphasia'}, {'icd_code': 'G8191', 'desc': 'Hemiplegia, unspecified affecting right dominant side'}, {'icd_code': 'N3281', 'desc': 'Overactive bladder'}, {'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'R739', 'desc': 'Hyperglycemia, unspecified'}, {'icd_code': 'B9689', 'desc': 'Other specified bacterial agents as the cause of diseases classified elsewhere'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'S0181XA', 'desc': 'Laceration without foreign body of other part of head, initial encounter'}, {'icd_code': 'W06XXXA', 'desc': 'Fall from bed, initial encounter'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'E8339', 'desc': 'Other disorders of phosphorus metabolism'}], 'summary': 'ADMISSION LABS:\n___ 06:10PM BLOOD WBC-6.6 RBC-3.75* Hgb-11.8* Hct-34.1* \nMCV-91 MCH-31.3 MCHC-34.5 RDW-13.8 Plt ___\n___ 10:10PM BLOOD Neuts-83* Bands-2 Lymphs-7* Monos-8 Eos-0 \nBaso-0 ___ Myelos-0\n___ 06:10PM BLOOD ___ PTT-32.4 ___\n___ 06:10PM BLOOD ___\n___ 10:10PM BLOOD Glucose-169* UreaN-12 Creat-0.5 Na-141 \nK-3.7 Cl-110* HCO3-20* AnGap-15\n___ 10:10PM BLOOD Calcium-7.1* Phos-3.3 Mg-1.6\n___ 05:40PM BLOOD Lactate-1.3\n.\nDISCHARGE LABS:\n___ 06:30AM BLOOD WBC-7.6 RBC-2.81* Hgb-9.0* Hct-25.4* \nMCV-90 MCH-32.0 MCHC-35.4* RDW-16.7* Plt ___\n___ 06:30AM BLOOD Neuts-77.0* Lymphs-11.5* Monos-9.4 \nEos-1.8 Baso-0.4\n___ 06:30AM BLOOD Glucose-102* UreaN-5* Creat-0.5 Na-140 \nK-3.6 Cl-101 HCO3-29 AnGap-14\n___ 06:30AM BLOOD Calcium-8.0* Phos-3.1 Mg-1.8\n.\nIMAGING:\nCXR ___ to eval for fluid overload:\nLungs are mildly hyper expanded and clear. Pulmonary and \nmediastinal vascularity are diminished, suggesting hypovolemia \nor hypotension. Heart size is normal. There is no pleural \nabnormality. Epidural infusion catheter projects over the \nmidline.\nMs. ___ was admitted to the gynecologic oncology service \nafter undergoing an ex-lap, radical resection of pelvic tumor to \ninclude radical abdominal hysterectomy, bilateral \nsalpingo-oophorectomy, rectosigmoid resection, primary \nanastomosis by Dr. ___ with mobilization of the \nsplenic flexure, total omentectomy, bladder peritonectomy, \nappendectomy, protective ileostomy, radical resection of \nperitoneal carcinomatosis, and placement of bilateral ureteral \nstents by Dr. ___ Urology. Please see the operative \nreports for full details. \n.\nHer post-operative course is detailed as follows. She was \nbriefly monitored in the ICU post-operatively due to significant \nintraoperative blood loss (EBL 3500). She received 8 units \npRBCs, 4 units FFP, 1 unit platelets, and 7500 cc IV fluid \nduring the procedure. She arrived in the ICU intubated and \nsedated but was successfully extubated overnight. She required \none additional IV fluid bolus for hypotension (SBP 80-90), but \nher vital signs remained stable therafter.\n.\nOn post-operative day 1, her urine output was adequate so her \nFoley catheter was removed and she voided spontaneously.\n.\nImmediately postoperatively, her pain was controlled with an \nepidural. Her epidural was discontinued and she was transitioned \nto IV Dilaudid on POD 3. Her diet was slowly advanced given \nnausea on POD4 and she was transitioned to PO oxycodone and \nacetaminophen by POD 5. \n.\nBy post-operative day 6, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled.'}}
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{'final_diagnoses': ['Ovarian cancer', 'Final pathology pending'], 'procedures': ['Exploratory laparotomy.', 'Radical resection of pelvic tumor to include radical \nabdominal hysterectomy, bilateral salpingo-oophorectomy, \nrectosigmoid resection.', 'Primary anastomosis by Dr. ___ with mobilization \nof the splenic flexure.', 'Total omentectomy.', 'Bladder peritonectomy.', 'Appendectomy.', 'Protective ileostomy.', 'Radical resection of peritoneal carcinomatosis.', 'Placement of bilateral ureteral stents by Dr. ___ \nUrology.'], 'visit_summary': 'Ms. ___ was admitted to the gynecologic oncology service \nafter undergoing an ex-lap, radical resection of pelvic tumor to \ninclude radical abdominal hysterectomy, bilateral \nsalpingo-oophorectomy, rectosigmoid resection, primary \nanastomosis by Dr. ___ with mobilization of the \nsplenic flexure, total omentectomy, bladder peritonectomy, \nappendectomy, protective ileostomy, radical resection of \nperitoneal carcinomatosis, and placement of bilateral ureteral \nstents by Dr. ___ Urology. Please see the operative \nreports for full details. \n.\nHer post-operative course is detailed as follows. She was \nbriefly monitored in the ICU post-operatively due to significant \nintraoperative blood loss (EBL 3500). She received 8 units \npRBCs, 4 units FFP, 1 unit platelets, and 7500 cc IV fluid \nduring the procedure. She arrived in the ICU intubated and \nsedated but was successfully extubated overnight. She required \none additional IV fluid bolus for hypotension (SBP 80-90), but \nher vital signs remained stable therafter.\n.\nOn post-operative day 1, her urine output was adequate so her \nFoley catheter was removed and she voided spontaneously.\n.\nImmediately postoperatively, her pain was controlled with an \nepidural. Her epidural was discontinued and she was transitioned \nto IV Dilaudid on POD 3. Her diet was slowly advanced given \nnausea on POD4 and she was transitioned to PO oxycodone and \nacetaminophen by POD 5. \n.\nBy post-operative day 6, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was then discharged home \nin stable condition with outpatient follow-up scheduled.', 'medications_prescribed': ['Ibuprofen 600 mg PO Q6H:PRN pain \nRX *ibuprofen 600 mg 1 tablet(s) by mouth every 6 hours Disp \n#*50 Tablet Refills:*1', 'OxycoDONE (Immediate Release) ___ mg PO Q3H:PRN pain \ndo not drink alcohol or drive while taking \nRX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours Disp \n#*50 Tablet Refills:*0', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*50 Capsule Refills:*2', 'Loratadine 10 mg PO PRN allergic rhinitis', 'Lovastatin 40 mg oral qdaily', 'Acetaminophen ___ mg PO Q6H:PRN pain \ndo not take more than 4000mg acetaminophen in 24H \nRX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours \nDisp #*50 Tablet Refills:*2']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 88, 'gender': 'M', 'symptoms': 'Sudden onset headache, confusion and left arm tingling/weakness.', 'medical_history': ['Left Knee replacement ___', 'Right Knee arthroplasty', 'Abdominal Hernia Repair'], 'family_history': 'Brother with diabetes, grandmother with ___ in her ___.', 'present_illness': "___ year old RH man with no ___ transfered from OSH for \nintracerebral bleed. This morning around 10 or 11am he developed \nsudden onset severe headache and lightheadedness. While driving \nat noon, he became disoriented and confused and was driving on \nthe sidewalk. Police came and found the patient confused and \ncomplaining of left arm numbness and weakness. EMS was called \nand took him to ___\n.\nAt ___ the patient's vitals were T: 98.7 P: 89 BP: \n182/103 RR: 18 O2 Sat: 95% on RA. He had one GTC seizure \nobserved by the attending and RN and was given 1g fosphenytoin, \n2mg Ativan and 10mg labetalol. His head CT at ___ showed a \n2.1x1.3x2.5 cm R parietal parenchymal bleed with surrounding \nedema but no midline shift or mass effect.\n.\nHe was transferred to the ___ ___ where his vitals were T: 98 \nP: 72 BP: 151/80 RR: 20 O2 Sat: 96% on RA and Glucose 109.\n.\nIn the ___ the patient is awake and cooperative, but is slightly \ndelayed in answering questions. 6 days ago the patient was seen \nin the ___ for a fall after tripping on a chain. The \npatient fell on his left hand and had an anterior left 9th rib \ncontusion.", 'medications': [{'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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': '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 via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', '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': 'Inactive (Due to a change order)', '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': 'Clopidogrel', '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': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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': '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: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': 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': 'Discontinued via patient discharge', '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': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 403.0, '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': '16', 'valuenum': 16.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.83, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 125.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 334.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', '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': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '___', 'valuenum': 56.0, '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': '___', 'valuenum': 3.64, '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': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.7, '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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', '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': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.7', 'valuenum': 51.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '34.1', 'valuenum': 34.1, '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': '110', 'valuenum': 110.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, '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': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 290.0, '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': '13', 'valuenum': 13.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': '116', 'valuenum': 116.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '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': '33.0', 'valuenum': 33.0, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 383.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', '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': '___', 'valuenum': 3.89, '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': '27', 'valuenum': 27.0, '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': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '3+.'}, {'value': '29.5', 'valuenum': 29.5, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '8.6', 'valuenum': 8.6, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '___', 'valuenum': 249.0, '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': '8', 'valuenum': 8.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, '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': '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', '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': '___', 'valuenum': 4.25, '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '3+.'}, {'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': '33.1', 'valuenum': 33.1, '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': '122', 'valuenum': 122.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.83', 'valuenum': 3.83, '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': 'Vital Signs \nT 98, HR 72, BP 151/80, RR 20, SpO2 96%\n.\nGeneral Physical Exam\nGen: Lying in bed\nHEENT: NC/AT, moist oral mucosa\nNeck: No tenderness to palpation, normal ROM, supple, no carotid \nbruit\nCV: RRR, Nl S1 and S2\nLung: Clear to auscultation bilaterally\nAbd: +BS soft, nontender, nondistended\nExt: no edema in ___, pulses 2+ bilaterally\n.\nNeurologic examination:\nMental status:\nGeneral: alert, awake, normal affect\nOrientation: oriented to person, place, date, situation\nAttention: Was able to perform months of the year backwards.\n.\nExecutive function: Able to follow simple axial and appendicular \ncommands\n.\nMemory: ___ registration, ___ recall (5 min).\n.\nSpeech/Language: Patient was fluent with no paraphasic errors. \nAble to name objects. Normal prosody. Able to read and write. \nRepetition intact.\n.\nPraxis/ agnosia: Able to acting out brushing teeth with his left \nhand.\n.\nCalculations: Able to calculate 100-7 after some delay.\n.\nNeglect: Able to draw clock. Able to identify which side is \ntouched. Had difficulty describing left side of a picture but \nwas able to described it when he was prompted. Line bisection \nwas biased to the right, and did not copy the left side of a \ndrawing of a cube.\n.\nCranial Nerves:\nII: Normal Fundus. Pupils equally round and reactive to light. \nLeft visual field deficit bilaterally.\nIII, IV, VI: Nystagmus when looking to the left, otherwise \nextraocular movements intact bilaterally.\nV1-3: Sensation intact V1-V3.\nVII: Facial movement symmetric. Can keep eyes closed against \nresistance, can furrow forehead\nVIII: Hearing intact to finger rub bilaterally. Symmetric \nhearing on Weber test, no conduction hearing loss on ___ test\nIX & X: Palate elevation symmetric. Uvula is midline. Gives a \ngood cough.\nXI: Sternocleidomastoid and trapezius full strength bilaterally.\nXII: Good bulk. No fasciculations. Tongue midline, movements \nintact.\n.\nMotor:\nNormal bulk bilaterally. Tone normal. No observed myoclonus or \ntremor.\n Delt; C5 bic:C6 Tri:C7 Wr ext:C6 Fing ext:C7\nLeft 5 5 5 5 5\nRight 5 5 5 5 5\n.\n IP: Quad: Hamst: Dorsiflex: ___', 'diagnoses': [{'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '42831', 'desc': 'Acute diastolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'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': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '7089', 'desc': 'Urticaria, unspecified'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '72400', 'desc': 'Spinal stenosis, unspecified region'}, {'icd_code': 'V1272', 'desc': 'Personal history of colonic polyps'}, {'icd_code': 'V1254', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}], 'summary': '___ 02:15PM BLOOD WBC-13.6* RBC-4.72 Hgb-14.1 Hct-40.7 \nMCV-86 MCH-29.9 MCHC-34.7 RDW-13.5 Plt ___\n___ 02:15PM BLOOD Neuts-87.8* Lymphs-7.3* Monos-3.3 Eos-1.2 \nBaso-0.4\n___ 02:15PM BLOOD Plt ___\n___ 02:15PM BLOOD ___ PTT-25.7 ___\n___ 02:15PM BLOOD Glucose-98 UreaN-19 Creat-0.8 Na-143 \nK-4.0 Cl-107 HCO3-26 AnGap-14\n___ 06:57AM BLOOD ALT-14 AST-20 AlkPhos-110 TotBili-0.6\n___ 06:57AM BLOOD Albumin-4.7 Calcium-9.8 Phos-3.9 Mg-2.2\n\n___ am Phenytoin 7.2 --- ___ am phenytoin 8.7\n\nHDL 44 / LDL 112 (TC 193)\nHbA1c 5.4%\n\n.\nCT HEAD W/O CONTRAST ___\nPrelim Read-\nAcute intraparenchymal hemorrhage with adjacent surrounding \nedema, may be slightly increased in size from 2 hours prior \nstudy. No mass effect or shift of normally midline structures. \nAn underlying lesion cannot be excluded. MRI can be considered \nfor further characterization. \n.\nCTA HEAD and NECK W&W/O C & RECON ___\nPrelim Read-\nNo aneurysm or vascular malformation identified, in the region \nof the right parietal lobe IPH. However, occult mass or occult \nvascular malformation not excluded. Final read pending 3D \nrecons. \n.\nCHEST PORTABLE AP ___\nNo evidence of pneumonia. If symptoms persist, standard PA and \nlateral chest radiograph may be helpful to more fully assess the \nlungs. \n.\nMR HEAD W & W/O CONTRAST ___\nFINDINGS: There is again noted a right parietal intraparenchymal \nhemorrhage with surrounding edema and mass effect. There is no \nassociated enhancement. There is no evidence to suggest an \nunderlying arteriovenous malformation. A small area of chronic \nmicrohemorrhage is seen in left thalamus. Mild changes of small \nvessel disease are seen. No acute infarct noted. The midline \nstructures are central. No other lesions identified.\nIMPRESSION: Right parietal intraparenchymal hemorrhage with no \nevidence of abnormal enhancement to suggest underlying mass. \nHowever, follow up in ___ weeks may help for further \nconfirmation, if clinically indicated \n.\nTTE ___\nMr. ___ is a ___ man with minimal PMH --in particular, no \nh/o diabetes or hypertension or hyperlipidemia or CVA/MI-- whose \nonly medications on arrival were NSAID and narcotic pain meds, \nwho was was transferred here to ___ from an OSH with a large \nright parietal ICH as described above, and a possible GTC \nseizure at the OSH ___ before transfer. All his symptoms and exam \nfindings seem to have resolved over 2d in the hospital. He has \nnot had any more seizures here, where he has been kept on \nphenytoin after he was loaded with fos-phenytoin 1g at the OSH \n___. This will be continued for at least six months.\n\nHis MRI was consistent with the CT findings with the only \naddition that there is a tiny spot of hypointensity (old blood \nvs. calcium) in the Left thalamus, which is a location most c/w \nsmall vessel / HTN hemorrhage. There is no way to r/o an \nunderlying mass, so MRI needs to be repeated in about two \nmonths. His TTE did not reveal any cardiac thrombus or PFO to \nsuggest a cardioembolic problem, and his EF, etc. were normal as \ndescribed above. FLP was significant for LDL 112. HbA1c was \nnormal (5.4%) and the patient had no h/o diabetes.\n\nAs his ICH appearance and location is c/w hypertensive disease \n(versus less likely an underlying mass or vascular abnormality \nor early amyloid angiopathy), and with initial SBPs in the \n170s-180s, and with BPs on the floor ranging from the 100s up to \n150s, we started a low-dose ACE-inhibitor, which has been \nwell-tolerated over two days with SBPs in the 100s-120s. \nAntihypertensive med titration will be performed by his PCP as \nan outpatient. He was also started on low-dose simvastatin with \nLDL 112.'}}
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{'final_diagnoses': ['Intracerebral hemorrhage (stroke), Right parietal, centered over \nthe arm region of the postcentral gyrus.'], 'procedures': ['None'], 'visit_summary': 'Mr. ___ is a ___ man with minimal PMH --in particular, no \nh/o diabetes or hypertension or hyperlipidemia or CVA/MI-- whose \nonly medications on arrival were NSAID and narcotic pain meds, \nwho was was transferred here to ___ from an OSH with a large \nright parietal ICH as described above, and a possible GTC \nseizure at the OSH ___ before transfer. All his symptoms and exam \nfindings seem to have resolved over 2d in the hospital. He has \nnot had any more seizures here, where he has been kept on \nphenytoin after he was loaded with fos-phenytoin 1g at the OSH \n___. This will be continued for at least six months.\n\nHis MRI was consistent with the CT findings with the only \naddition that there is a tiny spot of hypointensity (old blood \nvs. calcium) in the Left thalamus, which is a location most c/w \nsmall vessel / HTN hemorrhage. There is no way to r/o an \nunderlying mass, so MRI needs to be repeated in about two \nmonths. His TTE did not reveal any cardiac thrombus or PFO to \nsuggest a cardioembolic problem, and his EF, etc. were normal as \ndescribed above. FLP was significant for LDL 112. HbA1c was \nnormal (5.4%) and the patient had no h/o diabetes.\n\nAs his ICH appearance and location is c/w hypertensive disease \n(versus less likely an underlying mass or vascular abnormality \nor early amyloid angiopathy), and with initial SBPs in the \n170s-180s, and with BPs on the floor ranging from the 100s up to \n150s, we started a low-dose ACE-inhibitor, which has been \nwell-tolerated over two days with SBPs in the 100s-120s. \nAntihypertensive med titration will be performed by his PCP as \nan outpatient. He was also started on low-dose simvastatin with \nLDL 112.', 'medications_prescribed': ['1. Phenytoin Sodium Extended 100 mg Capsule Sig: One (1) Capsule \nPO ONE tablet in the morning and at noon, then TWO tablets in \nthe evening (100mg, 100mg, 200mg for total daily dose of 400mg) \nfor 6 months: You need to have your blood level of phenytoin \n(Dilantin)monitored by your PCP.\nDisp:*120 Capsule(s)* Refills:*2*', '2. Simvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day: \nfor your cholesterol.\nDisp:*30 Tablet(s)* Refills:*2*', '3. Lisinopril 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily): \nfor blood pressure control, to prevent recurrent ICH/stroke.\nDisp:*30 Tablet(s)* Refills:*2*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 32, 'gender': 'M', 'symptoms': 'Chest pain', 'medical_history': ['- AML s/p bone marrow transplant and total body XRT in ___', '- Right breast cancer s/p lumpectomy, localized radiation and \nchemo in ___ ', '- Hypertension', '- DM2', '- NASH', '- IBS', '- migraine headaches', '- OSA- has not used CPAP in very long time ', '- s/p C-section x 2; second c-section complicated by ruptured \nuterus;', '- s/p bilateral cataract'], 'family_history': '- Mother CAD s/p stents in her ___\n- Maternal grandmother CAD age ___ w/ stents\n- Father "heart disease" details unknown', 'present_illness': '___ year old female with new onset chest pain and positive family \nhistory of premature CAD with past medical history significant \nfor AML s/p bone marrow transplant ___ years ago, history of \nbreast cancer s/p lumpectomy w/localized right chest wall \nradiation and chemotherapy in ___ who presented to ___ \non ___ with exertional chest pain x 2. Ruled out for MI; + \nstress test. Transferred to ___ and underwent cardiac cath \n(___) and found to have 2 vessel disease. Dr. ___ met with \npatient in the cath ___ and reviewed the risks and benefits of \ncardiac surgery. She agreed to surgical revascularization and \nconsent was obtained.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H: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': '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': 'IV', 'frequency': 'Q2H: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': 'HydrALAzine', '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': 'ONCE', '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': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H: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 via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', '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': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', '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': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H: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': 'Docusate Sodium', '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', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.05', 'valuenum': 1.05, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '134', 'valuenum': 134.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.2, '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': 23.7, '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': 'NORMAL.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', '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': 'OCCASIONAL.'}, {'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': '26.6', 'valuenum': 26.6, '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': '14', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, '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': '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': '7.8', 'valuenum': 7.8, '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': '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': 149.0, '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': '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': '3.9', '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': '12', 'valuenum': 12.0, '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': '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': '8.3', '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': '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': 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': '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': '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': '4.0', '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '8.2', 'valuenum': 8.2, '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': '33.3', 'valuenum': 33.3, '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': '154', 'valuenum': 154.0, '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': '2.81', 'valuenum': 2.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', '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': '8.1', 'valuenum': 8.1, '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': '33.9', 'valuenum': 33.9, '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': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.70', 'valuenum': 2.7, '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': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'PREOPERATIVE EXAM\nPulse: 100 ST Resp: 32 O2 sat: 98% RA\nB/P Right:cath site Left: 90-122/60\nHeight: 63" Weight:140Pounds\n\nGeneral: well appearing female resting in bed pain free \nSkin: Dry [x] intact [x]\nHEENT: PERRLA [] EOMI []\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 [] _____\nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: + Left:+\nDP Right:+ Left:+\n___ Right:+ Left:+\nRadial Right: TR band Left:+\nCarotid Bruit: none appreciated \n.\nDISCHARGE EXAM - \n98.2\nPO 127 / 76\nR Sitting ___ Ra \n.\nGeneral: NAD [x] \nNeurological: A/O x3 [x] non-focal [x] \nHEENT: PEERL [x] \nCardiovascular: RRR [x] Irregular [] Murmur [] Rub [] \nRespiratory: CTA [x] No resp distress [x]\nGI/Abdomen: Bowel sounds present [x] Soft [x] ND [x] NT [x]\nExtremities: \nRight Upper extremity Warm [x] Edema \nLeft Upper extremity Warm [x] Edema \nRight Lower extremity Warm [x] Edema -\nLeft Lower extremity Warm [x] Edema -\nSkin/Wounds: Dry [x] intact [x]\nSternal: CDI [x] no erythema or drainage [x]\n Sternum stable [x] Prevena [x]\nUpper extremity: Right [x] CDI [x]', 'diagnoses': [{'icd_code': '80006', 'desc': 'Closed fracture of vault of skull without mention of intracranial injury, with loss of consciousness of unspecified duration'}, {'icd_code': '82121', 'desc': 'Closed fracture of condyle, femoral'}, {'icd_code': '8910', 'desc': 'Open wound of knee, leg [except thigh], and ankle, without mention of complication'}, {'icd_code': '8730', 'desc': 'Open wound of scalp, without mention of complication'}, {'icd_code': '87341', 'desc': 'Open wound of cheek, without mention of complication'}, {'icd_code': '80106', 'desc': 'Closed fracture of base of skull without mention of intra cranial injury, with loss of consciousness of unspecified duration'}, {'icd_code': '8024', 'desc': 'Closed fracture of malar and maxillary bones'}, {'icd_code': 'E9682', 'desc': 'Assault by striking by blunt or thrown object'}, {'icd_code': 'E966', 'desc': 'Assault by cutting and piercing instrument'}, {'icd_code': '87363', 'desc': 'Open wound of tooth (broken) (fractured) (due to trauma), without mention of complication'}, {'icd_code': '87343', 'desc': 'Open wound of lip, without mention of complication'}], 'summary': '___ 09:06PM BLOOD WBC-12.0* RBC-4.11 Hgb-12.7 Hct-39.1 \nMCV-95 MCH-30.9 MCHC-32.5 RDW-13.6 RDWSD-47.1* Plt ___\n___ 09:06PM BLOOD ___ PTT-29.3 ___\n___ 09:06PM BLOOD Glucose-290* UreaN-21* Creat-0.9 Na-139 \nK-4.5 Cl-104 HCO3-25 AnGap-10\n___ 09:06PM BLOOD ALT-31 AST-31 LD(LDH)-148 AlkPhos-88 \nTotBili-0.2\n___ 09:06PM BLOOD Albumin-4.1\n___ 09:06PM BLOOD %HbA1c-9.7* eAG-232*\n\nDepartment of Anesthesia\nDivision of Cardiac Anesthesia\n___\nOffice: ___\nAnesthesia OR TEE Report\nName: ___ ___ MRN: ___ Date: ___ 08:01\nINDICATION(S): Intraoperative: CABG\nDOB/Age: ___ (age ___ CPT Code(s): ___, \n___\nSex: female ICD-10 Code(s): I34.0\nHeight/Weight: 64 in / 132 lbs Location/Status: West / In\nBSA: 1.65 m² Echocardiograph: PMS Epiq\nBP: Technical Quality: Good\nHR: Contrast Lot#/Rxn: None / (NA)\n___ MD:\nOrdering: ___, MD\n___ Staff:\nJob Staff Name\n___ Attending Dr. ___, MD\n___ - ___, MD\n___ (TEE) Procedure/Medications\nBlood loss: 0 ml Specimens: None\nTEE Complications: None\nCONCLUSION:\nMEASUREMENTS:\nLEFT ATRIUM ___ ATRIUM (RA)\n___ Ejection Velocity: 0.40m/\nsec (>0.55)\nLEFT VENTRICLE (LV)\nInferolateral Thickness: 0.9cm (nl M<1.1;F<1.0)\nEnd-diastolic (ED) Dimension: 4.5cm (nl M<5.9;F<5.3)\nPre-op TEE Visual Ejection\nFraction: >=45%(nl\nM:___;F:54-74)\nPost-op TEE Visual Ejection\nFraction: >=55%(nl\nM:52-72;F:54-74)\nTHORACIC AORTA/PULMONARY ARTERY (PA)\nAnnulus: 1.9cm\nSinus: 2.5cm (nl M<4.1;F<3.7)\nAORTIC VALVE (AV)\nPeak Velocity: 1.2m/sec (nl<=2.0)\nPeak Gradient: 6mmHg\nMean Gradient: 3mmHg\nAV VTI: 23cm\nLV Outflow Tract (LVOT)\nDiam: 2.0cm\nLVOT VTI: 13cm\nLVOT Peak Velocity: 0.6m/sec\nDimensionless Index: 0.50\nStroke Volume: 41mL\nStroke Volume Index: 24mL/m²\nValve Area\n(Continuity): 1.8cm²\nEMR 2853-P-IP-OP (___) Name: ___ MRN: ___ Study \nDate: ___ 8:01:00 p. ___\nSinus Index: 1.5cm/\nm2 (nl M<2.2;F<2.3)\nSinotubular Junction: 2.0cm\nAscending: 2.6cm (nl M<3.9;F<3.6)\nAscending Index: 1.6cm/\nm2 (nl M<2.0;F<2.3)\nArch: 2.1cm (nl<=3.0)\nDescending: 1.7cm (nl<=2.5)\nValve area index\n(Continuity):\n1.1cm2/\nm2\nMITRAL VALVE (MV)\nPeak E: 0.9m/sec\nRest Mean Gradient: 1mmHg\nVena Contracta: 0.4cm\nFINDINGS:\nADDITIONAL FINDINGS: No TEE related complications.\nPRE-OPERATIVE STATE: Pre-bypass assessment. Sinus rhythm.\nLeft Atrium ___ Veins: Dilated ___. No spontaneous \necho contrast or thrombus in the ___. \nRight Atrium (RA)/Interatrial Septum/Inferior Vena Cava (IVC): \nDIlated RA. No spontaneous echo\ncontrast or thrombus is seen in the RA/RA appendage. Normal \ninteratrial septum. No atrial septal defect by\n2D/color flow Doppler.\nLeft Ventricle (LV): Normal wall thickness. Normal cavity size. \nMild global hypokinesis. Mildly depressed\nejection fraction.\nRight Ventricle (RV): Mild cavity dilation. Mild global \nhypokinesis.\nAorta: Normal sinus diameter. Normal ascending diameter. Normal \narch diameter. Normal descending aorta\ndiameter. No dissection. Siimple atheroma of ascending aorta. \nSimple arch atheroma. Simple descending\natheroma.\nAortic Valve: Mildly thickened (3) leaflets. Mild leaflet \ncalcification. Minimal stenosis. No regurgitation.\nMitral Valve: Mildly thickened leaflets. Mild leaflet \ncalcification. No systolic prolapse. No stenosis. Mild annular\ncalcification. Mild-moderate [___] regurgitation. Central jet.\nPulmonic Valve: Normal leaflets. Trivial regurgitation.\nTricuspid Valve: Normal leaflets. Mild [1+] regurgitation. \nCentral jet.\nPericardium: No effusion.\nPOST-OP STATE: The post-bypass TEE was performed at 10:45:00. \nAtrial paced rhythm.\nSupport: Vasopressor(s): none.\nLeft Ventricle: Systolic function is improved. Global ejection \nfraction is normal.\nRight Ventricle: Improved systolic function.\nAorta: Intact. No dissection.\nAortic Valve: No change in aortic valve morphology from \npreoperative state. No change in aortic\nregurgitation.\nMitral Valve: No change in mitral valve morphology from \npreoperative state. No change in valvular\nregurgitation from preoperative state.\nEMR 2853-P-IP-OP (O___) Name: ___ MRN: ___ Study \nDate: ___ 8:01:00 p. ___\nTricuspid Valve: No change in tricuspid valve morphology vs. \npreoperative state.\nPericardium: No effusion.\nNotification: The surgeon/proceduralist was notified of the \nfindings at the time of the study.\nElectronically signed by Dr. ___ MD on ___ at \n17:39:25\nEMR 2853-P-IP-OP (___) Name: ___ MRN: ___ Study \nDate: ___ 8:01:00 p. ___\n.\n\n___ 03:30AM BLOOD WBC-13.6* RBC-3.44* Hgb-10.6* Hct-32.8* \nMCV-95 MCH-30.8 MCHC-32.3 RDW-14.1 RDWSD-48.6* Plt ___\n___ 05:23AM BLOOD WBC-18.0* RBC-2.45* Hgb-7.5* Hct-23.7* \nMCV-97 MCH-30.6 MCHC-31.6* RDW-13.8 RDWSD-49.3* Plt ___\n___ 12:10PM BLOOD WBC-20.3* RBC-3.04* Hgb-9.5* Hct-28.6* \nMCV-94 MCH-31.3 MCHC-33.2 RDW-13.4 RDWSD-46.4* Plt ___\n___ 05:23AM BLOOD ___\n___ 03:30AM BLOOD Glucose-107* UreaN-16 Creat-0.8 Na-143 \nK-4.5 Cl-100 HCO3-30 AnGap-13\n___ 04:27AM BLOOD Glucose-148* UreaN-19 Creat-0.9 Na-139 \nK-4.9 Cl-106 HCO3-26 AnGap-7*\nThe patient was admitted under cardiology and underwent cardiac \ncatheterization which revealed multi-vessel coronary artery \ndisease. Cardiac surgery was consulted and recommended surgical \nrevascularization. Patient agreed and underwent routine \npreoperative evaluation. Workup was unremarkable and she was \ncleared for surgery. \n\nThe patient was brought to the Operating Room on ___ where \nthe patient underwent CABG x 2 with Dr. ___. Overall the \npatient tolerated the procedure well and post-operatively was \ntransferred to the ___ in stable condition for recovery and \ninvasive monitoring. \nPOD 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. The \npatient was transferred to the telemetry floor for further \nrecovery. Chest tubes and pacing wires were discontinued \nwithout complication. ___ assisted with blood glucose \nmanagement. The patient will be discharged with prescription \nfor Insulin pens. She was transfused packed red blood cells for \npost-op, blood loss anemia. The patient was evaluated by the \nPhysical Therapy service for assistance with strength and \nmobility. By the time of discharge on POD 5 the patient was \nambulating freely, the wound was healing and pain was controlled \nwith oral analgesics. The patient was discharged home in good \ncondition with appropriate follow up instructions.'}}
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{'final_diagnoses': ['Coronary Artery Disease', 'Hypertension', 'AML s/p bone marrow transplant and total body XRT ', 'Breast cancer s/p lumpectomy, localized radiation and chemo ', 'Type II diabetes mellitus', 'NASH', 'OSA'], 'procedures': ['___ Coronary artery bypass grafting x 2 with a left internal \nmammary artery to left anterior descending artery and a free \nradial artery graft to the obtuse marginal artery.'], 'visit_summary': 'The patient was admitted under cardiology and underwent cardiac \ncatheterization which revealed multi-vessel coronary artery \ndisease. Cardiac surgery was consulted and recommended surgical \nrevascularization. Patient agreed and underwent routine \npreoperative evaluation. Workup was unremarkable and she was \ncleared for surgery. \n\nThe patient was brought to the Operating Room on ___ where \nthe patient underwent CABG x 2 with Dr. ___. Overall the \npatient tolerated the procedure well and post-operatively was \ntransferred to the ___ in stable condition for recovery and \ninvasive monitoring. \nPOD 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. The \npatient was transferred to the telemetry floor for further \nrecovery. Chest tubes and pacing wires were discontinued \nwithout complication. ___ assisted with blood glucose \nmanagement. The patient will be discharged with prescription \nfor Insulin pens. She was transfused packed red blood cells for \npost-op, blood loss anemia. The patient was evaluated by the \nPhysical Therapy service for assistance with strength and \nmobility. By the time of discharge on POD 5 the patient was \nambulating freely, the wound was healing and pain was controlled \nwith oral analgesics. The patient was discharged home in good \ncondition with appropriate follow up instructions.', 'medications_prescribed': ['1. Acetaminophen 500 mg PO Q6H:PRN Pain - Mild/Fever ', '2. Aspirin EC 81 mg PO DAILY \nRX *aspirin [Aspirin Low Dose] 81 mg 1 tablet(s) by mouth once a \nday Disp #*30 Tablet Refills:*1 ', '3. Furosemide 20 mg PO DAILY Duration: 5 Days \nRX *furosemide 20 mg 1 tablet(s) by mouth once a day Disp #*5 \nTablet Refills:*0 ', '4. Glargine 45 Units Breakfast\nRX *blood sugar diagnostic [OneTouch Verio] as directed four \ntimes a day Disp #*100 Strip Refills:*1\nRX *insulin glargine [Lantus Solostar U-100 Insulin] 100 unit/mL \n(3 mL) AS DIR 45 Units before BKFT; Disp #*3 Syringe Refills:*1\nRX *blood-glucose meter 1 glucometer as directed Disp #*1 Each \nRefills:*0\nRX *lancets [OneTouch Delica Lancets] 30 gauge as directed four \ntimes a day Disp #*100 Each Refills:*1\nRX *insulin syringe-needle U-100 [BD Insulin Syringe Ultra-Fine] \n31 gauge X ___ as directed up to 5x/day Disp #*100 Syringe \nRefills:*1 ', '5. Isosorbide Dinitrate 5 mg PO TID \nRX *isosorbide dinitrate 5 mg 1 tablet(s) by mouth three times a \nday Disp #*90 Tablet Refills:*5 ', '6. Metoprolol Tartrate 25 mg PO TID \nRX *metoprolol tartrate 25 mg 1 tablet(s) by mouth three times a \nday Disp #*90 Tablet Refills:*1 ', '7. Ranitidine 150 mg PO BID \nRX *ranitidine HCl [Zantac] 150 mg 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*0 ', '8. TraMADol 50 mg PO Q4H:PRN Pain - Moderate \n Reason for PRN duplicate override: Alternating agents for \nsimilar severity\nRX *tramadol 50 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*40 Tablet Refills:*0 ', '9. Atorvastatin 40 mg PO QPM \nRX *atorvastatin 40 mg 1 tablet(s) by mouth qpm Disp #*30 Tablet \nRefills:*1 ', '10. MetFORMIN XR (Glucophage XR) 1000 mg PO DAILY \nRX *metformin 1,000 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*1 ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 73, 'gender': 'M', 'symptoms': 'Epilepsy surgery pre-operative evaluation', 'medical_history': ['Seizure: Keppra low-medium range recently', 'Left fronto-temporal meningioma: s/p resection ___ MRI \ndoes\nnot show any recurrence', 'PTSD s/p domestical abuse (physical, sexual, emotion) by\nhusband ___ years ago; seeing therapist. No meds.', 'Depression', 'Anxiety', 'Headache', 'Memory loss: Thought ___ AEDs', 'Mild anemia: ? thalassemia in past', 'Fibromyalgia: Advil in the past; no meds now', 'GERD', 'Hepatitis: Drug induced, ___ Depakote', 'Insomnia', 'Back pain', 'Hysterectomy', 's/p Cesarean section x3'], 'family_history': 'Mother (DM, HTN, skin ca, cardiac disease), father \n(___).\n4 brothers, 4 sisters generally healthy (no neuro). 5 daughters,\n3 sons.', 'present_illness': '___ RHF admitted for surgical evaluation for intractable\nseizures. \n\nMrs. ___ neurological history began with headaches and\nvision changes; she was diagnosed with a left frontotemporal\nmeningioma which was ressected in ___. Her seizures \nreportedly\nbegan shortly after her operation. \n\nShe has two types of events:\n1. Complex partial. Aura is "unusual internal feeling" which is\ndifficult to describe followed by loss of awareness, staring,\njerking of right arm and leg. Lasts ___ minutes. Followed by \nmild\nconfusion. 1 per week, ppt by stress and sleep deprivation.\n2. Secondarily generalized tonic-clonic. Similar aura to abve.\nSame ictal phase as above followed by head and eye deviation to\nright, stiffening of body, generalized jerking. Tongue biting \nand\nincontinence present. Post-ictal, obtunded with right sided\nweakness. Less frequent - every few months. \n\nShe was admitted to the ___ in ___ after EEG showed\nrecurrent focal epileptiform discharges in bursts up to ___\nseconds (c/w focal complex partial status). Treated with Vimpat,\nDIlantin, Keppra, Lamicral, Depakote (which provided best sz\ncontrol but caused nausea, jaundice/elevated LFTs). Dilantin\ncaused possible lupus-like rxn (joint pain, aches, lethargy) and\nwas ineffective. Keppra ineffective. Lamictal rash in ___. \nTrileptal side effects difficult to recall. Vimpat briefly tried\nduring hospitalization in ___. Her seizures have been difficult\nto control since. \n\nShe is discouraged by both her seizures and the side effects of\nanti-epileptic medication (dizziness, fatigue, balance & memory\nproblems) and therefore pursued epilepsy surgery evaluation. \n\nShe met with ___ on ___. Plan was made to admit\npatient for epilepsy surgery evaluation.\n\nOn admission, the patient states that she is anxious and has\nchest pressure which she typically associates with anxiety. It \nis\nat the left lower sternal border without radiation. No N/V, arm\nparesthesias, light-headedness, palpitation, lower extremity\nedema, abdominal distention, PND. Reports orthopnea. Denies GI\ncomplaints including reflux, abdominal pain. Denies cough, SOB,\nwheeze.', 'medications': [{'medication': 'Furosemide', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': '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': 'Expired', 'route': 'SC', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': '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': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lansoprazole Oral Disintegrating Tab', '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': '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H: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': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', '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': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Glycopyrrolate', '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': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lansoprazole Oral Disintegrating Tab', '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', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'AcetaZOLamide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': '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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Protamine Sulfate', 'proc_type': 'Unit Dose', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'MRX1: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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Verapamil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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', 'doses_per_24_hrs': 3.0}, {'medication': 'Amlodipine', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H: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': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', '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': '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', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', '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': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Clopidogrel', '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: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': '26', 'valuenum': 26.0, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.2', 'valuenum': 12.2, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, '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': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '405', 'valuenum': 405.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': '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': '24', 'valuenum': 24.0, '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': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '120', 'valuenum': 120.0, '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': '10.9', 'valuenum': 10.9, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'L/min', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, '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': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '213', 'valuenum': 213.0, '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '12/.', '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': '4', 'valuenum': 4.0, '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': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.52', 'valuenum': 7.52, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '341', 'valuenum': 341.0, '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': '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': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, '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': '268', 'valuenum': 268.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, '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': '24', 'valuenum': 24.0, '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': '1.20', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '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': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '136', 'valuenum': 136.0, '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': '133', 'valuenum': 133.0, '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': '105', 'valuenum': 105.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '17.5', 'valuenum': 17.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, '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': '33.9', 'valuenum': 33.9, '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': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '0.7', '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 70+ is 75 (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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '128', 'valuenum': 128.0, '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': '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': '238', 'valuenum': 238.0, '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': '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': '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': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'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': '7.36', 'valuenum': 7.36, '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': '4.1', 'valuenum': 4.1, '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': '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': 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': '3.7', 'valuenum': 3.7, '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': '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': '139', 'valuenum': 139.0, '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': '24.7', 'valuenum': 24.7, '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': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, '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': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.69', 'valuenum': 2.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.5', 'valuenum': 41.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, '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': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': 'ROUTINE', 'comments': '___'}, {'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': '65', 'valuenum': 65.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'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': '3.5', 'valuenum': 3.5, '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': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, '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': 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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '7.40', 'valuenum': 7.4, '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': '24.3', 'valuenum': 24.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, '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': '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': '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': '137', 'valuenum': 137.0, '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': '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': '25', 'valuenum': 25.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.0', 'valuenum': 2.0, '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': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 44.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'QNS TO REPEAT. 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': '___'}, {'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': '8.2', 'valuenum': 8.2, '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': 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None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.4', 'valuenum': 42.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.1', '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': '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': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, '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': '30.0', 'valuenum': 30.0, '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': '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': 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': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, '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}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.93', 'valuenum': 2.93, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.2', 'valuenum': 45.2, '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': 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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', '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 = 59 if non African-American (mL/min/1.73 m2). Estimated GFR = 72 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': 129.0, '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': '3.5', 'valuenum': 3.5, '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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '56.2', 'valuenum': 56.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.3', 'valuenum': 52.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, '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': '29.5', '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': '266', 'valuenum': 266.0, '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': '3.05', 'valuenum': 3.05, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 191.0, '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': '3.9', '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': '29', 'valuenum': 29.0, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Admission exam:\nVS: 97.7 130/78 59 16 100 RA\nGEN: NAD NT ND appears fatigued\nHEENT: NCAT EEG cap on\nNECK: Supple\nCHEST/BACK: Spine tender in lumbar area (pt states this has been\nunchanged for many years)\nCARDIAC: RRR no m/r/g\nPULM: CTAB no r/r/w\nABD: nabs soft NT ND\nEXTREM: no c/c/e\nSKIN: WWP no rash\n\nMental Status: Alert, Attentive, ORiented X 3, Follows\nDirections, Language intact (fluency/comprehension/repetition),\nno paraphasic errors\n\nCN:\nII-- 3.5 to 2.5mm, PERRL, no RAPD\nIII,IV,VI- EOMI with physiologic nystagmus, extinguishes at end\ngaze; VFFC\nV- sensations on face intact and symmetric\nVII- facial expressions symmetric\nVIII- intact to voice\nIX,X- palate elevates midline\nXI- shrug full on Right; L-shoulder shrug limited by soreness\nXII- tongue protrudes midline\n\nMotor: Bulk, tone normal\nUE muscle groups-- FULL (not tested: finger flexors and\nInterossei)\n___ muscle groups-- IP (L 4+* pain limited, R 5), Quad (R 5,\nL-patient refused ___ pain), Hamstrings (incomplete test, \npatient\nrefused ___ pain), TA/Gastrocs (L 5, R 5)\n\nReflexes: Bi-2 /Tri-2/ Brachioradialis-2 Patellar-3 Ankle-1 \nPlantar-MUTE; no clonus\n\nNo Pronator Drift\nSensory: ___ intact/symmetric to light touch\nCoordination: FNF (hand to nose) intact; Joint proprioception on\nEHLs accurate\nGait: normal-base gait, normal initiation with arm swing, normal\ntandem gait, unstable when walking on toes\n\nDischarge exam:\nVS: 98.6 90/52 59 18 99 RA\nGEN: NAD NT ND appears fatigued\nHEENT: NCAT\nNECK: Supple\nCARDIAC: RRR no m/r/g\nPULM: CTAB no r/r/w\nABD: nabs soft NT ND\n\nMental Status: Alert, Attentive, ORiented X 3, Follows\nDirections, Language intact (fluency/comprehension/repetition),\nno paraphasic errors\n\nCN:\nII-- 5 to 3mm, PERRLA\nIII,IV,VI- EOMI with physiologic nystagmus\nV- sensations on face intact and symmetric\nVII- facial expressions symmetric\nVIII- intact to voice\nIX,X- palate elevates midline\nXI- intact shoulder shrug\nXII- tongue protrudes midline\n\nMotor: Bulk, tone normal\nMoving all four extremities at least against gravity \nNo Pronator Drift\nSensory: ___ intact/symmetric to light touch\nCoordination: FNF (hand to nose) intact\nGait: normal-base gait, normal initiation with arm swing', 'diagnoses': [{'icd_code': 'I350', 'desc': 'Nonrheumatic aortic (valve) stenosis'}, {'icd_code': 'I9789', 'desc': 'Other postprocedural complications and disorders of the circulatory system, not elsewhere classified'}, {'icd_code': 'D684', 'desc': 'Acquired coagulation factor deficiency'}, {'icd_code': 'F05', 'desc': 'Delirium due to known physiological condition'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'I6523', 'desc': 'Occlusion and stenosis of bilateral carotid arteries'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'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': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'I701', 'desc': 'Atherosclerosis of renal artery'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'M353', 'desc': 'Polymyalgia rheumatica'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'R918', 'desc': 'Other nonspecific abnormal finding of lung field'}, {'icd_code': 'T45515A', 'desc': 'Adverse effect of anticoagulants, initial encounter'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital 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'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}], 'summary': "Admission labs:\n\n___ 06:00PM BLOOD WBC-8.7 RBC-5.23 Hgb-10.1* Hct-32.0* \nMCV-61* MCH-19.3* MCHC-31.5 RDW-15.6* Plt ___\n___ 06:00PM BLOOD Neuts-56.3 ___ Monos-5.3 Eos-1.8 \nBaso-1.0\n___ 06:00PM BLOOD ___ PTT-32.0 ___\n___ 06:00PM BLOOD Plt ___\n___ 06:00PM BLOOD Glucose-91 UreaN-16 Creat-0.9 Na-142 \nK-4.4 Cl-105 HCO3-28 AnGap-13\n___ 06:00PM BLOOD ALT-14 AST-24 LD(LDH)-248 CK(CPK)-101 \nAlkPhos-73 TotBili-0.4\n___ 06:00PM BLOOD CK-MB-2 cTropnT-<0.01\n___ 05:05AM BLOOD CK-MB-2 cTropnT-<0.01\n___ 06:00PM BLOOD Albumin-4.4 Calcium-9.8 Phos-3.2 Mg-2.1\n___ 06:00PM BLOOD D-Dimer-<150\n___ 05:05AM BLOOD %HbA1c-5.3 eAG-105\n___ 06:00PM BLOOD TSH-1.5\n.\nCardiovascular ReportECGStudy Date of ___ 4:23:04 ___\n \nSinus bradycardia. Baseline artifact. Normal tracing. No \nprevious tracing\navailable for comparison.\n \nRead ___\n ___\n___\n.\nCXR ___\nIMPRESSION: \n \n1. No acute cardiopulmonary abnormalities identified.\n \n2. Likely enlarged right thyroid lobe. Further evaluation with a \nnon-urgent\nthyroid ultrasound is recommended.\n\nEEG ___\n This is an abnormal continuous EMU monitoring study because of \nbreach effect, focal slowing, and occasional interictal \ndischarges over left \nhemisphere. This is indicative of focal cerebral dysfunction \nwith an \nepileptogenic potential. There were no electrographic seizures \non this \nrecording. Compared to prior days' recording, there are no \nfurther \nelectrographic seizures. \n\nEEG ___:\nThis is an abnormal continuous EMU monitoring study because of a \nfrequent electrographic seizures described in detail above. \nThese appeared with a focal onset over the left frontal and \nanterior temporal region (F7 and FP1) and had secondary \ngeneralization. There were, in total, three with clinical \ncorrelate visualized on video and at least two more without \nclear clinical correlate. Background continues to demonstrate \nbreach effect over left hemisphere along with asymmetric slowing \nover the left lateral temporal and inferior temporal regions. \nThese findings are indicative of a highly epileptogenic focal \nstructural lesion\n___ h/o anxiety and seizures since resection of meningioma ___ \npresented for epilepsy surgery evaluation and was found to have \nseizures captured electrographically to be over the left frontal \nand anterior temporal region (F7 and FP1) and had secondary \ngeneralization. \n\nACTIVE ISSUES\n# Epilepsy: Patient has a history of meningioma s/p resection \nand has intractable seizures which is difficult to control even \nwith multiple drugs. Patient is admitted for LTM/seizure \npre-surgical evaluation. Patient was connected to continuous \nEEG. She was then weaned of Keppra. The evening of ___, after \nkeppra was completely weaned off, patient had multiple episodes \nof generalized tonic clonic seizures as well as non-convulsive \ngeneralized seizures. These were captured on EEG. The seizure \nfocus was localize to be over the left frontal and anterior \ntemporal region (F7 and FP1) before secondary generalization. \nPatient was given IV ativan and loaded back on Keppra and \ncontinued on her home dose of gabapentin. She experienced \npost-ictal fatigue and confusion for the majority of the day \nafter the generalized seizure events but had no further seizure \nepisodes. She was discharged with her original doses of AEDs. \nShe will likely need further pre-surgical evaluations after this \nadmission. \n\n# Chest discomfort: As noted on admission HPI, pt stated that \nthis has intermittently been present for several years during \ntimes of stress but has never seen a physician about this issue. \nHer EKG was normal with negative troponin. She is unlikely to \nhave had an MI. D-dimer was negative, making pulmonary embolism \nhighly unlikely. CXR was normal. No tenderness on exam \nsuggestive of musculoskeletal cause. Not consistent with GI \netiology by hx. Patient suspects this is secondary to anxiety \nwhich may indeed be the case. Will defer elective stress test \nto outpatient provider.\n\n# Anemia: Baseline unclear. Her Hct has been stable. Will defer \nfurther work up to outpatient provider.\n\n# HTN: currently normotensive. Patient was reportedly only \ntaking her vasoactive medications when she had a headache. She \nis continued on her outpatient medications.\n.\nINACTIVE ISSUES\n# GERD: contniue Ranitidine 150mg 1 Tablet Daily\n# Fibromyalgia: continue Gabapentin 600mg at night\n# Depression: continue Mirtazapine 15mg ___ Tabs at night\n# Bone health: determine when end date for Vitamin D is\n.\nTRANSITIONAL ISSUES\n# Likely enlarged right thyroid lobe: Further evaluation with a \nnon-urgent\nthyroid ultrasound is recommended.\n# Consider an elective stress test to evaluate her intermittent \nchest pain.\n# Anemia work up."}}
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{'final_diagnoses': ['Epilepsy'], 'procedures': ['None'], 'visit_summary': '___ h/o anxiety and seizures since resection of meningioma ___ \npresented for epilepsy surgery evaluation and was found to have \nseizures captured electrographically to be over the left frontal \nand anterior temporal region (F7 and FP1) and had secondary \ngeneralization. \n\nACTIVE ISSUES\n# Epilepsy: Patient has a history of meningioma s/p resection \nand has intractable seizures which is difficult to control even \nwith multiple drugs. Patient is admitted for LTM/seizure \npre-surgical evaluation. Patient was connected to continuous \nEEG. She was then weaned of Keppra. The evening of ___, after \nkeppra was completely weaned off, patient had multiple episodes \nof generalized tonic clonic seizures as well as non-convulsive \ngeneralized seizures. These were captured on EEG. The seizure \nfocus was localize to be over the left frontal and anterior \ntemporal region (F7 and FP1) before secondary generalization. \nPatient was given IV ativan and loaded back on Keppra and \ncontinued on her home dose of gabapentin. She experienced \npost-ictal fatigue and confusion for the majority of the day \nafter the generalized seizure events but had no further seizure \nepisodes. She was discharged with her original doses of AEDs. \nShe will likely need further pre-surgical evaluations after this \nadmission. \n\n# Chest discomfort: As noted on admission HPI, pt stated that \nthis has intermittently been present for several years during \ntimes of stress but has never seen a physician about this issue. \nHer EKG was normal with negative troponin. She is unlikely to \nhave had an MI. D-dimer was negative, making pulmonary embolism \nhighly unlikely. CXR was normal. No tenderness on exam \nsuggestive of musculoskeletal cause. Not consistent with GI \netiology by hx. Patient suspects this is secondary to anxiety \nwhich may indeed be the case. Will defer elective stress test \nto outpatient provider.\n\n# Anemia: Baseline unclear. Her Hct has been stable. Will defer \nfurther work up to outpatient provider.\n\n# HTN: currently normotensive. Patient was reportedly only \ntaking her vasoactive medications when she had a headache. She \nis continued on her outpatient medications.\n.\nINACTIVE ISSUES\n# GERD: contniue Ranitidine 150mg 1 Tablet Daily\n# Fibromyalgia: continue Gabapentin 600mg at night\n# Depression: continue Mirtazapine 15mg ___ Tabs at night\n# Bone health: determine when end date for Vitamin D is\n.\nTRANSITIONAL ISSUES\n# Likely enlarged right thyroid lobe: Further evaluation with a \nnon-urgent\nthyroid ultrasound is recommended.\n# Consider an elective stress test to evaluate her intermittent \nchest pain.\n# Anemia work up.', 'medications_prescribed': ['Gabapentin 600 mg PO HS', 'Hydrochlorothiazide 12.5 mg PO DAILY', 'LeVETiracetam 1250 mg PO BID', 'Lisinopril 10 mg PO DAILY', 'Metoprolol Succinate XL 12.5 mg PO DAILY', 'Ranitidine 150 mg PO DAILY', 'Mirtazapine ___ mg PO HS', 'Diastat *NF* (diazepam) ___ mg Other PRN:seizure > 5 \nminutes', 'Vitamin D2 *NF* (ergocalciferol (vitamin D2)) 50,000 unit \nOral weekly']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 42, 'gender': 'M', 'symptoms': 'Pt. returns to ___ for a cranioplasty', 'medical_history': ['as noted in previous summary'], 'family_history': 'Non contributory', 'present_illness': 'Pt. known to us from a previous admition where he was here for a \nprolonged stay after a SAH, respiratory failure and cerebral \nedema resulting in a hemicraniectomy. He is here for replacement \nof his cranial bone flap.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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', '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': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxcarbazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 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': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H: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': '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': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '42.5', 'valuenum': 42.5, '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': '33.4', 'valuenum': 33.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '374', 'valuenum': 374.0, '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': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': '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': '116', 'valuenum': 116.0, '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': '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': '4.6', 'valuenum': 4.6, '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, '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': '34.4', 'valuenum': 34.4, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.09', 'valuenum': 4.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'MS: Awake, Alert, mouths words and nods to questions\n\nPupils: 4mm to 2mm bilaterally\nEOM: Intact\nCN ___ grossly intact\n\nMotor Uppers:\nHG 5\nB 4\nT 4\n\nMotor lowers:\n\nIP 4\nH 4\nQ 1\n___ 1\nAT 1\n\nNo Clonus\n\nTrach intact, care per ___ down size or D/C as \ntolerated\n\nWound: R cranial wound, with staple closure', 'diagnoses': [{'icd_code': '8246', 'desc': 'Trimalleolar fracture, closed'}, {'icd_code': '30560', 'desc': 'Cocaine abuse, unspecified'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '31400', 'desc': 'Attention deficit disorder without mention of hyperactivity'}, {'icd_code': '30981', 'desc': 'Posttraumatic stress disorder'}, {'icd_code': '30520', 'desc': 'Cannabis abuse, unspecified'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '7291', 'desc': 'Myalgia and myositis, unspecified'}, {'icd_code': 'E9689', 'desc': 'Assault by unspecified means'}, {'icd_code': 'E8499', 'desc': 'Accidents occurring in unspecified place'}], 'summary': 'Post op CT:\nFINDINGS: Patient is status post right frontal cranioplasty, \nwith expected \npost-procedural pneumocephalus. Left- sided ventriculostomy \ndrain again \nidentified entering from the left frontal region, with tip at \nmidline. Size of \nventricles is slightly larger compared to prior study. \nHypodensity and \nencephalomalacia in the frontal lobes bilaterally and territory \nof the ACA, is \nnot significantly changed compared to prior study. Old bilateral \nlacunes are \nagain identified. There is no new hemorrhage. Mild opacification \nof the left \nmastoid air cells is again identified. \n \nIMPRESSION: \n1. Status post right frontal bone flap restoration, expected \npostprocedural \npneumocephalus. \n2. Left-sided ventriculostomy tube again identified in unchanged \nposition. \nSlight increase in size of ventricles compared to prior study. \n3. Otherwise, no significant change from prior study.\nPt. admitted on ___ from ___ for replacement of \nthe cranial bone flap. Operative and post operative course were \nuncomplicated. \n\nWe did look into decanulating his trach by consulting orgional \nsurgeon, but felt it would be safest to downsize or decanulate \nthe trach at ___ where he will have long term care.\n\nAs stated in the follow up instructions, ___ should make an \nappointment to be seen by Dr. ___ in 6 weeks with a non \ncontrast CT.'}}
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{'final_diagnoses': ['___', 'Cerebral aneursym rupture', 'Cerebral edema', 'Respiratory failure/ s/p trach and Peg'], 'procedures': ['Cranioplasty'], 'visit_summary': 'Pt. admitted on ___ from ___ for replacement of \nthe cranial bone flap. Operative and post operative course were \nuncomplicated. \n\nWe did look into decanulating his trach by consulting orgional \nsurgeon, but felt it would be safest to downsize or decanulate \nthe trach at ___ where he will have long term care.\n\nAs stated in the follow up instructions, ___ should make an \nappointment to be seen by Dr. ___ in 6 weeks with a non \ncontrast CT.', 'medications_prescribed': ['1. Acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed. ', '2. Docusate Sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 \ntimes a day). ', '3. Metronidazole 500 mg Tablet Sig: ___ Tablets PO Q8H (every 8 \nhours): Course per ___. ', '4. Vancomycin 250 mg Capsule Sig: One (1) Capsule PO Q6H (every \n6 hours). ', '5. Methylphenidate 5 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '6. Amantadine 50 mg/5 mL Syrup Sig: One (1) PO BID (2 times a \nday). ', '7. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation Q6H (every 6 hours) as \nneeded. ', '8. Levetiracetam 500 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '9. Chlorhexidine Gluconate 0.12 % Mouthwash Sig: One (1) ML \nMucous membrane BID (2 times a day). ', '10. Bacitracin Zinc 500 unit/g Ointment Sig: One (1) Appl \nTopical TID (3 times a day). ', '11. Diltiazem HCl 60 mg Tablet Sig: One (1) Tablet PO QID (4 \ntimes a day). ', '12. Propranolol 40 mg Tablet Sig: Two (2) Tablet PO TID (3 times \na day). ', '13. Bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) \nTablet, Delayed Release (E.C.) PO DAILY (Daily). ', '14. Senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday). ', '15. Ondansetron 4 mg Tablet, Rapid Dissolve Sig: One (1) Tablet, \nRapid Dissolve PO Q8H (every 8 hours) as needed. ', '16. Ondansetron HCl (PF) 4 mg/2 mL Solution Sig: One (1) \nInjection Q8H (every 8 hours) as needed for n/v. ', '17. Metoclopramide 5 mg/mL Solution Sig: One (1) Injection Q6H \n(every 6 hours). ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'F', 'symptoms': 'SOB', 'medical_history': ['# CAD: Chronic Stable Angina', '# CHF EF<20% in ___, moderately dilated LV', '# Rheumatic heart dz s/p MVR ___ years ago and redo in ___ with\na 25 Carbomedics mechanical valve', '# AICD ___ for VT/torsade', '# Chronic A-fib on coumadin', '# Heparin Induced Thrombocytopenia', '# Hydrocephalus s/p VP shunt ___', '# Neuro: CVAs, R subdural hematoma without residual deficits, ?\nSZ'], 'family_history': 'Non-Contributory\nNon-Contributory', 'present_illness': "Ms ___ is a ___ year old ___ female with a history of \nclass III heart failure, rheumatic heart disease with MVR \noriginally in ___ s/p redo in ___, currently on coumadin, \nsevere dilated cardiomyopathy with LVEF ___ and BiV pacemaker \ns/p recent upgrade, heparin induced thrombocytopenia, chronic \nAF, VT/torsades with ICD, CVAs in past with no residual deficits \nwho presents with shortness of breath from outaptient \ncardiologist's office. \n.\nShe reports feeling more SOB over last few weeks and says she \nfeels worse since BIV upgrade on ___. On ___ she \ncomplained of increased weight and her torsemide was increased \nto 80mg BID. Initially this stabilized her symptoms, but \nsubsequently she noted worsening of the shortness of breath. She \npresented to the ___ clinic today as an urgent visit \nwhere she complained of shortness of breath at rest, orthopnea, \nPND(2 pillow), and abdominal bloating. Currently has to stop \nwhen climbing stairs, which is worse than one week ago. Prior to \nBiV upgrade she was able to climb stairs without stoping. Her \n___ baseline is 116-117 lbs; her weight at the clinic was 122 \nlbs. She also complains of insomnia and increased tremolousness. \n\n.\nIn the office she was noted to have a JVP to earlobe in upright \nposition. Her vitals were BP104/60, HR 84. She was noted to have \nascited and hepatomegaly but no lower extremity edema. \n.\nThe patient is in process of undergoing cardiac transplant \nevaluation as outpatient. \n.\nOn review of systems, s/he denies any cough, hemoptysis, black \nstools or red stools. S/he denies recent fevers, chills or \nrigors. S/he denies exertional buttock or calf pain. All of the \nother review of systems were negative.\n. \nCardiac review of systems is notable for absence of chest pain, \nankle edema, palpitations, syncope or presyncope.", 'medications': [{'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Neutra-Phos', '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': 'Sarna Lotion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Omeprazole', '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': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LOPERamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'Q4H: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': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID: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': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '14.8', 'valuenum': 14.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.45', 'valuenum': 0.45, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, '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': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, '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': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 87.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '12.6', 'valuenum': 12.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': 'abnormal', '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': '0.45', 'valuenum': 0.45, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.95', 'valuenum': 13.95, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, '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': '___'}, {'value': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '203', 'valuenum': 203.0, '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': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '517', 'valuenum': 517.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.95', 'valuenum': 0.95, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, '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': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '1.1', 'valuenum': 1.1, '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', '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': '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '98', 'valuenum': 98.0, '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': '12.9', 'valuenum': 12.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.62', 'valuenum': 2.62, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.5', 'valuenum': 45.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '151', 'valuenum': 151.0, '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': '2.72', 'valuenum': 2.72, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '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': '___', 'valuenum': 71.0, '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': 9057.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 624.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '2', 'valuenum': 2.0, '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': '___', 'valuenum': 77.0, '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': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '28.7', 'valuenum': 28.7, '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': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '167', 'valuenum': 167.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.87', 'valuenum': 2.87, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.8', 'valuenum': 0.8, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.0, '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': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, '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': '2.97', 'valuenum': 2.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '29.2', 'valuenum': 29.2, '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': '31.2', 'valuenum': 31.2, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '123', 'valuenum': 123.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.7', 'valuenum': 0.7, '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 109.0, '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': '1.2', 'valuenum': 1.2, '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': '138', 'valuenum': 138.0, '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': '28.3', 'valuenum': 28.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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. RARE GIANT PLATELETS.'}, {'value': '12.8', 'valuenum': 12.8, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.4', 'valuenum': 44.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '133', 'valuenum': 133.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.6', 'valuenum': 0.6, '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': 3.3, '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admisison:\nVS: 98, 100/85, 24, 99 2Lt \nGENERAL: AO self place time, NAD \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple with JVP to earlobe. No TM. \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or \nS4. \nLUNGS: Crackles at left base, mild. \nABDOMEN: Distended to touch, with umb hernia. ___ appreciated to \ntouch. NTTP, +BS\nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.', 'diagnoses': [{'icd_code': 'A419', 'desc': 'Sepsis, unspecified organism'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'J90', 'desc': 'Pleural effusion, not elsewhere classified'}, {'icd_code': 'K830', 'desc': 'Cholangitis'}, {'icd_code': 'K8051', 'desc': 'Calculus of bile duct without cholangitis or cholecystitis with obstruction'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'H9190', 'desc': 'Unspecified hearing loss, unspecified ear'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'R197', 'desc': 'Diarrhea, unspecified'}, {'icd_code': 'T3695XA', 'desc': 'Adverse effect of unspecified systemic antibiotic, initial encounter'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': '___ 05:35AM BLOOD WBC-8.3 RBC-4.19* Hgb-12.0 Hct-36.5 \nMCV-87 MCH-28.8 MCHC-33.0 RDW-16.2* Plt ___\n___ 06:40AM BLOOD WBC-8.1 RBC-4.21 Hgb-12.2 Hct-36.9 MCV-88 \nMCH-29.1 MCHC-33.2 RDW-16.6* Plt ___\n___ 05:40AM BLOOD WBC-6.6 RBC-3.88* Hgb-11.3* Hct-34.6* \nMCV-89 MCH-29.0 MCHC-32.6 RDW-16.9* Plt ___\n___ 05:25AM BLOOD WBC-5.6 RBC-3.68* Hgb-10.6* Hct-32.8* \nMCV-89 MCH-28.9 MCHC-32.4 RDW-16.9* Plt ___\n___ 05:21PM BLOOD WBC-6.0 RBC-4.17* Hgb-12.1 Hct-37.3 \nMCV-90 MCH-29.1 MCHC-32.5 RDW-17.1* Plt ___\n___ 05:35AM BLOOD Glucose-80 UreaN-38* Creat-1.5* Na-136 \nK-3.6 Cl-90* HCO3-34* AnGap-16\n___ 06:40AM BLOOD Glucose-96 UreaN-19 Creat-1.1 Na-138 \nK-2.6* Cl-92* HCO3-30 AnGap-19\n___ 05:40AM BLOOD Glucose-101 UreaN-20 Creat-1.2* Na-139 \nK-3.1* Cl-99 HCO3-29 AnGap-14\n___ 05:40AM BLOOD Glucose-117* UreaN-22* Creat-1.1 Na-139 \nK-3.6 Cl-102 HCO3-27 AnGap-14\n___ 03:20PM BLOOD Glucose-115* UreaN-23* Na-140 K-3.5 \nCl-101 HCO3-29 AnGap-14\n___ 05:25AM BLOOD Glucose-98 UreaN-29* Creat-1.2* Na-140 \nK-3.5 Cl-100 HCO3-29 AnGap-15\n___ 05:21PM BLOOD Glucose-74 UreaN-31* Creat-1.3* Na-138 \nK-4.1 Cl-101 HCO3-28 AnGap-13\n___ 05:21PM BLOOD ALT-19 AST-21 LD(LDH)-220 CK(CPK)-49 \nAlkPhos-58 TotBili-0.8\n___ 05:25AM BLOOD CK-MB-3 cTropnT-0.03*\n___ 05:21PM BLOOD CK-MB-NotDone cTropnT-0.03*\n___ 05:35AM BLOOD Calcium-9.9 Phos-4.6* Mg-2.4\n___ 06:40AM BLOOD Calcium-10.1 Phos-3.1 Mg-2.2\n___ 05:40AM BLOOD Calcium-9.5 Phos-2.7 Mg-2.3\n___ 05:40AM BLOOD Calcium-9.1 Phos-2.8 Mg-2.5\n___ 05:21PM BLOOD TotProt-7.2 Albumin-4.6 Globuln-2.6 \nCalcium-9.7 Phos-3.2 Mg-2.6\n___ 05:21PM BLOOD TSH-15*\n___ 05:21PM BLOOD T4-7.3 Free T4-1.3\n___ 05:25AM BLOOD Digoxin-0.4*\n\nECHO ___\nThe left atrium is markedly dilated. The right atrium is \nmoderately dilated. Left ventricular wall thicknesses are \nnormal. The left ventricular cavity is severely dilated with \nsevere global hypokinesis (LVEF = 20 %). The basal lateral and \nbasal anterior walls contract best. No masses or thrombi are \nseen in the left ventricle. The right ventricular cavity is \nmildly dilated with borderline normal free wall function. The \ndiameters of aorta at the sinus and ascending levels are normal. \nThe aortic valve leaflets (3) are minimally thickened with good \nleaflet excursion and no aortic stenosis. Trace aortic \nregurgitation is seen. A bileaflet mitral valve prosthesis is \npresent. The mitral prosthesis appears well seated, with normal \ndisc motion and transvalvular gradients. No mitral regurgitation \nis seen. [Due to acoustic shadowing, the severity of mitral \nregurgitation may be significantly UNDERestimated.] The \ntricuspid valve leaflets are mildly thickened. Moderate [2+] \ntricuspid regurgitation is seen. There is borderline pulmonary \nartery systolic hypertension (based on likely dilated IVC that \nwas not visualized). There is no pericardial effusion. \n\nECHO ___\nCircumferential and radial strain measurements of the left \nventricle were made in the parasternal short axis window at the \nlevel of papillary muscle. Spectral Doppler velocity-time \nintegral (VTI) measurements were obtained in the apical \nfive-chamber window at the left ventricular outflow tract. VTI \nis proportional to stroke volume.\n\nMeasurements were obtained in the following biventricular pacing \nmodes:\n\nRV pacing only\nbiventricular pacing (right ventricle delayed 0, 10, 20, and 50 \nmsec)\nbiventricular pacing (left ventricle delayed 10, 20, 50, and 80 \nmsec)\n\nBoth VTI (12) and intraventricular mechanical synchrony were \nmaximized during biventricular pacing with a 50 msec delay \nbetween right and left ventricular activation (right ventricle \nactivated 50 msec before left ventricle).\n\nThe worst values for both VTI (8) and intraventricular \nmechanical synchrony occurred during biventricular pacing with a \n0 msec delay between right and left ventricular activation \n(simultaneous right and left ventricular activation).\n\nIMPRESSION: optimal biventricular pacemaker setting is right \nventricle activated 50 msec before left ventricle\nBriefly this is a ___ year old ___ female with a history of \nNYHA-III CHF with LVEF ___ and BiV pacemaker s/p upgrade in \n___, RHD with MVR originally in ___ s/p redo in ___ \npresenting with worsened dyspnea.\n \n# Acute CHF exacurbation: Symptoms onset is associated with BiV \nupgrade. No historical evidence of infection, bleeding, ACS or \nmed noncompliance to explain decompensation. BiV pacing was \noptimized as noted in the results section. She was placed on \nfurosemide ggt and metolazone and diuresed aproximately 5 Lt for \nthe duration of stay. Her symptoms were notably improved on \ndischarge. She was discharged on toresemide 80 mg twice daily in \naddition to metolazone 2.5 mg twice a day. She has baseline low blood pressure and her ACEi and BB were held at presentation. \nHer carvedilol was replaced with metoprolol to decrease anti \nalpha effects in the setting of hypotension. Her lisinopril was \nheld on discharge as her blood pressure was borderline. Please \nrestart during outpatinet visits as pressure tolerates. Digoxin \nwas increased to daily dosing given sub therapeutic level. \n \n# A Fib: Remained rate controlled currently. Digoxin and \nwarfarin (goal INR 2.5-3.5) were continued. Initially held \ncarvedilol for low blood pressures during diuresis. Metoprolol \nwas started as pressures tolerated. \n\n# Asymptomatic hypotension: She has a history of baseline low \nblood pressure. During diuresis with furosemide ggt her pressure \ndecreased to mid ___, while she remained asymptomatic. At this \npoint the furosemide ggt was discontinued and she was \ntrasnitioned to her home toresemide dose, and blood pressure \nreturned to hospital baseline. \n\n# Hypothyroidism: TSH was elevated but her free T4 was within \nnormal range, suggesting subclinical hypothyroidism. Her \nlevothyroxine dose was increased to 125 mcg.\n\n# h/o MVR: RHD at ___, required MVR > ___ yrs ago with redo \nin ___. \n\n# h/o HIT: No heparin products were given.'}}
|
{'final_diagnoses': ['congestive heart failure'], 'procedures': ['None'], 'visit_summary': 'Briefly this is a ___ year old ___ female with a history of \nNYHA-III CHF with LVEF ___ and BiV pacemaker s/p upgrade in \n___, RHD with MVR originally in ___ s/p redo in ___ \npresenting with worsened dyspnea.\n \n# Acute CHF exacurbation: Symptoms onset is associated with BiV \nupgrade. No historical evidence of infection, bleeding, ACS or \nmed noncompliance to explain decompensation. BiV pacing was \noptimized as noted in the results section. She was placed on \nfurosemide ggt and metolazone and diuresed aproximately 5 Lt for \nthe duration of stay. Her symptoms were notably improved on \ndischarge. She was discharged on toresemide 80 mg twice daily in \naddition to metolazone 2.5 mg twice a day. She has baseline low blood pressure and her ACEi and BB were held at presentation. \nHer carvedilol was replaced with metoprolol to decrease anti \nalpha effects in the setting of hypotension. Her lisinopril was \nheld on discharge as her blood pressure was borderline. Please \nrestart during outpatinet visits as pressure tolerates. Digoxin \nwas increased to daily dosing given sub therapeutic level. \n \n# A Fib: Remained rate controlled currently. Digoxin and \nwarfarin (goal INR 2.5-3.5) were continued. Initially held \ncarvedilol for low blood pressures during diuresis. Metoprolol \nwas started as pressures tolerated. \n\n# Asymptomatic hypotension: She has a history of baseline low \nblood pressure. During diuresis with furosemide ggt her pressure \ndecreased to mid ___, while she remained asymptomatic. At this \npoint the furosemide ggt was discontinued and she was \ntrasnitioned to her home toresemide dose, and blood pressure \nreturned to hospital baseline. \n\n# Hypothyroidism: TSH was elevated but her free T4 was within \nnormal range, suggesting subclinical hypothyroidism. Her \nlevothyroxine dose was increased to 125 mcg.\n\n# h/o MVR: RHD at ___, required MVR > ___ yrs ago with redo \nin ___. \n\n# h/o HIT: No heparin products were given.', 'medications_prescribed': ['1. Warfarin 1 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___. ', '2. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '3. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '4. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). \n ', '5. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '6. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '7. Trazodone 50 mg Tablet Sig: 0.5 Tablet PO HS (at bedtime) as \nneeded.\nDisp:*30 Tablet(s)* Refills:*0*', '8. Levothyroxine 150 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '9. Metoprolol Tartrate 50 mg Tablet Sig: One (1) Tablet PO BID \n(2 times a day).\nDisp:*60 Tablet(s)* Refills:*2*', '10. Alendronate 70 mg Tablet Sig: One (1) Tablet PO once a week. \n ', '11. Spironolactone 25 mg Tablet Sig: One (1) Tablet PO once a \nday. ', '12. Calcium Carbonate 500 mg Capsule Sig: One (1) Capsule PO \nonce a day. ', '13. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO once a day. ', '14. K-Dur 20 mEq Tab Sust.Rel. Particle/Crystal Sig: Two (2) Tab \nSust.Rel. Particle/Crystal PO twice a day.\nDisp:*60 Tab Sust.Rel. Particle/Crystal(s)* Refills:*2*', '15. Metolazone 2.5 mg Tablet Sig: One (1) Tablet PO twice a day.\nDisp:*60 Tablet(s)* Refills:*2*']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'planned right internal carotid stenting', 'medical_history': ['Dyslipidemia', 'CAD, s/p multivessel stenting', 'Severe bilateral carotid disease', 'Probable Interstitial lung disease', 'Possible myelodysplastic syndrome with a history of pancytopenia', '(s/p bone marrow biopsy ___', 'BPH', 'Osteoarthritis', 'Remote Hydrocele repair', 'Wrist fracture, s/p surgery', 'Tonsillectomy', 'Cardiac Risk Factors: Dyslipidemia, smoking hx'], 'family_history': 'Father died from an MI at age ___, paternal uncle died of an MI \nat age ___', 'present_illness': 'Mr. ___ is a ___ year old man with history of dyslipidemia, \nCAD s/p stenting, severe bilateral carotid disease, ILD, \nmyelodysplastic syndrome transferred to the CCU for monitoring. \nPt is s/p stenting to R.ICA on ___, L.ICA ___. Pt denies \nthat he had neurologic symptoms including difficulty with \nspeech, confusion, numbness, weakness, paresthesias, or \nsyncopal/pre-syncopal type episodes. \n. \nCurrently, pt reports L.shoulder "heaviness", L.shoulder=sharp \npain upon movement. Denies weakness/paresthesias. Also, reports \nsore throat. Denies current/recent headache, dizziness/LH, \nchanges in vision, stroke, TIA, odynophagia/dysphagia, \nCP/palp/SOB/orthopnea/PND/edema/claudication, abdominal \npain/N/V/D/C/melena/brbpr, dysuria/hematuria, +chronic joint \npain-arthritis, -rash, no h.o easy bruising/bleeding or blood \nclots. ', 'medications': [{'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H: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': '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': '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': 'Levothyroxine Sodium', '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': 'Diltiazem Extended-Release', '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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PrednisoLONE Acetate 0.12% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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/NG', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS: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': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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}]}, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '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': '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': '1.9', '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': '3.6', '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': '15', 'valuenum': 15.0, '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': '32.3', 'valuenum': 32.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '223', 'valuenum': 223.0, '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': '3.62', 'valuenum': 3.62, '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': '45.9', 'valuenum': 45.9, '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': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', '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': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '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': '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': 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': '4.09', 'valuenum': 4.09, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, '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': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, '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': '33.5', 'valuenum': 33.5, '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': '237', 'valuenum': 237.0, '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': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, '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': '18', 'valuenum': 18.0, '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.0', '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': '3.7', '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': '15', 'valuenum': 15.0, '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': '35.2', 'valuenum': 35.2, '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': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '244', 'valuenum': 244.0, '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': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '46.0', 'valuenum': 46.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, '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': '32.4', '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': '278', 'valuenum': 278.0, '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': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, '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': '46.1', 'valuenum': 46.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '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': '4.1', 'valuenum': 4.1, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T96.5 , BP114/66 , HR66 , RR 17 , O2 98-100% on RA \nGen: NAD, appears his stated age, NAD \nHEENT: NCAT, perrla, EOMI, anicteric, MMM, no facial asymmetry \nNeck: no JVD, no LAD \nCV: PMI located in ___ intercostal space, midclavicular line. \nRR, normal S1, S2. No S4, no S3. \nChest: B/L ae no w/c/r \nAbd: +bs, soft, NTND, No HSM or tenderness. No abdominial \nbruits. \nExt: No c/c/e. No femoral bruits, \nSkin: No stasis dermatitis, \nPulses: \nRight: Carotid 2+ with faint bruit; Femoral 2+ without bruit; 2+ \nDP \nLeft: Carotid 2+ with very faint bruit; Femoral 2+ without \nbruit; 2+ DP \nNeuro: AAOx3, CN2-12 intact, but ?slight weakness L.CN11. Motor: \nRUE ___ throughout. L.UE ___ distally. ___ shoulder strength. \nB/L ___ intact ___. Sensation intact to LT, no tremors, \nproprioreception intact. Cerebellar function intact. No speech \ndifficulties or facial asymmetry. ', 'diagnoses': [{'icd_code': 'S32592A', 'desc': 'Other specified fracture of left pubis, initial encounter for closed fracture'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'R32', 'desc': 'Unspecified urinary incontinence'}, {'icd_code': 'W010XXA', 'desc': 'Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter'}, {'icd_code': 'Y92091', 'desc': 'Bathroom in other non-institutional residence as the place of occurrence of the external cause'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}], 'summary': '___ 03:56AM BLOOD WBC-5.6 RBC-4.03* Hgb-11.9* Hct-33.5* \nMCV-83 MCH-29.6 MCHC-35.6* RDW-14.8 Plt ___\n___ 03:56AM BLOOD Glucose-113* UreaN-17 Creat-1.2 Na-141 \nK-3.5 Cl-109* HCO3-24 AnGap-12\n___ 02:34AM BLOOD CK(CPK)-102\n___ 02:34AM BLOOD CK-MB-4\n___ 03:56AM BLOOD Calcium-8.6 Phos-3.4 Mg-1.7\n___ 02:34AM BLOOD %HbA1c-5.7\n___ 02:34AM BLOOD Triglyc-107 HDL-44 CHOL/HD-2.0 LDLcalc-22\n\nMRI/MRA of Head and Neck:\n\nMultiple small acute infarcts in the right frontal precentral \nand right \nparietal postcentral subcortical in location, with patent major \nintracranial arteries, likely related to embolic etiology. \n\nAtherosclerotic disease, involving the right common carotid \nartery \nbifurcation, left anterior cerebral artery and bilateral \ncavernous carotid \nartery segments. \n\nMRI OF THE BRAIN: There are multiple FLAIR hyperintense foci, in \nthe cerebral white matter, subcortical and periventricular in \nlocation, predominant subcortical white matter, in both cerebral \nhemispheres. On the diffusion sequences, there are multiple, \n___, small areas of restricted diffusion, in the right frontal \n(precentral) and one in the right parietal postcentral \nsubcortical location, the larger one in the right precentral \nlocation measuring 1.1 x 0.7 cm, and representing acute \ninfarcts. The ventricles and extra-axial CSF spaces are normal. \nThe visualized arterial flow voids are noted to be patent. The \nvisualized portions of the paranasal sinuses and the mastoid air \ncells reveal increased signal in the anterior ethmoid air cells \non both sides, in the right mastoid air cells, with small amount \nof fluid versus mucosal thickening in the left maxillary sinus. \n \nMR ANGIOGRAM OF THE HEAD: The distal left vertebral, basilar, \nposterior \ninferior cerebellar, and the posterior cerebral arteries are \npatent. The \nintracranial internal carotid, anterior and middle cerebral \narteries are \npatent without focal flow-limiting stenosis, occlusion, or \naneurysm more than 3 mm, within the resolution of MR angiogram. \nThere is contour irregularity of the cavernous carotid arteries \non both sides, related to atherosclerotic calcifications. The A1 \nsegment of the elft anterior cerebral artery is irregular and \nsmall inc aliber likely due to atherosclerotic disease. \n \nMR ANGIOGRAM OF THE NECK: The origins of the arch vessels are \npatent. \nHowever, the origins of the vertebral arteries are not clearly \nevaluated, due to overlapping artifacts. However, they appear to \nbe patent on the source images, with tortuosity of the V1 \nsegment on the left side. Patient shas bilateral carotid artery \nstents in the distal common carotid and proximal internal \ncarotid arteries, evaluation of which is limited on the present \nstudy. Though there is decreased signal along the presumed \ncourse of the stents, with some hypointense areas on the medial \naspect of the right cervical internal carotid artery which can \nbe due to atherosclerotic calcifications, assessment is limited \non the present study. However, there is no flow limitation \ndistally. \nMr. ___ is a ___ year old male with history of CAD s/p \nstenting, s/p left ICA stent, s/p right ICA stenting on this \nadmission admitted to the CCU for montoring of hypotension and \nthen observed for new left-sided upper extremity weakness. \n. \n# CAD/Ischemia: \nPt has a history of CAD. Reports 5 stents. Per report ___, LAD, \nD1 widely patent. Pt was continued on ASA, plavix and a statin \nand anti-hypertensives and anti-anginals (imdur), and flomax \nwere held upon admission to CCU to maintain pt\'s blood pressure \nat an adequate level post-carotid stenting.\n. \n# Pump/valves: \nPt remained clinically euvolemic throughout admission. Following \ncarotid stenting the pt was placed on phenylephrine to maintain \nsystolic blood pressures in the 120\'s. The morning following the \nprocedure the pt was administered a 250 cc normal saline bolus \nand tolerating weaning of phenylephrine. Antihypertensives were \nheld to promote cerebral blood flow. The night prior to \ndischarge the pt was restarted on Flomax. No additional \nvasopressors or fluid boluses were required to maintain blood \npressure.\n.\n# Rhythm: \nFollowing carotid stenting the pt was in sinus bradycardia. As \nhe had a history of sinus bradycardia the rhythm was expected \npost-procedure and he was monitored on telemetry. Nodal agents \nwere held. \n. \n# HTN: \nThe pt was started on Neosyn following the carotid stenting. He \nwas weaned off Neosyn the following day and was restarted on \nhome dose of Flomax. The patient was instructed to follow up \nwith outpatient cardiologist to restart Imdur when blood \npressure tolerates.\n. \n# Urinary retention: \nPt has a history of BPH, and Flomax was held immediately \nfollowing stenting in order to maintain cerebral perfusion. Pt \nhad poor urine output following the procedure that improved when \na foley was placed. On day of discharge the foley was \ndiscontinued and pt was restarted on Flomax and produced \nadequate urine. Baseline creatinine was noted to be unknown but \ncreatinine was stable at 1.3 (1.2 on admission) post-procedure. \n\n. \n# Neurologic:\nOn day 2 of admission the pt developed left shoulder "weakness" \ns/p stent to right ICA with ___ proximal left upper extremity \nstrength. His EKG was unchanged and the patient had no cardiac \nsymptoms. Hemoglobin A1C was within normal limits and a lipied \npanel was also within normal limits. CT of the head did not \nreveal any acute intracranial hemorrhage. MRI/MRA of head and \nneck showed multiple small acute infarcts in the right frontal \nprecentral and right parietal postcentral subcortical in \nlocation, with patent major intracranial arteries, likely \nrelated to embolic etiology. The patient had serial neuro checks \nwhich did not reveal additional neurologic deficits. On day of \ndischarge pt\'s left upper extremity strength was mildly \nimproved, and a physical therapy consultation recommended \noutpatient occupational therapy for the left hand. The patient \nwas given a script for outpatient occupational therapy. \n. \n# FEN: \nPatient was administered a cardiac diet, and electrolytes were \nrepleted as needed.\n. \n# Prophylaxis: \nThe patient was continued on aspirin and plavix. He was \nadministered subcutaneous heparin. A bowel regimen was \nadministered and incentive spirometry was encouraged. \n. \n# Code: \nThe patient was full code.'}}
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{'final_diagnoses': ['Right Internal Carotid Stenting', 'CVA', 'Hypertension', 'Coronary Artery Disease'], 'procedures': ['Right internal carotid stenting'], 'visit_summary': 'Mr. ___ is a ___ year old male with history of CAD s/p \nstenting, s/p left ICA stent, s/p right ICA stenting on this \nadmission admitted to the CCU for montoring of hypotension and \nthen observed for new left-sided upper extremity weakness. \n. \n# CAD/Ischemia: \nPt has a history of CAD. Reports 5 stents. Per report ___, LAD, \nD1 widely patent. Pt was continued on ASA, plavix and a statin \nand anti-hypertensives and anti-anginals (imdur), and flomax \nwere held upon admission to CCU to maintain pt\'s blood pressure \nat an adequate level post-carotid stenting.\n. \n# Pump/valves: \nPt remained clinically euvolemic throughout admission. Following \ncarotid stenting the pt was placed on phenylephrine to maintain \nsystolic blood pressures in the 120\'s. The morning following the \nprocedure the pt was administered a 250 cc normal saline bolus \nand tolerating weaning of phenylephrine. Antihypertensives were \nheld to promote cerebral blood flow. The night prior to \ndischarge the pt was restarted on Flomax. No additional \nvasopressors or fluid boluses were required to maintain blood \npressure.\n.\n# Rhythm: \nFollowing carotid stenting the pt was in sinus bradycardia. As \nhe had a history of sinus bradycardia the rhythm was expected \npost-procedure and he was monitored on telemetry. Nodal agents \nwere held. \n. \n# HTN: \nThe pt was started on Neosyn following the carotid stenting. He \nwas weaned off Neosyn the following day and was restarted on \nhome dose of Flomax. The patient was instructed to follow up \nwith outpatient cardiologist to restart Imdur when blood \npressure tolerates.\n. \n# Urinary retention: \nPt has a history of BPH, and Flomax was held immediately \nfollowing stenting in order to maintain cerebral perfusion. Pt \nhad poor urine output following the procedure that improved when \na foley was placed. On day of discharge the foley was \ndiscontinued and pt was restarted on Flomax and produced \nadequate urine. Baseline creatinine was noted to be unknown but \ncreatinine was stable at 1.3 (1.2 on admission) post-procedure. \n\n. \n# Neurologic:\nOn day 2 of admission the pt developed left shoulder "weakness" \ns/p stent to right ICA with ___ proximal left upper extremity \nstrength. His EKG was unchanged and the patient had no cardiac \nsymptoms. Hemoglobin A1C was within normal limits and a lipied \npanel was also within normal limits. CT of the head did not \nreveal any acute intracranial hemorrhage. MRI/MRA of head and \nneck showed multiple small acute infarcts in the right frontal \nprecentral and right parietal postcentral subcortical in \nlocation, with patent major intracranial arteries, likely \nrelated to embolic etiology. The patient had serial neuro checks \nwhich did not reveal additional neurologic deficits. On day of \ndischarge pt\'s left upper extremity strength was mildly \nimproved, and a physical therapy consultation recommended \noutpatient occupational therapy for the left hand. The patient \nwas given a script for outpatient occupational therapy. \n. \n# FEN: \nPatient was administered a cardiac diet, and electrolytes were \nrepleted as needed.\n. \n# Prophylaxis: \nThe patient was continued on aspirin and plavix. He was \nadministered subcutaneous heparin. A bowel regimen was \nadministered and incentive spirometry was encouraged. \n. \n# Code: \nThe patient was full code.', 'medications_prescribed': ['1. Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '2. Aspirin 325 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).', '3. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '4. Rosuvastatin 5 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '5. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. Diflunisal 500 mg Tablet Sig: One (1) Tablet PO once a day.', '7. Chloroquine Phosphate 500 mg Tablet Sig: One (1) Tablet PO \nevery other day.', '8. Repliva ___ (New Formulation) 151-200-1-0.8 mg Tablet Sig: \nOne (1) Tablet PO once a day.', '9. Flomax 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO at bedtime.', '10. Tamsulosin 0.4 mg Capsule, Sust. Release 24 hr Sig: One (1) \nCapsule, Sust. Release 24 hr PO HS (at bedtime).', '11. Outpatient Occupational Therapy\nPatient needs occupational therapy for his left arm and hand.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'F', 'symptoms': 'S/p fall', 'medical_history': ['Hypertension', 'Depression', 'Hypercholesterolemia', 'Cognitive decline', 'Cervical stenosis with impingement of cord', 'Glaucoma', 'Tonsillectomy', 'Question of TIA'], 'family_history': 'NC', 'present_illness': 'Ms. ___ is a pleasant ___ y.o. F with hypertension and \ndepression, who presents s/p fall from standing. Fall was \nunwitnessed. The patient lives with her son. Son reports hearing \na thump from another room, and he found her sitting on the \nfloor. The patient states that the "walker got away from me." \nDenies loss of consciousness and was ambulatory afterward. She \ncomplains of left inner and outer thigh pain. Denies head, neck \nor back pain. Son reports upper respiratory symptoms including \ncough and congestion off and on in past week but not for last \ncouple of days. Denies fevers, urinary symptoms, diarrhea, \npalpitations, shortness of breath, chest pain. Patient reports \nlast bowel movement may have been up to 1 week ago, typically \npasses bowel movements ___ times per week.', 'medications': [{'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': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Losartan Potassium', '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': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Multivitamins', '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/NG', '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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', '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': 'Guaifenesin-Dextromethorphan', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'DAILY', 'doses_per_24_hrs': 1.0}]}, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': 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 = 39 if non African-American (mL/min/1.73 m2) . Estimated GFR = 47 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': 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': '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': '128', 'valuenum': 128.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, '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': '27.6', 'valuenum': 27.6, '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': '86', 'valuenum': 86.0, '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': 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': '3.23', 'valuenum': 3.23, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, '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': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '251', 'valuenum': 251.0, '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': '3.35', 'valuenum': 3.35, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.0', 'valuenum': 47.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '80', 'valuenum': 80.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 94.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134.8', 'valuenum': 134.8, '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': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<20.'}, {'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': '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', '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': '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': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, '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': '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': 'MOD.'}, {'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': 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': 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': '1.011', 'valuenum': 1.011, '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': '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': '5', 'valuenum': 5.0, '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}], 'exams': 'ADMISSION EXAM: \nVS: 97 138/68 63 20 95%RA\nGENERAL: very thin elderly woman, lying supine with legs \npropped up with bent knees; patient clearly in pain holding on \nto right hip and thigh; patient selectively responds verbally to \nquestions, sometimes shrugging her shoulders and staring, \nsometimes responding when it is made clear that the examiner \nexpects a response; sometimes oriented to hospital and year, \nsometimes not. Can count easily backwards from 10 to 1, but \ncannot do months of year backwards\nHEENT: dry mucus membranes\nCARDIAC: RRR\nLUNG: generalized wheezing anteriorly and laterally, good air \nmovement\nABDOMEN: very thin, abdominal muscles firm, nontender, \nnondistended\nEXT: no edema', 'diagnoses': [{'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'C258', 'desc': 'Malignant neoplasm of overlapping sites of pancreas'}, {'icd_code': 'C7801', 'desc': 'Secondary malignant neoplasm of right lung'}, {'icd_code': 'C778', 'desc': 'Secondary and unspecified malignant neoplasm of lymph nodes of multiple regions'}, {'icd_code': 'C786', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'C7802', 'desc': 'Secondary malignant neoplasm of left lung'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C792', 'desc': 'Secondary malignant neoplasm of skin'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'R112', 'desc': 'Nausea with vomiting, unspecified'}, {'icd_code': 'T451X5A', 'desc': 'Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'G893', 'desc': 'Neoplasm related pain (acute) (chronic)'}], 'summary': "___ 03:30AM BLOOD WBC-12.3*# RBC-4.06* Hgb-11.2* Hct-35.4* \nMCV-87 MCH-27.6 MCHC-31.7 RDW-15.3 Plt ___\n___ 06:30AM BLOOD WBC-10.8 RBC-3.95* Hgb-11.2* Hct-34.0* \nMCV-86 MCH-28.3 MCHC-32.8 RDW-15.7* Plt ___\n___ 05:35AM BLOOD WBC-11.4* RBC-3.41* Hgb-8.8* Hct-29.5* \nMCV-87 MCH-26.0* MCHC-30.0* RDW-15.2 Plt ___\n___ 03:30AM BLOOD Neuts-69.3 ___ Monos-2.8 Eos-0.9 \nBaso-0.3\n___ 03:30AM BLOOD ___ PTT-26.7 ___\n___ 03:30AM BLOOD Glucose-104* UreaN-22* Creat-0.7 Na-146* \nK-3.7 Cl-103 HCO3-34* AnGap-13\n___ 05:35AM BLOOD Glucose-118* UreaN-21* Creat-0.8 Na-142 \nK-3.6 Cl-99 HCO3-36* AnGap-11\n\nPELVIS (AP ONLY) Study Date of ___ 2:33 AM \nSINGLE FRONTAL VIEW OF THE PELVIS AND RIGHT HIP, TWO VIEWS: \nThere is fracture of the superior pubic ramus on the right which \nis minimally displaced. In addition, there is a nondisplaced \nfracture of the left superior pubic ramus. There is no evidence \nof dislocation or proximal femoral fracture. There is extensive \nvascular calcification. There are degenerative changes of the \nlumbar spine. \n\nCHEST (PORTABLE AP) Study Date of ___ 10:01 AM \nIMPRESSION: Clear lungs. \nMs. ___ is a pleasant ___ y.o. F with hypertension and \ndepression, who presented s/p mechanical fall from standing, \nfound to have R superior ramus fracture. \n\n#. Right and Left superior ramus fracture. \nPatient noted to have minimally displaced fracture of the right \nsuperior pubic ramus \nand nondisplaced fracture of the left superior pubic ramus, \nresulting from fall. Orthopedics followed with patient and \nconfirmed that she does not need surgery. She may bear weight \nas tolerated on both extremities. She was given pain control \nwith standing acetaminophen 650mg po TID and small doses of \nmorphine as needed, initially. Morphine was switched to \ntramadol in setting of delirium after getting morphine. \n\n#. s/p Fall. \nThe patient's fall was unwitnessed, but per her history, it \nappears to have been mechanical. She has no known cardiac \nhistory, though she does have a history of hypertension. She \nhas no known seizure history. She denied loss of consciousness. \nShe was noted by her primary care physician to have had falls in \nthe past though preferred to not change her living situation \nwith her son. She did have a mild contraction alkalosis on the \nmorning after presentation and may have been dehydrated prior to \nher fall; because there are no plans for surgery, she was \nallowed to eat p.o. to rehydrate herself. She was evaluated by \nphysical therapy and tolerated standing and sitting up to the \nchair. Patient may attempt walking with walker as tolerated. \nShe should continue with physical therapy. \n\n#. Leukocytosis. \nShe had a mild leukocytosis on admission but was afebrile. Her \nurine analysis was negative. She did have diffuse wheezing on \nlung exam, though denied any shortness of breath and had a clear \nchest xray. Her elevated WBC may be secondary to stress. \n \n#. Normocytic anemia. \nPatient's baseline appears to be Hct ___ and appeared to be \nstable on presentation. She does not have any hematomas visible \non examination. She was noted to have a hematocrit drop to 30 \nin the next few days, but her hematocrit remained stable by the \ntime of discharge. Her hematocrit should be rechecked the day \nafter discharge at the rehabilitation facility to ensure that it \nis stable. \n \n#. Hypertension. \nPatient was continued on home antihypertensives \nhydrochlorothiazide. The trandolapril was restarted upon \ndischarge. \n\n#. Question of TIA. \nClopidogrel was held on presentation because of possibility of \northopedic surgery but was restarted because the patient was not \nneeding to undergo surgery. \n \n#. Glaucoma. \nContinued Levobunolol. \n\n#. Nutrition. \nThere was some concern of aspiration with eating initially, but \nChest Xray was clear. Patient was evaluated by Speech and \nSwallow team who noted no signs of aspiration; they recommended \nthin liquids and regular solids-- the solids should be eaten in \nsmall pieces with a few sips of water in between. She should \nalso have Q8hour oral care, and her oral cavity should be \nexamined for leftover food after each meal. \n\n#. Patient was DNR/DNI during this hospitalization."}}
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{'final_diagnoses': ['Minimally displaced fracture of right superior pubic ramus', 'Nondisplaced fracture of the left superior pubic ramus', 'S/p Fall', 'Hypertension', 'Depression', 'Hypercholesterolemia', 'Cognitive decline', 'Cervical stenosis with impingement of cord', 'Glaucoma'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is a pleasant ___ y.o. F with hypertension and \ndepression, who presented s/p mechanical fall from standing, \nfound to have R superior ramus fracture. \n\n#. Right and Left superior ramus fracture. \nPatient noted to have minimally displaced fracture of the right \nsuperior pubic ramus \nand nondisplaced fracture of the left superior pubic ramus, \nresulting from fall. Orthopedics followed with patient and \nconfirmed that she does not need surgery. She may bear weight \nas tolerated on both extremities. She was given pain control \nwith standing acetaminophen 650mg po TID and small doses of \nmorphine as needed, initially. Morphine was switched to \ntramadol in setting of delirium after getting morphine. \n\n#. s/p Fall. \nThe patient's fall was unwitnessed, but per her history, it \nappears to have been mechanical. She has no known cardiac \nhistory, though she does have a history of hypertension. She \nhas no known seizure history. She denied loss of consciousness. \nShe was noted by her primary care physician to have had falls in \nthe past though preferred to not change her living situation \nwith her son. She did have a mild contraction alkalosis on the \nmorning after presentation and may have been dehydrated prior to \nher fall; because there are no plans for surgery, she was \nallowed to eat p.o. to rehydrate herself. She was evaluated by \nphysical therapy and tolerated standing and sitting up to the \nchair. Patient may attempt walking with walker as tolerated. \nShe should continue with physical therapy. \n\n#. Leukocytosis. \nShe had a mild leukocytosis on admission but was afebrile. Her \nurine analysis was negative. She did have diffuse wheezing on \nlung exam, though denied any shortness of breath and had a clear \nchest xray. Her elevated WBC may be secondary to stress. \n \n#. Normocytic anemia. \nPatient's baseline appears to be Hct ___ and appeared to be \nstable on presentation. She does not have any hematomas visible \non examination. She was noted to have a hematocrit drop to 30 \nin the next few days, but her hematocrit remained stable by the \ntime of discharge. Her hematocrit should be rechecked the day \nafter discharge at the rehabilitation facility to ensure that it \nis stable. \n \n#. Hypertension. \nPatient was continued on home antihypertensives \nhydrochlorothiazide. The trandolapril was restarted upon \ndischarge. \n\n#. Question of TIA. \nClopidogrel was held on presentation because of possibility of \northopedic surgery but was restarted because the patient was not \nneeding to undergo surgery. \n \n#. Glaucoma. \nContinued Levobunolol. \n\n#. Nutrition. \nThere was some concern of aspiration with eating initially, but \nChest Xray was clear. Patient was evaluated by Speech and \nSwallow team who noted no signs of aspiration; they recommended \nthin liquids and regular solids-- the solids should be eaten in \nsmall pieces with a few sips of water in between. She should \nalso have Q8hour oral care, and her oral cavity should be \nexamined for leftover food after each meal. \n\n#. Patient was DNR/DNI during this hospitalization.", 'medications_prescribed': ['Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO \nDAILY (Daily).', 'Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Levobunolol 0.5 % Drops Sig: One (1) Drop Ophthalmic DAILY \n(Daily).', 'Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day).', 'Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily).', 'Heparin (Porcine) 5,000 unit/mL Solution Sig: One (1) ml \nInjection TID (3 times a day).', '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 QHS: PRN as needed \nfor constipation.', 'Acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO TID (3 \ntimes a day).', 'Tramadol 50 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for pain.', 'Trandolapril 2 mg Tablet Sig: One (1) Tablet PO once a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 88, 'gender': 'F', 'symptoms': 'Right knee pain', 'medical_history': ['-Paroxysmal atrial fibrillation (on Coumadin)', '-CVA (R MCA ___ that was discovered after right hip \nrepair', '-Osteoporosis', '-Depression / anxiety', '-Restless legs syndrome', '-s/p Right hip fracture and ORIF (___)', '-s/p TAH', '-known small secundum ASD'], 'family_history': 'Her father died of a stroke. There is no history of sudden \ncardiac death or cardiomyopathy.', 'present_illness': '___ F with a h/o CVA on coumadin, anxiety, SVT, and recurrent \nnear syncope, who presents with R. knee pain following an \nunwitnessed fall, with head strike but no LOC. Last night, she \nwas putting a folding table away after which the table tipped \nover and caused her to fall with the table striking her right \nknee. She denies any dizziness, diaphoresis, or palpitations \nduring these episodes.\n.\nAfter the fall, she was able to ambulate using a cane, which she \nuses intermittently at baseline, however the pain became worse \nwith decreased ROM in her knee and inability to ambulate. She \nwas brought into the ED by her son.\n.\nAt baseline, she is very functional and can complete all her \nADLs without difficulty. \n. \nIn the ED, initial VS 97.6 56 167/72 14 100% on RA. Labs showed \nINR 2.7. Ct Head was negative. Xray of R knee and CT showed \nlipohemarthrosis in suprapatellar space and tibial plateau \nfracture. She was seen by ortho who thought the mgmt would \nlikely be non-operative. She was fitted into a brace and given \noxycodone for pain. \n. \nOn the floor, her vitals were 96.4, 134/68, 51, 15, 95% RA. At \nthat time her pain was noted to be controlled with oxycodone. \nGiven that her case had not been staffed with an attending, she \nwas made NPO and her coumadin was held, in case she was to go to \nthe OR. This morning, she is complaining of severe pain within \nher knee joint and feels as though the oxycodone is not \neffectively controlling her pain. She states she did not sleep \nwell last night given the pain and anxiety. She also reports \nmore hoarseness and congestion in her throat, but attributes \nthat to dryness.', 'medications': [{'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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': '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': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bumetanide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H', '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': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Metolazone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bumetanide', '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', 'route': 'IV', 'frequency': 'X1 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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Torsemide', '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': 'X1 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': 'Ampicillin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'LACOSamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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}, {'medication': 'Vancomycin', '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 via patient discharge', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Bumetanide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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 Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', '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': 'LACOSamide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'LACOSamide - STAT Dose', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefTAZidime', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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 IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Metolazone', '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': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 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': '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': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': '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': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', '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': 'Acetaminophen IV', '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': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% (Mini Bag Plus)', 'proc_type': 'Miscellaneous Charges', 'status': 'Inactive (Due to a change order)', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.02', 'valuenum': 1.02, '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': '0.0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78.4', 'valuenum': 78.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '376', 'valuenum': 376.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.62', 'valuenum': 1.62, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.96', 'valuenum': 9.96, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59.3', 'valuenum': 59.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': '<0.2.'}, {'value': '7.8', 'valuenum': 7.8, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '405', 'valuenum': 405.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', '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': '12', 'valuenum': 12.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35', 'valuenum': 35.0, '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': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.6, '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': 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': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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}, {'value': '13', 'valuenum': 13.0, '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': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, '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': '1.12', 'valuenum': 1.12, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '122', 'valuenum': 122.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '27.2', 'valuenum': 27.2, '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': '30.3', 'valuenum': 30.3, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '17.1', 'valuenum': 17.1, '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': 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': '61.8', 'valuenum': 61.8, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 120.0, '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': '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': '___', 'valuenum': 91.0, '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': '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': '5.7', 'valuenum': 5.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': 149.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, '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': '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': '29.9', 'valuenum': 29.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-1', 'valuenum': -1.0, '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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '36.5', 'valuenum': 36.5, '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': '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': '9.9', 'valuenum': 9.9, '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': 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': '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': '32.2', 'valuenum': 32.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '324', 'valuenum': 324.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.70', 'valuenum': 2.7, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63.2', 'valuenum': 63.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '1.6', 'valuenum': 1.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '12', 'valuenum': 12.0, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': '<0.2.'}, {'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': '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': 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 2.3, . estimated GFR (eGFR) is likely between 20 and 24 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': '10', 'valuenum': 10.0, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, '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': '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': '260', 'valuenum': 260.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '___', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1319', 'valuenum': 1319.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'AVAILABLE AT ___ LAB.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE BY INDIRECT IMMUNOFLUORESCENCE.'}, {'value': '138.7', 'valuenum': 138.7, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '1.6', 'valuenum': 1.6, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, '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': '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': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 123.0, '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 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{'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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.8, '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': 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': '32', 'valuenum': 32.0, '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': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '434', 'valuenum': 434.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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'abnormal', '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 126.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': 3.7, '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': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '34', 'valuenum': 34.0, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.2.'}, {'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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 129.0, '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': '253', 'valuenum': 253.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, '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': '___', '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': 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': '34', 'valuenum': 34.0, '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': '22.2', 'valuenum': 22.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '359', 'valuenum': 359.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, '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': '0.04', 'valuenum': 0.04, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.2', 'valuenum': 60.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, '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': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', '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': '364', 'valuenum': 364.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '58.7', 'valuenum': 58.7, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.4', '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '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': '2.4', 'valuenum': 2.4, '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': '___', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '31', 'valuenum': 31.0, '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': '___', 'valuenum': 8.0, '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': '7.5', 'valuenum': 7.5, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 73.0, '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': '0', 'valuenum': 0.0, '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': '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': 4.1, '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': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, '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': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': '17.0', 'valuenum': 17.0, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60.3', 'valuenum': 60.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '408', 'valuenum': 408.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, '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': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '59.7', 'valuenum': 59.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', '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': '402', 'valuenum': 402.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60.2', 'valuenum': 60.2, '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': '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': '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': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, '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 2.1, . estimated GFR (eGFR) is likely between 22 and 27 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': 65.0, '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': 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': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '0.14', 'valuenum': 0.14, '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': '83', 'valuenum': 83.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '457', 'valuenum': 457.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '57.7', 'valuenum': 57.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '23', 'valuenum': 23.0, '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': '113', 'valuenum': 113.0, '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': 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': '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': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.0, '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': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '34', 'valuenum': 34.0, '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': '___', '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': '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': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', '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': '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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.5, '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': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '35', 'valuenum': 35.0, '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': '28.5', 'valuenum': 28.5, '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': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, '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': '454', 'valuenum': 454.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.7', 'valuenum': 16.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.82', 'valuenum': 2.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '57.8', 'valuenum': 57.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, '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': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '426', 'valuenum': 426.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.68', 'valuenum': 2.68, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61.9', 'valuenum': 61.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '22', 'valuenum': 22.0, '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': '115', 'valuenum': 115.0, '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': 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': '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': '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': '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': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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}], 'exams': 'Admission Physical Exam:\nVitals: T: 96.4 BP: 134/68 P: 51-60 R: 16 O2: 95RA \nGeneral: lying in bed in moderate pain. \nHEENT: MM dry, OP 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 \nExt: ___ in immobilizer with edema in R ankle > L ankle. \nOtherwise WWP\nVascular: 2+ DP and ___ pulses bilaterally.\nNeuro: AxOx3, CN II-XII intact. Sensation grossly intact to \nlight touch in upper and lower extremities. Muscle strength ___ \nin upper extremities. R. Hip flexion limited by pain, but able \nto move toes and plantar/dorsiflex R. ankle normally.\n\nDischarge Physical Exam:\nVitals: T: 99 BP: 134/71 P: 60-65 R: 18 O2: 94RA \nGeneral: lying in bed in moderate pain. \nHEENT: MM dry, OP clear. \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 \nExt: ___ in knee brace with edema in R ankle > L ankle. TTP over \nsuprapatellar region and over ankle. Otherwise WWP with good \ncapillary refill. No erythema or deformities noted over lumbar \nregion. Midline TTP over L4-5.\nVascular: 2+ DP in ___\nNeuro: Sensation intact in LUE bilaterally. Strength ___ with \nplantar/dorsiflexion of right ankle.', 'diagnoses': [{'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'J9602', 'desc': 'Acute respiratory failure with hypercapnia'}, {'icd_code': 'J690', 'desc': 'Pneumonitis due to inhalation of food and vomit'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'J90', 'desc': 'Pleural effusion, not elsewhere classified'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'N184', 'desc': 'Chronic kidney disease, stage 4 (severe)'}, {'icd_code': 'E874', 'desc': 'Mixed disorder of acid-base balance'}, {'icd_code': 'G9340', 'desc': 'Encephalopathy, unspecified'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'J439', 'desc': 'Emphysema, unspecified'}, {'icd_code': 'J479', 'desc': 'Bronchiectasis, uncomplicated'}, {'icd_code': 'E8770', 'desc': 'Fluid overload, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'R1310', 'desc': 'Dysphagia, unspecified'}, {'icd_code': 'E860', 'desc': 'Dehydration'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'M5430', 'desc': 'Sciatica, unspecified side'}, {'icd_code': 'E559', 'desc': 'Vitamin D deficiency, unspecified'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'F4321', 'desc': 'Adjustment disorder with depressed mood'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}], 'summary': "Admission Labs:\n___ 11:12PM BLOOD WBC-8.1# RBC-4.08* Hgb-12.1 Hct-35.4* \nMCV-87 MCH-29.7 MCHC-34.3 RDW-13.1 Plt ___\n___ 11:12PM BLOOD ___ PTT-38.2* ___\n___ 11:12PM BLOOD Glucose-97 UreaN-18 Creat-0.8 Na-137 \nK-3.8 Cl-98 HCO3-31 AnGap-12\n\nDischarge Labs:\n___ 08:00AM BLOOD WBC-6.6 RBC-3.87* Hgb-11.8* Hct-33.8* \nMCV-87 MCH-30.4 MCHC-34.9 RDW-13.9 Plt ___\n___ 08:00AM BLOOD Glucose-104* UreaN-19 Creat-0.7 Na-133 \nK-3.9 Cl-95* HCO3-30 AnGap-12\n___ 08:00AM BLOOD ___ PTT-40.7* ___\n___ 08:00AM BLOOD Calcium-8.5 Phos-3.0 Mg-1.8\n___ 07:21AM BLOOD ___\n\nStudies:\nRight Knee/Ankle XR (___): FINDINGS: There is profound \nosteopenia which reduces the sensitivity for detecting subtle \nnondisplaced fracture. Within that limitation, there is a \nprominent lipohemarthrosis indicating an intra-articular \nfracture. There is subtle depression along the medial tibial \nplateau; however, no discrete fracture line is identified. There \nis no malalignment. Minimal squaring of the tibial plateaus is \nevident, but no significant stigmata of degenerative disease \nappreciated. Soft tissue swelling is noted circumferentially \naround the knee joint. \n \nThe ankle mortise is preserved, the talar dome is intact. No \ndiscrete \nfracture is identified. No ankle effusion is noted. \n \nIMPRESSION: Occult tibial plateau fracture, suspected medially. \nThere is \nlipohemarthrosis. If indicated, consider CT scan for further \nevaluation, \nalthough the medial tibial plateau should be treated as \nfractured until proven otherwise. \n.\nCT R. Knee ___: Minimally depressed medial \ntibial plateau fracture at its posterior aspect with \nlipohemarthrosis. \n.\nCT Head (___): IMPRESSION: 1. No intracranial hemorrhage or \nfracture. \n2. Old right frontal infarct. 3. Punctate hypodensity in the \nleft pons of unclear clinical significance; MR may be considered \nfor further evaluation.\n.\nCT-Cervical spine (___): IMPRESSION: No fracture or \nmalalignment with normal prevertebral soft tissues; severe \nmultilevel degenerative changes.\n.\nCXR Lumbosacral Spine (___): FINDINGS: There are five \nnon-rib-bearing lumbar-type vertebral bodies. There is \ngeneralized demineralization. There is loss of intervertebral \ndisc space height at L5-S1. This is stable since the ___ study. There are no compression fractures. No abnormal \n___- or retrolisthesis is seen. There are degenerative \nchanges of bilateral hip joints, right side worse than left. \nThere is a portion of an intramedullary rod and proximal pin \nwithin the right femur, stable since ___\n.\n___ (___): Negative for DVT\n.\nHip XRays (___): The patient is status post repair of \nprior femoral neck fracture. No new \nfracture is identified. The position of the hardware appears to \nbe unchanged \nsince the prior film of ___. \nThe pelvis and left hip appear intact. \nIMPRESSION: No new fracture. \n.\nCXR (___): The cardiac size is at the upper limits of \nnormal. Some tortuosity of the \naorta is present. The lung fields are clear. There is no \nevidence of \npneumonia. \nIMPRESSION: \nLungs clear.\nThis is a ___ with hx of CVA on coumadin, SVT, and recurrent \nnear syncope, who presents following an unwitnessed mechanical \nfall with headstrike but no LOC with significant R. knee pain \nwith noted medial tibial plateau fracture. \n.\n#Fall/Tibial Plateau Fracture - The patient presented to the \nhospital with R knee pain following an unwitnessed mechanical \nfall with headstrike but no LOC and was noted to have a medial \ntibial plateau fracture with lipohemarthrosis identified on XR \nand CT of her right ankle. While the patient does have a history \nof syncope and SVT, she denied any palpitations or prodromal \nsymptoms prior to her fall. She was seen by orthopedics and her \nknee was placed in an immobilizer as her fracture was determined \nto be non-operative. Her pain was effectively managed with 2.5mg \noxycodone every four hours with Nabumetone 500mg ___ times daily \nand Lidoderm patches. (She was subsequently discharged to rehab)\n.\n#Fever - During her hospitalization, the patient was noted to be \nfebrile and was noted to have a new oxygen requirement, however \ndenied cough and did not have CXR evidence of infection. Her \nfever resolved over a very short period and her O2 sats returned \nto baseline on RA within hours. It was thought her fever was due \nto atelectasis. At the same time, she was noted to have \nincreased swelling over the dorsum of her right foot and was \nordered for a LENIs which did not demonstrate a DVT. \nSubsequently a UA was obtained and did not demonstrate any \nevidence of gross infection. \n.\n#Bradycardia - On admission the patient's HR was noted to be in \nthe ___ and low ___, however the patient was completely \nasymptomatic. Her EKG demonstrated sinus bradycardia with no \nevidence of AV block to suggest nodal delay; however she did \nhave a high normal QTc at 470 that was unchanged from prior \nEKGs. Her home dose of metoprolol was reduced, however the \npatient's HR remained in the ___. Therefore, at discharge, \nher metoprolol was stopped and will ___ with her \ncardiologist/PCP about restarting her beta-blocker. \n.\n#Headache - During the course of her hospitalization, the \npatient described a band like frontal headache without any \nnausea or photophobia that she sporadically has in the past, \nwhich was consistent with a tension headache. Given her \nallergies to tylenol and aspirin, her headaches were managed \nwith oxycodone and they resolved prior to discharge. \n.\n#Back Pain - During the course of her hospitalization, the \npatient reported midline tenderness over her lumbar spine. She \ndenied any change to her urinary habits and her exam at the time \nwas not notable for any overt deformities or step-offs and her \nlower extremities were neurovascularly intact. However, given \nher history of osteoporosis and multiple fractures in the past \n(including, per her daughter, ribs), it was possible that she \ncould have compression fractures in her spine. Lumbosacral XR \ndemonstrated no acute evidence of compression fracture. Her back \npain improved prior to discharge.\n.\n#Lipohemarthrosis - The patient was noted to have \nlipohemarthrosis secondary to her mechanical fall and tibial \nplateau fracture. At admission, her HCT was 35, which was \nconsistent with her baseline and remained close to her baseline \nthroughout her admission. \n. \n#h/o CVA: Upon admission the patient's INR was 2.7; however \ngiven the possibility for operative management, her coumadin was \ninitially held. However, following the change in functional \nstatus and non-operative plans, her coumadin was restarted, but \nher INR was subsequently elevated to 4.3, and her coumadin was \nheld again. Her coumadin was titrated according to her INR and \nat discharge her INR was 1.9 on 4mg coumadin. Thus, she was \ndischarged on 6mg Coumadin with INR check on ___. \n. \n#SVT: While the patient has a history of SVT, her EKG on \nadmission was notable for sinus bradycardia. Given her \nbradycardia, her home metoprolol dose was decreased and the \npatient remained asymptomatic with no episodes of tachycardia \nthroughout her admission. Ultimately, her metoprolol was \ndiscontinued completely although the patient once she is \nambulating more may require some beta blockade.\n. \n#Anxiety/RLS/Depression: She was stable without any mood \nsymptoms throughout her admission and continued her home dose of \ngabapentin for RLS, clonazepam for anxiety, and celexa for \ndepression.\n."}}
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{'final_diagnoses': ['Right Tibial Plateau Fracture', 'Lipohemearthrosis of the R. Knee', 'Sinus Bradycardia', 'Previous stroke, on coumadin (blood thinner)', 'Osteoporosis', 'Restless Leg', 'Anxiety/Depression'], 'procedures': ['None'], 'visit_summary': "This is a ___ with hx of CVA on coumadin, SVT, and recurrent \nnear syncope, who presents following an unwitnessed mechanical \nfall with headstrike but no LOC with significant R. knee pain \nwith noted medial tibial plateau fracture. \n.\n#Fall/Tibial Plateau Fracture - The patient presented to the \nhospital with R knee pain following an unwitnessed mechanical \nfall with headstrike but no LOC and was noted to have a medial \ntibial plateau fracture with lipohemarthrosis identified on XR \nand CT of her right ankle. While the patient does have a history \nof syncope and SVT, she denied any palpitations or prodromal \nsymptoms prior to her fall. She was seen by orthopedics and her \nknee was placed in an immobilizer as her fracture was determined \nto be non-operative. Her pain was effectively managed with 2.5mg \noxycodone every four hours with Nabumetone 500mg ___ times daily \nand Lidoderm patches. (She was subsequently discharged to rehab)\n.\n#Fever - During her hospitalization, the patient was noted to be \nfebrile and was noted to have a new oxygen requirement, however \ndenied cough and did not have CXR evidence of infection. Her \nfever resolved over a very short period and her O2 sats returned \nto baseline on RA within hours. It was thought her fever was due \nto atelectasis. At the same time, she was noted to have \nincreased swelling over the dorsum of her right foot and was \nordered for a LENIs which did not demonstrate a DVT. \nSubsequently a UA was obtained and did not demonstrate any \nevidence of gross infection. \n.\n#Bradycardia - On admission the patient's HR was noted to be in \nthe ___ and low ___, however the patient was completely \nasymptomatic. Her EKG demonstrated sinus bradycardia with no \nevidence of AV block to suggest nodal delay; however she did \nhave a high normal QTc at 470 that was unchanged from prior \nEKGs. Her home dose of metoprolol was reduced, however the \npatient's HR remained in the ___. Therefore, at discharge, \nher metoprolol was stopped and will ___ with her \ncardiologist/PCP about restarting her beta-blocker. \n.\n#Headache - During the course of her hospitalization, the \npatient described a band like frontal headache without any \nnausea or photophobia that she sporadically has in the past, \nwhich was consistent with a tension headache. Given her \nallergies to tylenol and aspirin, her headaches were managed \nwith oxycodone and they resolved prior to discharge. \n.\n#Back Pain - During the course of her hospitalization, the \npatient reported midline tenderness over her lumbar spine. She \ndenied any change to her urinary habits and her exam at the time \nwas not notable for any overt deformities or step-offs and her \nlower extremities were neurovascularly intact. However, given \nher history of osteoporosis and multiple fractures in the past \n(including, per her daughter, ribs), it was possible that she \ncould have compression fractures in her spine. Lumbosacral XR \ndemonstrated no acute evidence of compression fracture. Her back \npain improved prior to discharge.\n.\n#Lipohemarthrosis - The patient was noted to have \nlipohemarthrosis secondary to her mechanical fall and tibial \nplateau fracture. At admission, her HCT was 35, which was \nconsistent with her baseline and remained close to her baseline \nthroughout her admission. \n. \n#h/o CVA: Upon admission the patient's INR was 2.7; however \ngiven the possibility for operative management, her coumadin was \ninitially held. However, following the change in functional \nstatus and non-operative plans, her coumadin was restarted, but \nher INR was subsequently elevated to 4.3, and her coumadin was \nheld again. Her coumadin was titrated according to her INR and \nat discharge her INR was 1.9 on 4mg coumadin. Thus, she was \ndischarged on 6mg Coumadin with INR check on ___. \n. \n#SVT: While the patient has a history of SVT, her EKG on \nadmission was notable for sinus bradycardia. Given her \nbradycardia, her home metoprolol dose was decreased and the \npatient remained asymptomatic with no episodes of tachycardia \nthroughout her admission. Ultimately, her metoprolol was \ndiscontinued completely although the patient once she is \nambulating more may require some beta blockade.\n. \n#Anxiety/RLS/Depression: She was stable without any mood \nsymptoms throughout her admission and continued her home dose of \ngabapentin for RLS, clonazepam for anxiety, and celexa for \ndepression.\n.", 'medications_prescribed': ['1. clonazepam 0.5 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', '2. clonazepam 1 mg Tablet Sig: One (1) Tablet PO QHS (once a day \n(at bedtime)).', '3. citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. gabapentin 300 mg Capsule Sig: Two (2) Capsule PO DAILY \n(Daily).', '5. gabapentin 400 mg Capsule Sig: Three (3) Capsule PO HS (at \nbedtime).', '6. risedronate 150 mg Tablet Sig: One (1) Tablet PO once a \nmonth.', '7. oxycodone 5 mg Tablet Sig: Half Tablet PO every four (4) \nhours as needed for pain: Hold for sedation, RR<12.', '8. warfarin 6 mg Tablet Sig: One (1) Tablet PO once a day: \nPlease check INR on ___. ', '9. Calcium 600 + D(3) 600 mg(1,500mg) -400 unit Tablet Sig: Two \n(2) Tablet PO once a day.', '10. Senna Plus 8.6-50 mg Tablet Sig: One (1) Tablet PO once a \nday.', '11. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as \nneeded for constipation.', '12. nabumetone 500 mg Tablet Sig: One (1) Tablet PO three times \na day.', '13. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily): Apply \nto right knee; 12 hours on and 12 hours off.', '14. lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily): Please \napply to right ankle; 12 hours on, 12 hours off.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 64, 'gender': 'F', 'symptoms': '"I felt depressed and anxious so I came to the hospital"', 'medical_history': ['PSYCHIATRIC HISTORY:\nDx/Sxs: h/o depression with psychotic features, anxiety,\nsubstance abuse, panic attacks, agoraphobia, social phobia\nHospitalizations: reports ___, last ___ years ago at ___ and\n___\nSA/SIB: multiple SA by cutting self, last ___ years ago\nadmitted to ___\nMedication Trials: Klonopin, Seroquel (fainting)\nPsychiatrist/Therapist: None current, seen at ___ urgent care\nclinic and referred to ___ but \nnever\nfollowed up', 'PAST MEDICAL HISTORY:\nBack pain, abdominal pain, somatization disorder. Reports hx of\ntwo concussions about ___ year ago.'], 'family_history': 'FAMILY PSYCHIATRIC HISTORY:\nDenies. Denies history of suicidality/suicide attempt.', 'present_illness': 'Pt. is a ___ year old female with hx of depressive disorder with\npsychotic features, anxiety disorder, substance abuse, \npreviously\nreferred to ___ urgent care clinic after PCP referral, who now\npresents to ER BIBA reporting depression, anxiety, SI and AH. \nPt.\nreports experiencing worsening depressed mood for past 4 months\nwith chronic poor sleep, decreased energy, increased appetite,\npoor attention and concentration, amotivation and anhedonia,\nguilt, feeling hopeless and helpless. Pt. reports that worsening\nmood comes in the context of being without psychiatric treatment\nfor a while, being told that she may have cervical cancer and\nrecent illness of her mother. Pt. reports that her anxiety\n"crying and screaming", social phobia and agoraphobia have also\nincreased with more frequent panic attacks, which she links to\nthe reduction of clonazepam from 2mg daily to 0.5mg daily\nrecently. Pt. reports that over past 3 months, she has also been\nexperiencing increased frequency of hearing voices call her by\nname, criticizing her and now states that they are "asking for \nmy\nblood", but denies that they have told her to harm herself. Pt.\npreviously reported experiencing chronic auditory hallucinations\nat nighttime. She states that over the past two days, she has\nbeen having increased thoughts of self-harm but denies intent,\nstating that she became scared by the thoughts and wanted to \ncome\nto hospital for treatment. She also endorses feeling more\nparanoid over the last two days, relating that she had to leave \na\nfriend\'s house as she didn\'t feel safe there. She also endorses\nsome periods of decreased need for sleep and irritability, but\ndenies other signs or symptoms of mania. She denies grandiose\ndelusions, or thought broadcasting/insertion/withdrawal, denies\nvisual hallucinations, denies HI. She states that if she leaves\nthe ER, she doesn\'t know what she will do and does not feel she\nwould be able to keep herself safe.', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'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', 'route': 'IV', 'frequency': 'Q1H: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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', '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': 'Fexofenadine', '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', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Albuterol-Ipratropium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', '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': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'EPINEPHrine', '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': 'DINNER', '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': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', '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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', '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': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN: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': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', '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': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'DAILY', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'HS: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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluticasone-Salmeterol Diskus (500/50) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Cepacol (Menthol)', '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': 'DINNER', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'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': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Ranitidine', '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': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H: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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'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': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', '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': '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': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID: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': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fexofenadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, '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': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '34.8', 'valuenum': 34.8, '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': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, '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': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '47', 'valuenum': 47.0, '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': '32', 'valuenum': 32.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': 0.4, '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 0.9,. Estimated GFR = 63 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': 181.0, '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': '239', 'valuenum': 239.0, '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': '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': '4.4', '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.4, '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': 166.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '___', 'valuenum': 12.0, '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': 24.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, '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': '169', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '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': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.48', 'valuenum': 7.48, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '435', 'valuenum': 435.0, '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': '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': '4', 'valuenum': 4.0, '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': '174', 'valuenum': 174.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.52', 'valuenum': 7.52, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '445', 'valuenum': 445.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.6', 'valuenum': 4.6, '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': '2', 'valuenum': 2.0, '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': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.49', 'valuenum': 7.49, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '458', 'valuenum': 458.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '26', 'valuenum': 26.0, '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': '1.35', 'valuenum': 1.35, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '44', 'valuenum': 44.0, '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': '276', 'valuenum': 276.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '135', 'valuenum': 135.0, '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': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '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': '20.1', 'valuenum': 20.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 173.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'NOTE NEW REFERENCE RANGE AS OF ___.'}, {'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': '___', 'valuenum': 16.7, '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': 23.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '187', 'valuenum': 187.0, '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': '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': '159', 'valuenum': 159.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': '135', 'valuenum': 135.0, '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': '68', 'valuenum': 68.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.4, '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': 28.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 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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': '32.6', 'valuenum': 32.6, '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': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 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'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '25.8', 'valuenum': 25.8, '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': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '109', 'valuenum': 109.0, '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': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': 0.4, 'ref_range_upper': 1.1, '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': '4.8', 'valuenum': 4.8, '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, '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': '25.9', 'valuenum': 25.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '165', 'valuenum': 165.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, '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': '25.8', 'valuenum': 25.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, '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': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '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': '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': '___', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '4.7', '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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'PHYSICAL EXAMINATION: \nVS: BP: 96/64 HR: 84 temp: 98.0 Resp: 16 O2 sat: 96% RA \nweight: 170.6 lbs\n\nPE:\nGeneral:Hsipanic female appearing stated age, in NAD. \nHEENT: Normocephalic. EOMMI. Sclerae anicteric. \nBack: No significant deformity, no focal tenderness. Trace CVA\ntenderness\nLungs: Clear to auscultation; no crackles or wheezes.\nCV: Regular rate and rhythm; no murmurs/rubs/gallops.\nAbdomen: Soft, obese. Slight suprapubic tenderness. + BS.\nExtremities: No clubbing, cyanosis, or edema. Erythema of palms\nand soles.\nSkin: Warm and dry, no rash or significant lesions.\n\nNeurological:\n *Cranial Nerves-\n I: Not tested\n II: Unable to assess.\n III, IV, VI: Extraocular movements intact bilaterally\nwithout nystagmus.\n V, VII: Facial strength intact and symmetric.\n VIII: Hearing intact to voice.\n IX, X: Palatal elevation symmetrical.\n XI: Sternocleidomastoid and trapezius strength intact.\n XII: Tongue midline without fasciculations.\n *Motor- Normal bulk and tone bilaterally. No abnormal\nmovements, tremors. \n *Sensation- Intact to light touch throughout.\n *Normal gait and station. \n\nMENTAL STATUS EXAM:\n--appearance: Hispanic overweight female, appears stated age,\nwith four empty cups of apple juice in front of her, moderately\ngroomed, rubbing her hand on her chest and shaking her knee\n--behavior/attitude: sitting in chair, good eye contact,\ncooperative, engaged in interview \n--speech: Speaking ___ slowly, in a quiet voice, sometimes\nmumbling, no dysarthria/aphasia\n--mood (in patient\'s words): "regular\x95better than yesterday"\n--affect: anxious, flattened, incongruent with affect\n--thought content (describe): focused on increasing her dose of\nclonazepam, auditory hallucinations (none currently, worse at\nnight, command), concern over ill mother, guilt over inability \nto\ncontact her sons\n--thought process: Linear\n--perception: does not appear to be responding to internal\nstimuli despite her stated CAH\n--SI/HI: denies SI and HI. \n--insight: Limited \n--judgment: Fair given she is now seeking help \n\nCOGNITIVE EXAM:\n--orientation: oriented to person [x], place [x], day [does not\nattempt], month [___], year [x], situation [x]\n--attention/concentration: DOWB: ___ - ___, then declines\nto try again, if given ___, able to complete ___ - ___, \nthen gives up. \n--memory (table, apple, ___: immediate recall intact, remote\nrecall ___ with multiple choice. \n--calculations: quarters in $2.25 -declines, quarters in $1 [x],\nquarters in $2 [x], still refuses $2.25\n--language: grossly intact\n--fund of knowledge: Able to name past presidents ___ \nand\n___\n--proverbs: "look before leap" - Unable\n--similarities/analogies: "apple/orange" "I don\'t know"', 'diagnoses': [{'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'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': 'E8781', 'desc': 'Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': 'V5331', 'desc': 'Fitting and adjustment of cardiac pacemaker'}], 'summary': '___ 12:05AM GLUCOSE-82 UREA N-6 CREAT-1.0 SODIUM-139 \nPOTASSIUM-4.1 CHLORIDE-104 TOTAL CO2-26 ANION GAP-13\n___ 12:05AM ALT(SGPT)-33 AST(SGOT)-23 ALK PHOS-52 TOT \nBILI-0.4\n___ 12:05AM TSH-1.2\n___ 12:05AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 12:05AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-POS amphetmn-NEG mthdone-NEG\n___ 12:05AM WBC-7.3 RBC-4.36 HGB-14.1 HCT-40.1 MCV-92 \nMCH-32.4* MCHC-35.2* RDW-13.1\n___ 12:05AM NEUTS-50.3 ___ MONOS-7.8 EOS-5.2* \nBASOS-1.8\n___ 12:05AM PLT COUNT-313\n___ 12:05AM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 12:05AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n1. Psychiatric: Pt. admitted for report of worsening depressive \nsymptoms, anxiety and panic symptoms and CAH in the context of \nmultiple stressors including gyn health concerns, and worries \nfor her mothers health. Initially, pt. appeared anxious but did \nnot appear to be overtly responding to internal stimuli. Pt. was \ncontinued on outpatient citalopram, perphenazine, clonazepam, \nwith trazodone 50mg qHS as needed for insomnia. Following \nadmission, pt. reported that the immediate precipitant to her \npresentation to the ER was having gone to a party where she \ndrank a beer and immediately felt "strange afterwards." Soon \nafter the party she reported feeling that her heart was racing, \nshe was sweating, felt very anxious, and had an acute worsening \nof her auditory hallucinations, and developed suicidal ideation \nwith thoughts of slitting her wrists, which led her to present \nto the ER. She reported following admission, her symptoms \nimproved with much improvement in her anxiety, felt back to her \nbaseline and denied psychotic symptoms. This reports of such \nshort lived symptomatology was most suggestive of substance \ninduced symptoms or a panic attack. Further collateral gathered \nfrom pt.\x92s partner, however, suggested that pt.\x92s anxiety was \nstill significant as he reported she was calling him every hour \nfrom the inpatient unit. He expressed that such behavior had \nbeen escalating over the past few months and was significantly \nlimiting pt.\x92s ability to remain alone at home and care for \nherself. He reported that pt. was previously on a higher dose of \nclonazepam (1mg BID) for years with good control of symptoms and \nimproved sleep, but after losing her prior treaters, pt. had \nbeen unable to get another prescriber and had been reliant on ER \nrefills, resulting in decreased dosing and increased symptoms. \nFollowing discussion with pt., clonazepam was increased to 1mg \nBID for improved control of anxiety. Pt. subsequently reported \nsignificant improvement in anxiety, with increase in energy and \nlessened worries. Pt. reported improvement in depressed mood, \nanxiety, ruminative thoughts, denied experiencing continued \npanic attacks and stated she felt safe and ready for discharge. \nAt time of discharge, pt. denied suicidal ideation, intent, plan \nor preparation, was future oriented with plans to return home to \ncook and clean, and plans to followup with referred treaters, \nand stated that if she felt unsafe, she would contact treaters, \nor call ___ and return to the ER.\n\n2. Medical: \n#UTI: Pt. continued on Bactrim and phenazopyridine as inpatient, \nresolved at time of discharge.\n#Smoking cessation: Pt. started on nicotine patch and nicotine \ngum as inpatient, provided with prescriptions on discharge.\n#GI: Continued outpatient omeprazole.\n\n3. Psychosocial: Communicated with the patient\'s partner \n___ additional collateral, and the patient\'s status, \ntreatment\nprogress, and disposition. Aftercare planning included followup \nwith PCP and referral for mental health treaters.\n\n4. Legal: ___'}}
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{'final_diagnoses': ['I. hx of Major Depression with psychotic features; Hx of panic\ndisorder with agoraphobia, and hx of Substance abuse', 'II. defer', 'III. H/o head trauma ', 'IV. psychosocial stressors, lack of outpatient treters', 'V. 40'], 'procedures': ['None'], 'visit_summary': '1. Psychiatric: Pt. admitted for report of worsening depressive \nsymptoms, anxiety and panic symptoms and CAH in the context of \nmultiple stressors including gyn health concerns, and worries \nfor her mothers health. Initially, pt. appeared anxious but did \nnot appear to be overtly responding to internal stimuli. Pt. was \ncontinued on outpatient citalopram, perphenazine, clonazepam, \nwith trazodone 50mg qHS as needed for insomnia. Following \nadmission, pt. reported that the immediate precipitant to her \npresentation to the ER was having gone to a party where she \ndrank a beer and immediately felt "strange afterwards." Soon \nafter the party she reported feeling that her heart was racing, \nshe was sweating, felt very anxious, and had an acute worsening \nof her auditory hallucinations, and developed suicidal ideation \nwith thoughts of slitting her wrists, which led her to present \nto the ER. She reported following admission, her symptoms \nimproved with much improvement in her anxiety, felt back to her \nbaseline and denied psychotic symptoms. This reports of such \nshort lived symptomatology was most suggestive of substance \ninduced symptoms or a panic attack. Further collateral gathered \nfrom pt.\x92s partner, however, suggested that pt.\x92s anxiety was \nstill significant as he reported she was calling him every hour \nfrom the inpatient unit. He expressed that such behavior had \nbeen escalating over the past few months and was significantly \nlimiting pt.\x92s ability to remain alone at home and care for \nherself. He reported that pt. was previously on a higher dose of \nclonazepam (1mg BID) for years with good control of symptoms and \nimproved sleep, but after losing her prior treaters, pt. had \nbeen unable to get another prescriber and had been reliant on ER \nrefills, resulting in decreased dosing and increased symptoms. \nFollowing discussion with pt., clonazepam was increased to 1mg \nBID for improved control of anxiety. Pt. subsequently reported \nsignificant improvement in anxiety, with increase in energy and \nlessened worries. Pt. reported improvement in depressed mood, \nanxiety, ruminative thoughts, denied experiencing continued \npanic attacks and stated she felt safe and ready for discharge. \nAt time of discharge, pt. denied suicidal ideation, intent, plan \nor preparation, was future oriented with plans to return home to \ncook and clean, and plans to followup with referred treaters, \nand stated that if she felt unsafe, she would contact treaters, \nor call ___ and return to the ER.\n\n2. Medical: \n#UTI: Pt. continued on Bactrim and phenazopyridine as inpatient, \nresolved at time of discharge.\n#Smoking cessation: Pt. started on nicotine patch and nicotine \ngum as inpatient, provided with prescriptions on discharge.\n#GI: Continued outpatient omeprazole.\n\n3. Psychosocial: Communicated with the patient\'s partner \n___ additional collateral, and the patient\'s status, \ntreatment\nprogress, and disposition. Aftercare planning included followup \nwith PCP and referral for mental health treaters.\n\n4. Legal: ___', 'medications_prescribed': ['1. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO twice a day.\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*0*', '2. nicotine 21 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily).\nDisp:*30 Patch 24 hr(s)* Refills:*0*', '3. perphenazine 8 mg Tablet Sig: ___ Tablets PO HS (at bedtime): \nTake additional 8mg for total dose of 16mg HS if needed for \nanxiety/agitation.\nDisp:*30 Tablet(s)* Refills:*0*', '4. citalopram 20 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily).\nDisp:*45 Tablet(s)* Refills:*0*', '5. trazodone 50 mg Tablet Sig: 0.5 - 1 Tablet PO at bedtime as \nneeded for insomnia.\nDisp:*10 Tablet(s)* Refills:*0*', '6. clonazepam 1 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).\nDisp:*28 Tablet(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 26, 'gender': 'M', 'symptoms': 'Dyspnea on exertion', 'medical_history': ['Aortic stenosis', 'Hypercholesterolemia- has not required medication', 'Hypertension', 'Obstructive sleep apnea (CPAP)', 'TIA ___ years ago', 'Pulmonary sarcoidosis', 'Obesity', '___ Hepatitis A', 'GERD', 'ADHD', 'Depression/Anxiety', 'Ankle fracture', 'Psoriasis', 'Psoriatic arthritis', 'Carpal tunnel surgery s/p surgery bilaterally', 'Trigger finger s/p surgery'], 'family_history': 'Premature coronary artery disease- Maternal uncles had heart \ndisease. Two died suddenly in their ___ from ? cardiac disease. \nAnother died from an MI in his ___.', 'present_illness': "Very nice ___ year old male ___'s witness with a history of \npulmonary sarcoidosis and known aortic stenosis that has been \nfollowed for the last few years. His most recent echocardiogram \nrevealed severe aortic stenosis. He has has symptoms of \nprogressive dyspnea on exertion over the past six months. He was \nreferred for a cardiac catheterization and was found to have \ninsignificant coronary artery disease. He was originally \nscheduled for surgery last week however the knowledge of his \nrefusal for blood product was not know until the morning of \nsurgery. His surgery was thus delayed so that a discussion \nregarding his surgery could be held. He is preop for aortic \nvalve replacement.", 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fluoxetine', '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': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Polacrilex', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Polacrilex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '2.5', 'valuenum': 2.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.7', 'valuenum': 43.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '7.7', 'valuenum': 7.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.0', 'valuenum': 48.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.77', 'valuenum': 4.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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}], 'exams': 'BP: 131/98. Heart Rate: 73. Resp. Rate: 14. O2 Saturation%: 100.\nHeight:5\'8" Weight:119.7 kg\n\nGeneral: NAD, obese\nSkin: Dry [x] intact [x] psoriatic plaques on knees\nHEENT: PERRLA [x] EOMI [x]\nNeck: Supple [] Full ROM [x]\nChest: Lungs clear bilaterally [x]\nHeart: RRR [x] Irregular [] Murmur [] grade _3/6 systolic_\nAbdomen: Soft [x] non-distended [x] non-tender [x] bowel sounds \n+ [x]\nExtremities: Warm [x], well-perfused [x] Edema [] _none_.\nIngrown toenail is clinically not infected. \nVaricosities: None [x]\nNeuro: Grossly intact [x]\nPulses:\nFemoral Right: 2+ Left:2+\nDP Right: 2+ Left:2+\n___ Right: 2+ Left:2+\nRadial Right: 2+ Left:2+\n\nCarotid Bruit Right: Left:\nradiation of cardiac murmur', 'diagnoses': [{'icd_code': '29650', 'desc': 'Bipolar I disorder, most recent episode (or current) depressed, unspecified'}, {'icd_code': '9130', 'desc': 'Abrasion or friction burn of elbow, forearm, and wrist, without mention of infection'}, {'icd_code': 'E956', 'desc': 'Suicide and self-inflicted injury by cutting and piercing instrument'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': 'Echo ___: PRE-BYPASS: The left atrium is mildly dilated. No \nspontaneous echo contrast or thrombus is seen in the body of the \nleft atrium or left atrial appendage. No atrial septal defect is \nseen by 2D or color Doppler. Left ventricular wall thicknesses \nand cavity size are normal. Left ventricular wall thicknesses \nare normal. The left ventricular cavity size is normal. Overall \nleft ventricular systolic function is normal (LVEF>55%). The \nright ventricular free wall thickness is normal. The right \nventricular cavity is mildly dilated with normal free wall \ncontractility. There are simple atheroma in the aortic root. \nThere are simple atheroma in the descending thoracic aorta. The \nnumber of aortic valve leaflets cannot be determined. The aortic \nvalve leaflets are severely thickened/deformed. There is severe \naortic valve stenosis (valve area <1.0cm2). No aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. Trivial mitral regurgitation is seen. There is no \npericardial effusion. \nPOST CPB: 1. Preserved bi-ventriculr systolci function. 2. \nBio-proshetic (tri-leaflet) valve seen in the aortic position. \nWell seated and stable with good leaflet excursion. No \nappreciable transvalvulart gradient. 3. No other change. \n\nChest PA & Lat: ___\nMediastinal wires and right IJ central line are seen and \nunchanged position. There is unchanged cardiomegaly. There is \nimproved aeration with improvement of the opacities within the \nright perihilar and lower lung fields. This likely represents \nimprovement of the pulmonary interstitial edema. There are no \npneumothoraces. \n\nAdmission Labs:\n___ WBC-31.6*# RBC-4.88 Hgb-14.7 Hct-43.4 MCV-89 MCH-30.1 \nMCHC-33.9 RDW-12.4 RDWSD-40.2 Plt ___\n___ ___ PTT-26.6 ___\n___ UreaN-20 Creat-1.1 Na-143 K-3.6 Cl-110* HCO3-23 \n___ Calcium-8.0* Phos-2.3* Mg-3.1*\n\nDischarge Labs:\n___ WBC-8.8 RBC-4.19* Hgb-12.6* Hct-37.6* MCV-90 MCH-30.1 \nMCHC-33.5 RDW-12.3 RDWSD-39.6 Plt ___\n___ Glucose-137* UreaN-22* Creat-1.0 Na-134 K-4.6 Cl-95* \nHCO3-26 \n___ Mg-2.4\n\nMicro\n___ MRSA SCREEN (Final ___: No MRSA isolated.\nMr. ___ was a same day admit and on ___ was brought directly \nto the hospital where he underwent Aortic valve replacement \nwith a ___ tissue valve, 25 mm. Cardiopulmonary bypass time 92 minutes, \nCross-clamp time 63 minutes. Overall the patient tolerated the \nprocedure well and post-operatively was transferred to the CVICU \nin stable condition for recovery and invasive monitoring.\nPOD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable, weaned from inotropic and \nvasopressor support. Beta blocker was initiated and the patient \nwas gently diuresed toward the preoperative weight. The patient \nwas transferred to the telemetry floor for further recovery. \nChest tubes and pacing wires were discontinued without \ncomplication. The patient was evaluated by the physical therapy \nservice for assistance with strength and mobility. By the time \nof discharge on POD 4 the patient was ambulating freely, the \nwound was healing and pain was controlled with oral analgesics. \nThe patient was discharged to home in good condition with \nappropriate follow up instructions.'}}
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{'final_diagnoses': ['Aortic stenosis s/p Aortic valve replacement', 'Hypercholesterolemia- has not required medication', 'Hypertension', 'Obstructive sleep apnea (CPAP)', 'TIA ___ years ago', 'Pulmonary sarcoidosis', 'Obesity', '___ Hepatitis A', 'GERD', 'ADHD', 'Depression/Anxiety', 'Ankle fracture', 'Psoriasis', 'Psoriatic arthritis', 'Carpal tunnel surgery s/p surgery bilaterally', 'Trigger finger s/p surgery'], 'procedures': ['Aortic valve replacement'], 'visit_summary': 'Mr. ___ was a same day admit and on ___ was brought directly \nto the hospital where he underwent Aortic valve replacement \nwith a ___ tissue valve, 25 mm. Cardiopulmonary bypass time 92 minutes, \nCross-clamp time 63 minutes. Overall the patient tolerated the \nprocedure well and post-operatively was transferred to the CVICU \nin stable condition for recovery and invasive monitoring.\nPOD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable, weaned from inotropic and \nvasopressor support. Beta blocker was initiated and the patient \nwas gently diuresed toward the preoperative weight. The patient \nwas transferred to the telemetry floor for further recovery. \nChest tubes and pacing wires were discontinued without \ncomplication. The patient was evaluated by the physical therapy \nservice for assistance with strength and mobility. By the time \nof discharge on POD 4 the patient was ambulating freely, the \nwound was healing and pain was controlled with oral analgesics. \nThe patient was discharged to home in good condition with \nappropriate follow up instructions.', 'medications_prescribed': ['1. Albuterol Inhaler ___ PUFF IH Q4H:PRN wheezes', '2. Aspirin EC 81 mg PO DAILY', '3. Concerta (methylphenidate) 36 mg oral DAILY', '4. Docusate Sodium 100 mg PO BID hold for loose stools', '5. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID', '6. Metoprolol Tartrate 50 mg PO BID replaces atenolol RX *metoprolol tartrate 50 mg 1 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*3', '7. Montelukast 10 mg PO DAILY', '8. Furosemide 40 mg PO DAILY Duration: 7 Days RX *furosemide 40 mg 1 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0', '9. Potassium Chloride 10 mEq PO DAILY Duration: 7 Days take with lasix RX *potassium chloride [Klor-Con 10] 10 mEq 1 tablet(s) by mouth once a day Disp #*7 Tablet Refills:*0', '10. Ranitidine 150 mg PO BID RX *ranitidine HCl 150 mg 1 capsule(s) by mouth twice a day Disp #*60 Capsule Refills:*0', '11. Amiodarone 400 mg PO BID Duration: 7 Days then 200 mg twice daily x 14 days then 200 mg daily x 1 month RX *amiodarone 200 mg 2 tablet(s) by mouth twice a day Disp #*60 Tablet Refills:*0', '12. TraMADOL (Ultram) 50 mg PO Q6H:PRN pain RX *tramadol 50 mg 1 tablet(s) by mouth every eight (8) hours Disp #*60 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'M', 'symptoms': 'CHF/A fib/DOE', 'medical_history': ['MR', 'CAD', 'HTN', 'systolic CHF', 'RHD', 'A Fib', 'PUD with gastric bleed ___', 'varicosities', 'CRI'], 'family_history': 'NC', 'present_illness': '___ yo male recently treated for CHF ( lost 28 # with med rx). \nPrior to med management, he was experiencing DOE and had \ndecreased activity tolerance. Has been followed with echos for ___ \nyears. Most recent shows moderate to severe MR.', 'medications': [{'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Multivitamins W/minerals', '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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H: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': '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': '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': 'Inactive (Due to a change order)', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, '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': 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': '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': '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': '-323', 'valuenum': -323.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-445', 'valuenum': -445.0, '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': '-474', 'valuenum': -474.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-301', 'valuenum': -301.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-68', 'valuenum': -68.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-363', 'valuenum': -363.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': 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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LG*.'}, {'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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '>182*.'}, {'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': 'abnormal', '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': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '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': '1.39', 'valuenum': 1.39, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, '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': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, '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': '88', 'valuenum': 88.0, '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': '73.1', 'valuenum': 73.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', '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': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, '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': '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': '0.79', 'valuenum': 0.79, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.04', 'valuenum': 6.04, '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': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', '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': '26.9', 'valuenum': 26.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '92', 'valuenum': 92.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'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': '___', 'valuenum': 123.0, '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': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'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': '12', 'valuenum': 12.0, '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': '-60', 'valuenum': -60.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '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': '29', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.51', 'valuenum': 7.51, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, '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': '___', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 59.0, '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': '12', 'valuenum': 12.0, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '___', 'valuenum': 2.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 152.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '27.2', 'valuenum': 27.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, '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': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': 4.6, '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': '43.2', 'valuenum': 43.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.3', 'valuenum': 44.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '5.08', 'valuenum': 5.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '10.4', 'valuenum': 10.4, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 178.0, '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': '44', 'valuenum': 44.0, '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': '4.7', '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': '14', 'valuenum': 14.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '166', 'valuenum': 166.0, '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': '4.76', 'valuenum': 4.76, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.9', 'valuenum': 41.9, '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': '12.2', 'valuenum': 12.2, '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': '12', 'valuenum': 12.0, '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': '10.6', 'valuenum': 10.6, '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': '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': 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': '3', 'valuenum': 3.0, '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': '2.2', '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': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, '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': '7', 'valuenum': 7.0, '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': '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': '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': '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': 0.5, 'ref_range_upper': 1.2, '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': '2', 'valuenum': 2.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, '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': '16', 'valuenum': 16.0, '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': '39.5', 'valuenum': 39.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '173', 'valuenum': 173.0, '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': '4.56', 'valuenum': 4.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.5', 'valuenum': 40.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.31', 'valuenum': 1.31, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': 'VEN.', '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': 10.0, 'ref_range_upper': 18.0, '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 113.0, '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', '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': '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': '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.4', 'valuenum': 41.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '212', 'valuenum': 212.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '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': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.1', 'valuenum': 40.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '10.2', 'valuenum': 10.2, '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': '1.0', '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 (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': 109.0, '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': '2.4', 'valuenum': 2.4, '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': '5\'8" 114# right 104/70 left 108/72\nHR 88 RR 14 \nNAD\nskin unremarkable\nPERRL/EOMI/NCAT\nneck supple, full ROM, no JVD or carotid bruits appreciated\nCTAB\nregularly irregular ___ holosystolic murmur\nsoft, NT, ND\nextrems warm, well-perfused, 1+ ___ edema\nlarge bilat. varicosities, right greater than left', 'diagnoses': [{'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'G35', 'desc': 'Multiple sclerosis'}, {'icd_code': 'B964', 'desc': 'Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere'}, {'icd_code': 'R159', 'desc': 'Full incontinence of feces'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R338', 'desc': 'Other retention of urine'}, {'icd_code': 'N39490', 'desc': 'Overflow incontinence'}, {'icd_code': 'R471', 'desc': 'Dysarthria and anarthria'}, {'icd_code': 'R1310', 'desc': 'Dysphagia, unspecified'}], 'summary': 'Conclusions \nPREBYPASS\n\n1. The left atrium is mildly dilated. No spontaneous echo \ncontrast or thrombus is seen in the body of the left atrium or \nleft atrial appendage. No atrial septal defect is seen by 2D or \ncolor Doppler. \n\n2. The left ventricular cavity is moderately dilated. Overall \nleft ventricular systolic function is severely depressed (LVEF= \n___ %), in the setting of MR the EF may be an overestimation. \n\n3. The right ventricular cavity is mildly dilated with mild \nglobal free wall hypokinesis. \n\n4. There are simple atheroma in the descending thoracic aorta. \n\n5. The aortic valve leaflets are moderately thickened. Mild (1+) \naortic regurgitation is seen. \n\n6. The mitral valve leaflets are mildly thickened. Moderate (2+) \nmitral regurgitation is seen. \n\n7. Moderate [2+] tricuspid regurgitation is seen. \n\n8. Significant pulmonic regurgitation is seen. \n\n9. There is no pericardial effusion. \n\n10 Dr. ___ was notified in person of the results on 1040 at \n___. \n\nPOSTBYPASS\n1. Patient is on epinephrine and norepinephrine infusions\n\n2. The LV remains globally hypokinetic with an EF 20%.\n\n3. A well seated mitral annuloplasty ring is seen in the mitral \nannulus. No MR is seen.\n\n4. Aortic regurgitation remain 1+ post bypass\n\n5. Aortic contour is smooth post decannulation.\n\n6. Dr. ___ of findings 1457 on ___ \n I certify that I was present for this procedure in compliance \nwith ___ regulations.\n\nInterpretation assigned to ___, MD, Interpreting \nphysician \n \n___. ___ ___ SCHED \nCHEST (PORTABLE AP) Clip # ___ \nReason: eval for pneumothorax ___ chest tube removal \n \n\n \nUNDERLYING MEDICAL CONDITION: \n ___ year old man ___ MVRepair \nREASON FOR THIS EXAMINATION: \n eval for pneumothorax ___ chest tube removal \n\n \nWet Read: ___ ___ 8:01 ___\nNo ptx. CMG, b/l small effusions, retrocardiac opacity. \n\n \nFinal Report \nAP CHEST, 6:39 P.M., ___\n \nHISTORY: Mitral valve repair. Possible pneumothorax following \nchest tube \nremoval. \n \nIMPRESSION: AP chest compared to ___: \n \nLung volumes are lower following removal of the endotracheal \ntube, with \nworsened atelectasis at both lung bases, left greater than \nright, and increase \nin small bilateral pleural effusion. Increasing cardiac diameter \ncould be due \nin part to lower lung volumes, and probably some mediastinal \nfluid collection, \nalthough there is no distention of mediastinal veins to suggest \nhemodynamic \nsignificance. No pneumothorax. Upper lungs clear. Right jugular \nsheath ends \nat the junction of the brachiocephalic veins. \n \nThe study and the report were reviewed by the staff radiologist. \n\n \n___. ___ \n___. ___ \n___: FRI ___ 1:32 ___ \n \n Imaging Lab \n\n___ 08:30AM BLOOD WBC-8.4 RBC-3.55* Hgb-11.0* Hct-31.2* \nMCV-88 MCH-31.1 MCHC-35.4* RDW-14.8 Plt ___\n___ 07:10PM BLOOD WBC-8.3 RBC-4.40* Hgb-13.2* Hct-37.7* \nMCV-86 MCH-30.1 MCHC-35.0 RDW-14.2 Plt ___\n___ 05:30AM BLOOD ___\n___ 07:10PM BLOOD ___ PTT-34.1 ___\n___ 07:05AM BLOOD Glucose-94 UreaN-38* Creat-1.5* Na-136 \nK-5.2* Cl-105 HCO3-28 AnGap-8\n___ 07:10PM BLOOD Glucose-112* UreaN-39* Creat-1.5* Na-141 \nK-4.7 Cl-102 HCO3-30 AnGap-14\nOn ___ ___ underwent MVrepair (#34mm ring) with Dr. ___ \n. XCT=42min., CPB =68 minutes. He was transferred to the CVICU \nin stable condition on epinephrine, propofol and levophed drips. \nExtubated later that evening. POD#1 he required milrinone due to \ndecreased cardiac output. His rhythm was intermittently \nSR/AFib-rate controlled. The milrinone was weaned to off with a \nstable cardiac output/cardiac index. All tubes and lines were \ndiscontinued when criteria was met.POD#3 he was transferred to \nthe SDU for further telemetry and recovery. Beta-blocker \noptimized as BP tolerated. ___ was restarted on his Coumadin \nfor his intermittent AFib. Despite discussions regarding the \npotential risks of stroke if not taking Coumadin, ___ \nrefuses.At time of discharge Coumadin will be prescribed and he \nfollow-up for INR/ Coumadin dosing has been arranged. the \nremainder of his postoperative course was essentially \nuneventful. He continued to progress and on POD#6 he was \ndischarged to home with ___. All follow-up appointments were \nadvised.'}}
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{'final_diagnoses': ['MR ___ MV repair', 'CAD', 'HTN', 'systolic CHF', 'RHD', 'A Fib', 'PUD with gastric bleed ___', 'varicosities', 'CRI'], 'procedures': ['___ MV repair (34 mm annuloplasty ring)'], 'visit_summary': 'On ___ ___ underwent MVrepair (#34mm ring) with Dr. ___ \n. XCT=42min., CPB =68 minutes. He was transferred to the CVICU \nin stable condition on epinephrine, propofol and levophed drips. \nExtubated later that evening. POD#1 he required milrinone due to \ndecreased cardiac output. His rhythm was intermittently \nSR/AFib-rate controlled. The milrinone was weaned to off with a \nstable cardiac output/cardiac index. All tubes and lines were \ndiscontinued when criteria was met.POD#3 he was transferred to \nthe SDU for further telemetry and recovery. Beta-blocker \noptimized as BP tolerated. ___ was restarted on his Coumadin \nfor his intermittent AFib. Despite discussions regarding the \npotential risks of stroke if not taking Coumadin, ___ \nrefuses.At time of discharge Coumadin will be prescribed and he \nfollow-up for INR/ Coumadin dosing has been arranged. the \nremainder of his postoperative course was essentially \nuneventful. He continued to progress and on POD#6 he was \ndischarged to home with ___. All follow-up appointments were \nadvised.', 'medications_prescribed': ['1. Carvedilol 3.125 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day).\nDisp:*120 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:*0*', '3. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', '4. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed for pain.\nDisp:*45 Tablet(s)* Refills:*0*', '5. Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*0*', '6. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', '7. Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*0*', '8. Warfarin 1 mg Tablet Sig: per MD ___ PO DAILY (Daily).\nDisp:*90 Tablet(s)* Refills:*0*', '9. Furosemide 20 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '10. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal \nSig: One (1) Tab Sust.Rel. Particle/Crystal PO Q12H (every 12 \nhours) for 7 days.\nDisp:*14 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'Fatigue', 'medical_history': ['Type I DM', 'ESRD on HD ___', 'Quadriplegia from hyponatremia/CPM', 'OSA on CPAP', 'GERD', 'Stage 4 presacral left buttock decubitus ulcer c/b diverting colostomy', 'MRSA bacteremia ___ RIJ HD line infection', 'Tracheostomy s/p removal', 'PEG s/p removal with open connection between stomach and skin', 'Retinopathy', 'Pseudomonas osteomyelitis of sacral ulcer in ___', 'Asthma', 'HLD', 'Neurogenic bladder requiring intermittent catheterization and with recurrent UTIs', 'Gastroparesis', 'Oropharnygeal dysphagia s/p PEG s/p removal', 'Neuropathy', 'HTN'], 'family_history': 'Mother with asthma, father with diabetes', 'present_illness': 'Mr. ___ is a ___ year old male with PMH significant type 1 \nDM, ESRD on HD TTS, central pontine myelinolysis (secondary to \ncorrection of hyponatremia) and subsequent quadriplegia, history \nof stage 4 sacral decubitus ulcer complicated by colonic fistula \ns/p diverting colostomy, previous HD-line assoc. MRSA bacteremia \n(___), and history of recurrent multi-drug resistant\nUTIs in the setting of neurogenic bladder presenting after \nmissing two hemodialysis sessions. \n\nHe presents with weakness and a sensation of having a UTI. He \nmissed both his ___ and ___ dialysis. He reports that \nhe missed dialysis since his aids did not come to help him and \nhe is not able to get himself to a wheelchair independently. He \nreports one had car problems, the other stated that her mom \ndied, and a third stated that she was feeling sick. His ___ is \nsupposed to\nstraight cath him daily, but she has not come in since ___, \nand as he is not able to straight cath himself, he has not had \nany cath done since ___. He has noticed increased pus \ndeveloping at his urethral meatus.\n\nHe denies any chest pain, visual changes, headache, shortness of \nbreath, or confusion.', 'medications': [{'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acular LS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OS', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Acular LS', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OD', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Zymar', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'OS', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'PrednisoLONE Acetate 0.12% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'RIGHT EYE', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tobramycin-Dexamethasone Ophth Oint', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'PrednisoLONE Acetate 1% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', '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': 'PrednisoLONE Acetate 1% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Simvastatin', '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}]}, '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '1.4', 'valuenum': 1.4, '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': '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, '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': '27.5', 'valuenum': 27.5, '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': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, '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': '28', 'valuenum': 28.0, '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': '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': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '27.9', 'valuenum': 27.9, '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': '84', 'valuenum': 84.0, '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': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.1', 'valuenum': 6.1, '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': '29', 'valuenum': 29.0, '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': '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': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '33.1', 'valuenum': 33.1, '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': '28.9', 'valuenum': 28.9, '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': '83', 'valuenum': 83.0, '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': '16.5', 'valuenum': 16.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.97', 'valuenum': 3.97, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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}, {'value': '33.6', 'valuenum': 33.6, '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': '27.9', 'valuenum': 27.9, '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': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.99', 'valuenum': 3.99, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, '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': '28', 'valuenum': 28.0, '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': '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': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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}], 'exams': 'ADMISSION\n=========\nVITALS: T 97.9 BP 168 / 107 HR 82 RR 18 O2 Sat 100 \nGENERAL: Well-appearing male in no acute distress\nHEENT: PERRL, EOMI\nNECK: No lymphadenopathy or thyroidomegaly\nCHEST: R tunneled line in place.\nCARDIAC: Regular rate, no murmurs or rubs\nLUNGS: Crackles at bases. No wheezes. Normal work of breathing\nABDOMEN: Soft, nondistended. Some pressure sensation noted in \nsuprapubic region. LLQ with ostomy bag.\nEXTREMITIES: Able to slightly flex fingers and wiggle toes. \nUnable to move upper or lower extremities antigravity. No lower \nextremity edema\nSKIN: Distal extremities- shiny, taut. \nNEUROLOGIC: Quadriplegic. Normal speech, a&o x 3\n\nDISCHARGE\n=========\nVITALS: Reviewed in OMR\nGENERAL: Alert and oriented, no acute distress\nENT: NT/AC, MMM, EOMI\nCV: RRR, no murmurs, rubs, or gallops\nRESP: Diminished lung sounds at the left base, mild crackles at\nthe bases bilaterally, normal work of breathing\nGI: NT/ND, BS+. Colostomy bag with brown formed stool, no \nerythema or prolapse\nEXT: Warm and well perfused, non-edematous\nNEURO: CNII-XII grossly intact, ___ strength in BUEs, ___ \nstrength in BLEs.', 'diagnoses': [{'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '7820', 'desc': 'Disturbance of skin sensation'}, {'icd_code': '36610', 'desc': 'Senile cataract, unspecified'}, {'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': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': 'ADMISSION\n=========\n___ 07:17PM WBC-6.6 RBC-3.17* HGB-5.4* HCT-20.4* MCV-64* \nMCH-17.0* MCHC-26.5* RDW-17.8* RDWSD-40.6\n___ 07:17PM NEUTS-53.9 ___ MONOS-4.4* EOS-20.5* \nBASOS-1.2* IM ___ AbsNeut-3.54 AbsLymp-1.28 AbsMono-0.29 \nAbsEos-1.35* AbsBaso-0.08\n___ 07:17PM calTIBC-429 FERRITIN-22* TRF-330\n___ 07:17PM ALBUMIN-4.0 CALCIUM-8.8 PHOSPHATE-6.7* \nMAGNESIUM-2.7* IRON-20*\n___ 07:17PM cTropnT-0.20*\n___ 07:17PM LIPASE-6\n___ 07:17PM ALT(SGPT)-8 AST(SGOT)-12 CK(CPK)-64 ALK \nPHOS-317* TOT BILI-0.6\n___ 07:38PM LACTATE-1.1 K+-4.6\n\nDISCHARGE\n=========\n___ 06:35AM BLOOD WBC-8.9 RBC-3.97* Hgb-8.0* Hct-28.6* \nMCV-72* MCH-20.2* MCHC-28.0* RDW-24.1* RDWSD-60.2* Plt ___\n___ 06:35AM BLOOD Glucose-53* UreaN-41* Creat-7.7* Na-140 \nK-5.4 Cl-100 HCO3-21* AnGap-19*\n___ 06:35AM BLOOD Calcium-8.9 Phos-6.1* Mg-2.5\n\nIMAGING\n=======\n___ CXR: Moderate left pleural effusion as seen previously \nwith mild pulmonary edema.\n___ man with history of type I diabetes, ESRD on HD \n(TThSa), central pontine myelinolysis c/b quadriplegia, stage IV \nsacral decubitus ulcer c/b colonic fistula s/p divert colostomy, \nprior HD-line associated MRSA bacteremia, and neurogenic bladder \nc/b history of multi-drug resistant UTIs admitted for weakness \nin setting of two missed hemodialysis sessions.\n\n# ESRD\nHe presented for weakness in setting of two missed hemodialysis \nsessions. ESRD secondary to diabetic nephropathy (access with \nright-sided tunneled line). He completed HD session on ___ \nwith rapid improvement in symptoms. Subsequently declined repeat \nsession in house on ___ as he had already confirmed slot at \noutpatient HD at his usual ___ same day (5 ___ ___ \n___. He will otherwise resume HD sessions per usual schedule.\n\n# HOME SERVICES\nUpon discharge had arranged for home personal assistants (to \nhelp with mobility issues). Additionally arranged for home ___ \nservices. He was in agreement with plan for home services. \n\n# ANEMIA\nChronic anemia secondary to iron deficiency and renal failure. \nPresented with nadir Hgb 5.2. No signs of acute blood loss. \nReceived 2u pRBC with appropriate improvement. \n\n# ASYMPTOMATIC BACTERURIA\nUrine cultures from initial presentation subsequently growing \nenterococcus, full speciation and sensitivities not yet \navailable. He had no infectious signs or symptoms and so did not \nreceive antibiotics for urinary tract infection. He agreed to \nmonitor for symptoms of UTI and seek medical attention if any \nconcern.\n\nCHRONIC / STABLE ISSUES\n==================================\n\n# NEUROGENIC BLADDER / RECURRENT PYOCYSTITIS\nContinued daily straight catheterization with sterile saline \nflushes per prior urology recommendations.\n\n# TYPE I DIABETES\nContinued home insulin regimen. \n\n# STAGE IV DECUBITUS ULCER / CHRONIC PAIN\nContinued home oxycodone.\n\n# ASTHMA\nContinued home inhalers. \n\n# GERD \nContinued omeprazole and simethicone. \n\n# DEPRESSION \nContinued citalopram. \n\nTRANSITIONAL ISSUES\n==================================\n\n[ ] Noted to have asymptomatic bacteruria with enterococcus \nspecies (not yet speciated / no sensitivities available at time \nof discharge). No antibiotics started given absence of \ninfectious signs or symptoms, though if patient develops UTI \nsymptoms will need additional workup/treatment.\n\n[ ] Noted to have chronic anemia with component of iron \ndeficiency. Would likely benefit from outpatient iron infusion. \n\n#CONTACT: ___ (mother: ___'}}
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{'final_diagnoses': ['# ESRD', '# ANEMIA', '# ASYMPTOMATIC BACTERURIA', '# NEUROGENIC BLADDER / RECURRENT PYOCYSTITIS', '# TYPE I DIABETES', '# STAGE IV DECUBITUS ULCER / CHRONIC PAIN', '# ASTHMA', '# GERD', '# DEPRESSION'], 'procedures': ['None'], 'visit_summary': '___ man with history of type I diabetes, ESRD on HD \n(TThSa), central pontine myelinolysis c/b quadriplegia, stage IV \nsacral decubitus ulcer c/b colonic fistula s/p divert colostomy, \nprior HD-line associated MRSA bacteremia, and neurogenic bladder \nc/b history of multi-drug resistant UTIs admitted for weakness \nin setting of two missed hemodialysis sessions.\n\n# ESRD\nHe presented for weakness in setting of two missed hemodialysis \nsessions. ESRD secondary to diabetic nephropathy (access with \nright-sided tunneled line). He completed HD session on ___ \nwith rapid improvement in symptoms. Subsequently declined repeat \nsession in house on ___ as he had already confirmed slot at \noutpatient HD at his usual ___ same day (5 ___ ___ \n___. He will otherwise resume HD sessions per usual schedule.\n\n# HOME SERVICES\nUpon discharge had arranged for home personal assistants (to \nhelp with mobility issues). Additionally arranged for home ___ \nservices. He was in agreement with plan for home services. \n\n# ANEMIA\nChronic anemia secondary to iron deficiency and renal failure. \nPresented with nadir Hgb 5.2. No signs of acute blood loss. \nReceived 2u pRBC with appropriate improvement. \n\n# ASYMPTOMATIC BACTERURIA\nUrine cultures from initial presentation subsequently growing \nenterococcus, full speciation and sensitivities not yet \navailable. He had no infectious signs or symptoms and so did not \nreceive antibiotics for urinary tract infection. He agreed to \nmonitor for symptoms of UTI and seek medical attention if any \nconcern.\n\nCHRONIC / STABLE ISSUES\n==================================\n\n# NEUROGENIC BLADDER / RECURRENT PYOCYSTITIS\nContinued daily straight catheterization with sterile saline \nflushes per prior urology recommendations.\n\n# TYPE I DIABETES\nContinued home insulin regimen. \n\n# STAGE IV DECUBITUS ULCER / CHRONIC PAIN\nContinued home oxycodone.\n\n# ASTHMA\nContinued home inhalers. \n\n# GERD \nContinued omeprazole and simethicone. \n\n# DEPRESSION \nContinued citalopram. \n\nTRANSITIONAL ISSUES\n==================================\n\n[ ] Noted to have asymptomatic bacteruria with enterococcus \nspecies (not yet speciated / no sensitivities available at time \nof discharge). No antibiotics started given absence of \ninfectious signs or symptoms, though if patient develops UTI \nsymptoms will need additional workup/treatment.\n\n[ ] Noted to have chronic anemia with component of iron \ndeficiency. Would likely benefit from outpatient iron infusion. \n\n#CONTACT: ___ (mother: ___', 'medications_prescribed': ['Glargine 22 Units Breakfast\nHumalog 3 Units Breakfast\nHumalog 3 Units Lunch\nHumalog 3 Units Dinner', 'Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN shortness of breath', 'Ascorbic Acid ___ mg PO BID', 'Belladonna & Opium (16.2/30mg) ___ID:PRN bladder spasms', 'Bisacodyl 10 mg PR QHS:PRN Constipation - First Line', 'Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q8H', 'Brovana (arformoterol) 15 mcg/2 mL inhalation BID', 'Cetirizine 10 mg PO DAILY', 'Citalopram 20 mg PO DAILY', 'DiphenhydrAMINE 25 mg PO BID:PRN pruritis', 'Fluticasone Propionate NASAL 1 SPRY NU BID', 'Fluticasone-Salmeterol Diskus (100/50) 1 INH IH BID', 'HydrOXYzine 50 mg PO BID', 'Lidocaine Jelly 2% 1 Appl TP BID', 'Miconazole 2% Cream 1 Appl TP DAILY', 'Nephro-Vite (B complex-vitamin C-folic acid) 0.8 mg oral \nQAM', 'Omeprazole 40 mg PO BID', 'Ondansetron 4 mg PO Q8H:PRN nausea', 'OxyCODONE (Immediate Release) 10 mg PO Q6H:PRN Pain - \nModerate', 'OxyCODONE SR (OxyconTIN) 10 mg PO Q12H', 'OxyCODONE SR (OxyconTIN) 10 mg PO QAM', 'Senna 8.6 mg PO DAILY:PRN Constipation - First Line', 'sevelamer CARBONATE 1600 mg PO TID W/MEALS', 'Simethicone 80 mg PO TID', 'Triamcinolone Acetonide 0.1% Cream 1 Appl TP BID:PRN \nxerosis', 'Ursodiol 300 mg PO TID', 'Vitamin D 1000 UNIT PO DAILY', 'Vitamin E 1000 UNIT PO DAILY', 'Zeasorb (miconazole) (miconazole nitrate) 2 % topical \nDAILY:PRN', 'Zinc Sulfate 220 mg PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'M', 'symptoms': 'Prostate Cancer', 'medical_history': ['T2a prostate cancer, ___ 6 and 7, ___ cores bilateral (3\nother cores atypical).', '___, prostate MRI: 27 mL, gland-confined tumor on the\nleft, possible small focus on the right, no LAD.', 'Nephrolithiasis, glaucoma, cholesterol.'], 'family_history': 'Father died of prostate cancer at age ___ or ___.', 'present_illness': 'Mr. ___ is a ___ gentleman who had an elevated PSA \nup to 4.8 recently. Dr. ___ a prostate biopsy, \nidentifying prostate cancer bilaterally; however, the majority \nwas on the left, 4 cores on the left, ___ 3 and 4 up to 70% \nper core, and another two cores were atypical on the left. \nThere were 2 cores on the right, ___ 6, small volume. He\nhas not had any fatigue, abdominal pain, flank pain, nausea, \nvomiting, fever, chills, bowel issues, chest pain, shortness of \nbreath. No urinary problems. He is sexually active \napproximately once per month. His ___ sexual score was ___ \n(0 best). His urinary irritative score was ___, suggesting no\nurinary or rectal issues.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins W/minerals', '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': '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}, {'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': 'Discontinued', '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': 'Ramelteon', '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': '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Leuprolide Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Apixaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', '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': 'Maalox/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'TID: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Ondansetron', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 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', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Discontinued', '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', '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': 'Apixaban', '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': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': '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': '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', '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': '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': 'Cyanocobalamin', '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': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '0.92', 'valuenum': 0.92, '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': '___', 'valuenum': 19.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, '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': '93', 'valuenum': 93.0, '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': '81.3', 'valuenum': 81.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.14', 'valuenum': 2.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.04', 'valuenum': 0.04, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.54', 'valuenum': 0.54, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.64', 'valuenum': 6.64, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '54.7', 'valuenum': 54.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '15', 'valuenum': 15.0, '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': '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': '8.5', 'valuenum': 8.5, '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': 63.0, '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': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, '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 3.6, . estimated GFR (eGFR) is likely between 16 and 20 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': '388', 'valuenum': 388.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 117.0, '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': '200', 'valuenum': 200.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, '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': '50', 'valuenum': 50.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.0, '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': 74.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Measured by ___.'}, {'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': '180', 'valuenum': 180.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, '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': '0', 'valuenum': 0.0, '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': '___', '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '17.5', 'valuenum': 17.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', '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': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, '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': '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': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, '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': '170', 'valuenum': 170.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 0.06, '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': '116', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '263', 'valuenum': 263.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '20.2', 'valuenum': 20.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'OCCASIONAL*.'}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '2+*.'}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.21', 'valuenum': 2.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.05', 'valuenum': 0.05, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '52.4', 'valuenum': 52.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '17.0', 'valuenum': 17.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '34.3', 'valuenum': 34.3, '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': '140', 'valuenum': 140.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.38', 'valuenum': 2.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.06', 'valuenum': 0.06, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 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'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': '30.7', 'valuenum': 30.7, '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': '93', 'valuenum': 93.0, '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, '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': 6.1, 'flag': 'abnormal', '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': '51.9', 'valuenum': 51.9, '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': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': 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': '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': '2.3', 'valuenum': 2.3, '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': '___', 'valuenum': 3.5, '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': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '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': '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.4, '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': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': 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': '10', 'valuenum': 10.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.4, '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': 148.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '53', 'valuenum': 53.0, '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': '27.8', 'valuenum': 27.8, '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': '30.8', 'valuenum': 30.8, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '233', 'valuenum': 233.0, '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': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '52.6', 'valuenum': 52.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', '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': '2.1', 'valuenum': 2.1, '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 2.1, . estimated GFR (eGFR) is likely between 30 and 37 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': 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': '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': '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.3, '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': '48', 'valuenum': 48.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, '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': '30.8', 'valuenum': 30.8, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '260', 'valuenum': 260.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '51.6', 'valuenum': 51.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': 'NORMAL.'}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '31.5', 'valuenum': 31.5, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '15.3', 'valuenum': 15.3, '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': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '52.2', 'valuenum': 52.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', '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': '2.2', 'valuenum': 2.2, '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', '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': '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': '___', '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': 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': '44', 'valuenum': 44.0, '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': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 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'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': '3.1', 'valuenum': 3.1, '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': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, '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': '30.6', 'valuenum': 30.6, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '358', 'valuenum': 358.0, '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': '2.81', 'valuenum': 2.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '50.0', 'valuenum': 50.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '22', 'valuenum': 22.0, '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': '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': '3.2', 'valuenum': 3.2, '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': 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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '347', 'valuenum': 347.0, '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': '2.82', 'valuenum': 2.82, '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': '48.5', 'valuenum': 48.5, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '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': 86.0, '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': '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': '___', 'valuenum': 4.9, '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': 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': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': 'WdWn, male, NAD, AVSS\nInteractive, cooperative\nAbdomen soft, appropriately tender along incisions\nIncisions c/d/i w/out evidence hematoma, infection\nBilateral lower extremities w/out edema or pitting and there is \nno reported calf pain to deep palpation\nJP drain has been removed\nFoley catheter in place, secured to medial thigh', 'diagnoses': [{'icd_code': 'C772', 'desc': 'Secondary and unspecified malignant neoplasm of intra-abdominal lymph nodes'}, {'icd_code': 'C61', 'desc': 'Malignant neoplasm of prostate'}, {'icd_code': 'K264', 'desc': 'Chronic or unspecified duodenal ulcer with hemorrhage'}, {'icd_code': 'E43', 'desc': 'Unspecified severe protein-calorie malnutrition'}, {'icd_code': 'N1330', 'desc': 'Unspecified hydronephrosis'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I248', 'desc': 'Other forms of acute ischemic heart disease'}, {'icd_code': 'R64', 'desc': 'Cachexia'}, {'icd_code': 'Z681', 'desc': 'Body mass index [BMI] 19.9 or less, adult'}, {'icd_code': 'E870', 'desc': 'Hyperosmolality and hypernatremia'}, {'icd_code': 'R310', 'desc': 'Gross hematuria'}, {'icd_code': 'E872', 'desc': 'Acidosis'}, {'icd_code': 'C7951', 'desc': 'Secondary malignant neoplasm of bone'}, {'icd_code': 'K2210', 'desc': 'Ulcer of esophagus without bleeding'}, {'icd_code': 'I4891', 'desc': 'Unspecified atrial fibrillation'}, {'icd_code': 'Z7902', 'desc': 'Long term (current) use of antithrombotics/antiplatelets'}, {'icd_code': 'N139', 'desc': 'Obstructive and reflux uropathy, unspecified'}, {'icd_code': 'R599', 'desc': 'Enlarged lymph nodes, unspecified'}, {'icd_code': 'D630', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': 'E861', 'desc': 'Hypovolemia'}, {'icd_code': 'R1310', 'desc': 'Dysphagia, unspecified'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}, {'icd_code': 'K449', 'desc': 'Diaphragmatic hernia without obstruction or gangrene'}, {'icd_code': 'R197', 'desc': 'Diarrhea, unspecified'}, {'icd_code': 'K5730', 'desc': 'Diverticulosis of large intestine without perforation or abscess without bleeding'}], 'summary': '___ 07:11AM BLOOD WBC-11.4*# RBC-3.65* Hgb-11.9* Hct-36.8*\nMCV-101* MCH-32.5* MCHC-32.3 RDW-12.9 Plt ___\n___ 07:11AM BLOOD Glucose-124* UreaN-8 Creat-1.0 Na-139\nK-3.3 Cl-105 HCO3-28 AnGap-9\nMr. ___ was admitted to the Urology Service after \nundergoing robotic assisted laparoscopic prostatectomy. No \nconcerning intra-operative events occurred; please see dictated \noperative note for full details. The patient received \n___ antibiotic prophylaxis. At the end of the \nprocedure the patient was extubated and transported to the PACU \nfor further recovery before being transferred to the floor. He \nwas transferred from the PACU in stable condition. On POD0, pain \nwas well controlled on PCA, hydrated with intravenous fluids for \nurine output >30cc/hour, provided with pneumoboots and incentive \nspirometry for prophylaxis, and he ambulated once. On POD1, the \npatient was restarted on home medications, basic metabolic panel \nand complete blood count were checked, pain control was \ntransitioned from PCA to oral analgesics, diet was advanced to a \nclears/toast and crackers diet for breakfast and lunch. Diet \nwas advanced to regular after lunch and with further ambulation, \nthe JP drain was removed. Foley catheter care and leg bag \nteaching was provided by nursing. The remainder of the hospital \ncourse was unremarkable. The patient was discharged in stable \ncondition, eating well, ambulating independently, and with pain \ncontrol on oral analgesics. On exam, incision was clean, dry, \nand intact, with no evidence of hematoma collection or \ninfection. The patient was given explicit instructions to \nfollow-up in one week for post-operative evaluation and trial of \nvoiding.'}}
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{'final_diagnoses': ['PREOPERATIVE DIAGNOSIS: Prostate cancer.', 'POSTOPERATIVE DIAGNOSIS: Prostate cancer.'], 'procedures': ['Robotic prostatectomy with laparoscopic bilateral pelvic\n lymph node dissection.', 'Right full nerve-sparing, left non-nerve-sparing.'], 'visit_summary': 'Mr. ___ was admitted to the Urology Service after \nundergoing robotic assisted laparoscopic prostatectomy. No \nconcerning intra-operative events occurred; please see dictated \noperative note for full details. The patient received \n___ antibiotic prophylaxis. At the end of the \nprocedure the patient was extubated and transported to the PACU \nfor further recovery before being transferred to the floor. He \nwas transferred from the PACU in stable condition. On POD0, pain \nwas well controlled on PCA, hydrated with intravenous fluids for \nurine output >30cc/hour, provided with pneumoboots and incentive \nspirometry for prophylaxis, and he ambulated once. On POD1, the \npatient was restarted on home medications, basic metabolic panel \nand complete blood count were checked, pain control was \ntransitioned from PCA to oral analgesics, diet was advanced to a \nclears/toast and crackers diet for breakfast and lunch. Diet \nwas advanced to regular after lunch and with further ambulation, \nthe JP drain was removed. Foley catheter care and leg bag \nteaching was provided by nursing. The remainder of the hospital \ncourse was unremarkable. The patient was discharged in stable \ncondition, eating well, ambulating independently, and with pain \ncontrol on oral analgesics. On exam, incision was clean, dry, \nand intact, with no evidence of hematoma collection or \ninfection. The patient was given explicit instructions to \nfollow-up in one week for post-operative evaluation and trial of \nvoiding.', 'medications_prescribed': ['Acetaminophen 325-650 mg PO Q6H:PRN pain, fever>100', 'Bacitracin Ointment 1 Appl TP TID', 'Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES BID', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg ONE capsule(s) by mouth \ntwice a day Disp #*60 Capsule Refills:*0', 'Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP BOTH EYES BID', 'Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES HS', 'Ibuprofen 600 mg PO Q8H:PRN pain \nRX *ibuprofen 600 mg ONE tablet(s) by mouth Q8hrs Disp #*40 \nTablet Refills:*0', 'Ciprofloxacin HCl 500 mg PO Q12H Duration: 3 Days \nstart one day before scheduled trial of void/foley removal \nRX *ciprofloxacin 500 mg ONE tablet(s) by mouth twice a day Disp \n#*6 Tablet Refills:*0', 'Simvastatin 20 mg PO DAILY', 'OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ONE tablet(s) by mouth Q4hrs Disp #*40 Tablet \nRefills:*0']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 78, 'gender': 'M', 'symptoms': 'weight loss, lower extremity edema', 'medical_history': ['-hypertension', '-AVNRT diagnosed in ___ status post ablation', '-colorectal adenocarcinoma status post hemicolectomy in ___', '-gout', '-nontraumatic lumbar pain', '-Renal mass concerning for RCC seen on CT in ___, undergoing \nfurther workup'], 'family_history': 'Reviewed and found to be not relevant to this\nillness/reason for hospitalization.', 'present_illness': "Mr. ___ is a ___ male with the past medical\nhistory noted below who has been progressively more unwell over\nthe past 3 weeks. His daughter is at the bedside, given a good\naccount of everything. He has been short of breath, needing to\nprop up his head with his hands when he sleeps at night, has\npalpitations, and increasing leg swelling. Weight loss of \naround\n20lbs over a month, however after confirmation from the PCP, has\nbeen ongoing for a little longer than that. 3 weeks ago,\ndaughter describes an upper respiratory tract infection, with \ndry\ncough and low grade fevers, which resolved without any\nintervention.\n\nHe and his daughter are very concerned about H. pylori, a\ndiagnosed in ___ last week on upper endoscopy. PCP sent\nme the report. His abdomen bothers him, mostly epigastric and\nmild RUQ pain. The smell of food is nauseating to him, and\ncomplains of dysphagia to solids over a month. Explains that \nthe\nfood gets stuck easily, and must flush it down with large\nquantities of fluids. No obvious aspiration. Doesn't remember\nseeing any melena or maroon colored stools. He is constipated\ntoday and has poor appetite. His daughter is preparing soups \nand\npureed foods for him at home, in an attempt to keep up with\ncaloric needs.\n\nCTA ordered in ED, and negative for bowel ischemia.\n\nNo dietary indiscretion or medication changes.\n\nCXR in the ED shows bilateral pleural effusions,\n\nROS: Pertinent positives and negatives as noted in the HPI. All\nother systems were reviewed and are negative.", 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'thrombin (bovine)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Aspirin', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Apixaban', '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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone Cream 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamoxifen Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, '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': 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': 10.3, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, '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': '376', 'valuenum': 376.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '441', 'valuenum': 441.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, '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': '339', 'valuenum': 339.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.8', 'valuenum': 20.8, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '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': '2.6', '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': '135', 'valuenum': 135.0, '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': '24.2', 'valuenum': 24.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '119', 'valuenum': 119.0, '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': '2.87', 'valuenum': 2.87, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '30.5', 'valuenum': 30.5, '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': '___', 'valuenum': 98.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LOW.'}, {'value': '20.9', 'valuenum': 20.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.91', 'valuenum': 2.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '233', 'valuenum': 233.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '274', 'valuenum': 274.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': 'AVAILABLE AT THE ___ LAB.'}, {'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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 18.0, 'valueuom': 'U/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 39.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MEASURED BY ___;RESULTS FROM SAMPLES DRAWN PRIOR TO ___ ARE IN OUTSIDE LAB SYSTEM.'}, {'value': '___', 'valuenum': 3.1, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'MEASURED BY ___.'}, {'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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '___', 'valuenum': 5.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1173', 'valuenum': 1173.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, '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': '104', 'valuenum': 104.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.75', 'valuenum': 2.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 20.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CHECKED FOR CLOT.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}], 'exams': 'ADMISSION EXAM:\n===============\nVITALS: Afebrile and vital signs stable (see eFlowsheet)\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: Heart regular, ___ crescendo-decrescendo murmur, no rubs or\ngallops, JV not distended\nRESP: upper lung fields clear to auscultation, bilateral \ncrackles\nat bases/decreased breath sounds\nGI: Abdomen soft, non-distended, pain on deep palpation of\nepigastrium\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted, dark discoloration on \nlower\nextremities (?venous stasis)\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 PHYSICAL EXAM:\n========================\n\nVITALS: ___ 0757 Temp: 98.2 PO BP: 151/66 HR: 67 RR: 18 O2\nsat: 94% O2 delivery: 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: Heart regular, ___ crescendo-decrescendo murmur, no rubs or\ngallops, JV not distended\nRESP: upper lung fields clear to auscultation, bilateral \ncrackles\nat bases/decreased breath sounds\nGI: Abdomen soft, non-distended, pain on deep palpation of\nepigastrium\nGU: No suprapubic fullness or tenderness to palpation\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nSKIN: No rashes or ulcerations noted, dark discoloration on \nlower\nextremities (?venous stasis), small amount of pitting edema of\nthe bilateral ankles\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', 'diagnoses': [{'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '1985', 'desc': 'Secondary malignant neoplasm of bone and bone marrow'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '1759', 'desc': 'Malignant neoplasm of other and unspecified sites of male breast'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '28419', 'desc': 'Other pancytopenia'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '3963', 'desc': 'Mitral valve insufficiency and aortic valve insufficiency'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V4571', 'desc': 'Acquired absence of breast and nipple'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '7847', 'desc': 'Epistaxis'}], 'summary': "ADMISSION LABS:\n===============\n___ 03:21PM BLOOD WBC: 4.3 RBC: 3.80* Hgb: 11.8* Hct: 35.5*\nMCV: 93 MCH: 31.1 MCHC: 33.2 RDW: 12.2 RDWSD: 41.___* \n___ 03:21PM BLOOD ___: 15.2* PTT: 33.3 ___: 1.4* \n___ 03:21PM BLOOD Glucose: 99 UreaN: 23* Creat: 0.8 Na: 143\nK: 4.1 Cl: 106 HCO3: 23 AnGap: 14 \n___ 09:10PM BLOOD ALT: 29 AST: 35 LD(LDH): 182 CK(CPK): 45*\nAlkPhos: 97 TotBili: 0.9 \n___ 03:21PM BLOOD cTropnT: 0.05* \n___ 09:10PM BLOOD cTropnT: 0.05* \n___ 03:21PM BLOOD CK-MB: 1 proBNP: 3216* \n___ 09:10PM BLOOD Albumin: 3.2* \n___ 03:21PM BLOOD Calcium: 9.6 Phos: 4.2 Mg: 1.6 \n\nIMAGING: \n========\nCXR ___: \nSmall bilateral pleural effusions and patchy retrocardiac\nopacity, potentially atelectasis, with infection not excluded in \nthe correct clinical setting. \n\nCTA chest/ab/pelvis ___: \n1. No evidence of acute pulmonary embolism, though evaluation is \nmildly \nlimited due to timing of the intravenous contrast. \n2. Heterogeneous appearance of the liver, may be due to hepatic\ncongestion or hepatitis. There is associated thickening of the \ngallbladder\nwall likely secondary with no evidence of gallbladder dilation \nto suggest\ncholecystitis. \n3. Partly cystic and calcified mass with internal enhancement in\nthe right lower pole highly suspicious for renal cell carcinoma. \n Recommend\nrenal MRI. \n4. Status post right hemicolectomy with ileocolic anastomosis\nwith the transverse colon. No evidence of bowel ischemia. No \nbowel\nobstruction. \n5. Moderate nonhemorrhagic pleural effusions. \n\nTTE ___: \nThe left atrial volume index is moderately increased. Left \nventricular wall thickness, cavity size, and global systolic \nfunction are normal (LVEF = 70%). Tissue Doppler imaging \nsuggests an increased left ventricular filling pressure \n(PCWP>18mmHg). The diameters of aorta at the sinus, ascending \nand arch levels are normal. 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 \nmoderate pulmonary artery systolic hypertension. There is a \ntrivial/physiologic pericardial effusion. There are no \nechocardiographic signs of tamponade. \n\nCompared with the prior study (images reviewed) of ___, \npulmonary hypertension is worse. \n\nBARIUM ESOPHAGRAM ___: \nINDICATION: ___ year old man with difficulty swallowing, eval \nfor esophageal pathology// ?esophageal cause of dysphagia\nTECHNIQUE: Barium esophagram.\nDOSE: Acc air kerma: 27.5 mGy; Accum DAP: 549.18 uGym2; Fluoro \ntime: 04:08\nCOMPARISON: None.\nFINDINGS: \nThe esophagus was not dilated. There was no stricture within \nthe esophagus. There was no esophageal mass. The esophageal \nmucosa appear normal.\nThe primary peristaltic wave was normal, with contrast passing \nreadily into\nthe stomach. The lower esophageal sphincter opened and closed \nnormally.\nA 13 mm barium tablet was administered, which passed into the \nstomach without holdup.\nThere was no gastroesophageal reflux. There was no hiatal \nhernia.\nNo overt abnormality in the stomach or duodenum on limited \nevaluation.\n \nIMPRESSION: \nNormal esophagram.\n\nMICRO:\n======\n\nUrine culture negative\nUrine strep antigen negative\nUrine legionella antigen negative\n\nDISCHARGE LABS:\n===============\n\n___ 07:40AM BLOOD WBC-3.9* RBC-4.14* Hgb-12.7* Hct-38.0* \nMCV-92 MCH-30.7 MCHC-33.4 RDW-12.2 RDWSD-40.8 Plt ___ \n___ 07:40AM BLOOD Glucose-91 UreaN-17 Creat-0.9 Na-142 \nK-4.5 Cl-104 HCO3-25 AnGap-13\n___ 07:40AM BLOOD Calcium-9.6 Phos-4.3 Mg-1.5*\nMr. ___ is a ___ male with hypertension; AVNRT \ndiagnosed in ___ status post ablation; colorectal \nadenocarcinoma status post hemicolectomy in ___\ngout; nontraumatic lumbar pain, who presents with one month of \nshortness of breath, weight loss and leg edema.\n\nACTIVE ISSUES:\n==============\n\n# Dyspnea/Orthopnea/BNP elevation\nIt was ultimately unclear whether the pt's reports of dyspnea \nreflected HFpEF exacerbation given largely wnl TTE done on ___ \n(noting moderate pulmonary HTN and elevated L-sided filling \npressures) vs. deconditioning. He did not appear to be grossly \nvolume overloaded on exam but symptoms did seem improve somewhat \nwith low-dose furosemide, suggesting a least a component of \nvolume overload. He was diuresed with 20mg IV furosemide x2 \nwith improvement his dyspnea. Due to decreased PO intake at \ndischarge, he was not discharged home on standing furosemide. \nHe has f/u with his Cardiologist shortly after discharge, at \nwhich point furosemide may be started if indicated.\n\n# Dysphagia / weight loss:\nPt reports worsening dysphagia for the last few weeks to months \nbut recent endoscopy in ___ showed no masses in the \nesophagus, UGI/BAS was done here and was wnl, and laryngoscopy \ndone by ENT was negative. Speech/swallow evaluation was without \nevidence of dysphagia EGD in ___ did diagnose H. pylori, \nso in consultation with GI, decision was made to treat with \nquadruple therapy and follow-up as an outpatient for a repeat \nendoscopy. He was started on metronidazole, bismuth, \ndoxycycline, and PPI on ___, and discharged home to complete a \n2 week course on ___. He was tolerating soft solids but had \nno dietary restrictions from an aspiration standpoint.\n\n# Cystic calcified renal mass vs. RCC:\nHe was also found to have a cystic calcified renal mass vs. \nlikely RCC on CT torso, which could be a contributor to his \nweight loss as well. MRI was attempted in the inpatient setting \nbut insurance coverage was denied; PCP was contacted so that \nclose outpatient follow-up could be coordinated. \n\nCHRONIC ISSUES:\n===============\n\n#Hypertension\nContinued home regimen with lisinoipril, carvedilol, and \namlodipine \n\n#Gout\nContinued home dose of allopurinol\n\nTRANSITIONAL ISSUES:\n====================\n- Pt to f/u with his cardiologist shortly after discharge \nregarding need possible need for maintenance diuretic for HFpEF \nand moderate pulmonary HTN seen on TTE (not prescribed at \ndischarge given relative ___ and poor PO intake)\n- Pt will need outpatient MRI to f/u possible RCC seen on CTA \ntorso on admission\n- Pt will need repeat EGD a few weeks after completing quadruple \ntherapy and possibly esophageal manometry vs. video swallow eval \nif symptoms of dysphagia persist despite tx for h.pylori\n\n___ is clinically stable for discharge today. On the \nday of discharge, greater than 30 minutes were spent on the \nplanning, coordination, and communication of the discharge plan."}}
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{'final_diagnoses': ['PRIMARY: Volume overload due to diastolic heart failure \nexacerbation', 'Renal Mass', 'H.pylori infection', 'SECONDARY: Anemia', 'hypertension', 'gout', 'history of colon cancer'], 'procedures': ['none'], 'visit_summary': "Mr. ___ is a ___ male with hypertension; AVNRT \ndiagnosed in ___ status post ablation; colorectal \nadenocarcinoma status post hemicolectomy in ___\ngout; nontraumatic lumbar pain, who presents with one month of \nshortness of breath, weight loss and leg edema.\n\nACTIVE ISSUES:\n==============\n\n# Dyspnea/Orthopnea/BNP elevation\nIt was ultimately unclear whether the pt's reports of dyspnea \nreflected HFpEF exacerbation given largely wnl TTE done on ___ \n(noting moderate pulmonary HTN and elevated L-sided filling \npressures) vs. deconditioning. He did not appear to be grossly \nvolume overloaded on exam but symptoms did seem improve somewhat \nwith low-dose furosemide, suggesting a least a component of \nvolume overload. He was diuresed with 20mg IV furosemide x2 \nwith improvement his dyspnea. Due to decreased PO intake at \ndischarge, he was not discharged home on standing furosemide. \nHe has f/u with his Cardiologist shortly after discharge, at \nwhich point furosemide may be started if indicated.\n\n# Dysphagia / weight loss:\nPt reports worsening dysphagia for the last few weeks to months \nbut recent endoscopy in ___ showed no masses in the \nesophagus, UGI/BAS was done here and was wnl, and laryngoscopy \ndone by ENT was negative. Speech/swallow evaluation was without \nevidence of dysphagia EGD in ___ did diagnose H. pylori, \nso in consultation with GI, decision was made to treat with \nquadruple therapy and follow-up as an outpatient for a repeat \nendoscopy. He was started on metronidazole, bismuth, \ndoxycycline, and PPI on ___, and discharged home to complete a \n2 week course on ___. He was tolerating soft solids but had \nno dietary restrictions from an aspiration standpoint.\n\n# Cystic calcified renal mass vs. RCC:\nHe was also found to have a cystic calcified renal mass vs. \nlikely RCC on CT torso, which could be a contributor to his \nweight loss as well. MRI was attempted in the inpatient setting \nbut insurance coverage was denied; PCP was contacted so that \nclose outpatient follow-up could be coordinated. \n\nCHRONIC ISSUES:\n===============\n\n#Hypertension\nContinued home regimen with lisinoipril, carvedilol, and \namlodipine \n\n#Gout\nContinued home dose of allopurinol\n\nTRANSITIONAL ISSUES:\n====================\n- Pt to f/u with his cardiologist shortly after discharge \nregarding need possible need for maintenance diuretic for HFpEF \nand moderate pulmonary HTN seen on TTE (not prescribed at \ndischarge given relative ___ and poor PO intake)\n- Pt will need outpatient MRI to f/u possible RCC seen on CTA \ntorso on admission\n- Pt will need repeat EGD a few weeks after completing quadruple \ntherapy and possibly esophageal manometry vs. video swallow eval \nif symptoms of dysphagia persist despite tx for h.pylori\n\n___ is clinically stable for discharge today. On the \nday of discharge, greater than 30 minutes were spent on the \nplanning, coordination, and communication of the discharge plan.", 'medications_prescribed': ['1. Bismuth Subsalicylate 15 mL PO QID \nLast day: ___ \nRX *bismuth subsalicylate 262 mg/15 mL 15 mL by mouth Four times \ndaily Disp #*720 Milliliter Refills:*0 ', '2. Doxycycline Hyclate 100 mg PO Q12H \nlast day: ___ \nRX *doxycycline hyclate 100 mg 1 tablet(s) by mouth twice daily \nDisp #*25 Tablet Refills:*0 ', '3. MetroNIDAZOLE 500 mg PO TID \nlast day: ___ \nRX *metronidazole 500 mg 1 tablet(s) by mouth three times daily \nDisp #*36 Tablet Refills:*0 ', '4. Ondansetron ODT 4 mg PO Q6H:PRN nausea \nRX *ondansetron 4 mg 1 tablet(s) by mouth every 6 hours Disp \n#*15 Tablet Refills:*3 ', '5. Pantoprazole 40 mg PO Q12H \ndo not stop taking until advised by your PCP \n___ *pantoprazole 40 mg 1 tablet(s) by mouth twice daily Disp \n#*60 Tablet Refills:*3 ', '6. Acetaminophen 500 mg PO BID ', '7. Allopurinol ___ mg PO DAILY ', '8. amLODIPine 10 mg PO DAILY ', '9. Aspirin 325 mg PO DAILY ', '10. Carvedilol 3.125 mg PO BID ', '11. Ciprofloxacin 0.3% Ophth Soln ___ DROP BOTH EYES 4X DAILY ', '12. Lisinopril 40 mg PO DAILY ', '13. moxifloxacin 0.5 % ophthalmic (eye) 4x daily ', '14. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP BOTH EYES QID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 91, 'gender': 'M', 'symptoms': 'Rapid afib w/ shortness of breath', 'medical_history': ['"Prolapsed mitral valve"', 'Hx of stress test which showed mild ischemia in inferior \nregion(put on Plavix for this, in setting of ASA allergy)', 'Hypertension', 'History of cluster headaches', 'History of psoriasis', 'Hyperlipidemia', 'Macular degeneration (legally blind)'], 'family_history': '- Family history of heart disease. Father deceased of lung\ncancer in his ___.', 'present_illness': '___ well known to ___ service as he was just discharged to\nhome yesterday, was found to have rapid pulse by ___ this AM. \n___\ncalled this into ___. Beta-blocker was increased. His pulse\nremained elevated despite the additional Lopressor. I spoke with\nhis daughter who is an MD- we discussed taking ___ to local\n___ to eval rhythm for likely RAF/flutter. Rhythm confirmed in\n___. BP stable. HR 120s-130s. Pt to be transferred \nto\n___ 8 for RAF control. Of note, ___ pt had right basal\nganglia hemorrhage. He is therefore not likely a candidate for\nanticoagulation.', 'medications': [{'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': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QHS', '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': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', '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': 'Finasteride', '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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'QUEtiapine Fumarate', '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}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Donepezil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Amlodipine', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', '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': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'EVERY OTHER DAY', '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': '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': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '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': '8.8', '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': '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 = 62 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': 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': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '3.5', 'valuenum': 3.5, '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37', 'valuenum': 37.0, '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': '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': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, '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': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '34.3', 'valuenum': 34.3, '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': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62.0', 'valuenum': 62.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.10', 'valuenum': 3.1, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': 'ERROR. DISREGARD PREVIOUS RESULT OF 1.0.'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '27.2', 'valuenum': 27.2, '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': '33.2', 'valuenum': 33.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, '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': '159', 'valuenum': 159.0, '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': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, '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': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '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': '138', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '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': '4.9', 'valuenum': 4.9, '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': '37.9', 'valuenum': 37.9, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', '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': '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': 156.0, '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': '2.4', 'valuenum': 2.4, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, '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 physical:\nGeneral: exhausted from being up all night w/ attempts to rate\ncontrol RAF and for diuresis d/t vol overload. \nNeurological: A/O x3 [x] non-focal [x] \nHEENT: PEERL [x] \nCardiovascular: RRR [] Irregular [x-RAF 120-130's] Murmur []\nRub [] \nRespiratory: CTA [] No resp distress [] expiratory wheezing\nbilaterally.\nGI/Abdomen: Bowel sounds present [x] Soft [x] ND [x] NT [x]\nExtremities: \nRight Upper extremity Warm [x] Edema \nLeft Upper extremity Warm [x] Edema \nRight Lower extremity Warm [x] Edema \nLeft Lower extremity Warm [x] Edema \nPulses:\nDP Right: Left:\n___ Right: Left:\nRadial Right: Left:\nSkin/Wounds: Dry [x] intact [x]\nSternal: CDI [x] no erythema or drainage []\n Sternum stable [] Prevena []\nLower extremity: Right [] Left [] CDI []\nUpper extremity: Right [] Left [] CDI []\n\nDischarge physical exam:\n24 HR Data (last updated ___ @ 1201)\n Temp: 97.2 (Tm 98.3), BP: 121/75 (92-129/52-79), HR: 81\n(79-163), RR: 12 (___), O2 sat: 96% (94-97), O2 delivery: Ra\nFluid Balance (last updated ___ @ 1305)\n Last 8 hours Total cumulative -5ml\n IN: Total 270ml, PO Amt 270ml\n OUT: Total 275ml, Urine Amt 275ml\n Last 24 hours Total cumulative -334ml\n IN: Total 1166ml, PO Amt 790ml, IV Amt Infused 376ml\n OUT: Total 1500ml, Urine Amt 1500ml\n\nPhysical Examination:\nGeneral: NAD [x] \nNeurological: A/O x3 [x] non-focal [x] \nHEENT: PEERL [x] \nCardiovascular: RRR [x] Irregular [] Murmur [] Rub [] \nRespiratory: faint bilat exp wheeze posteriorly with few\nscattered rales bilat [x] No resp distress [x]\nGI/Abdomen: Bowel sounds present [x] Soft [x] ND [x] NT [x]\nExtremities: \nRight Lower extremity Warm [x] Edema -none\nLeft Lower extremity Warm [x] Edema -none\nPulses:\nDP Right:1 Left:1\n___ Right:1 Left:1\nRadial Right:1 Left:1\nSkin/Wounds: Dry [x] intact [x]\nSternal: CDI [x] no erythema or drainage [x]\n Sternum stable [x] Prevena []", 'diagnoses': [{'icd_code': '59971', 'desc': 'Gross hematuria'}, {'icd_code': '2800', 'desc': 'Iron deficiency anemia secondary to blood loss (chronic)'}, {'icd_code': '3310', 'desc': "Alzheimer's disease"}, {'icd_code': '23875', 'desc': 'Myelodysplastic syndrome, unspecified'}, {'icd_code': '29410', 'desc': 'Dementia in conditions classified elsewhere without behavioral disturbance'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '59689', 'desc': 'Other specified disorders of bladder'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '36250', 'desc': 'Macular degeneration (senile), unspecified'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': 'V0481', 'desc': 'Need for prophylactic vaccination and inoculation against influenza'}], 'summary': '___ 04:35AM BLOOD WBC-11.0* RBC-2.88* Hgb-9.5* Hct-28.9* \nMCV-100* MCH-33.0* MCHC-32.9 RDW-14.2 RDWSD-51.3* Plt ___\n___ 04:35AM BLOOD ___ PTT-71.0* ___\n___ 04:35AM BLOOD Glucose-122* UreaN-35* Creat-1.1 Na-138 \nK-4.3 Cl-96 HCO3-29 AnGap-13\n___ 04:45AM BLOOD WBC-8.7 RBC-2.89* Hgb-9.3* Hct-29.1* \nMCV-101* MCH-32.2* MCHC-32.0 RDW-14.1 RDWSD-51.6* Plt ___\n___ 04:45AM BLOOD ___ PTT-27.9 ___\n___ 04:45AM BLOOD Glucose-94 UreaN-32* Creat-1.0 Na-140 \nK-3.9 Cl-98 HCO3-30 AnGap-12\n\n___:\nThere is no spontaneous echo contrast in the body of the left \natrium. There is mild spontaneous echo\ncontrast in the left atrial appendage. The left atrial appendage \nejection velocity is mildly depressed. No\nspontaneous echo contrast or thrombus is seen in the body of the \nright atrium/right atrial appendage. The\nright atrial appendage ejection velocity is depressed. There is \nno evidence for an atrial septal defect by\n2D/color Doppler. Overall left ventricular systolic function is \nlow normal. The right ventricle has\ndepressed free wall motion. There are no aortic arch atheroma \nwith no atheroma in the descending aorta.\nThe aortic valve leaflets (3) are mildly thickened. No masses or \nvegetations are seen on the aortic valve.\nNo abscess is seen. There is mild [1+] aortic regurgitation. \nThere is a mitral annular ring. The annular\nring is well seated and normal mean gradient (heart rate \n119bpm). No masses or vegetations are seen on\nthe mitral valve. No abscess is seen. There is no mitral valve \nstenosis. There is trivial mitral\nregurgitation. 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.\nMr. ___ underwent a MV repair on ___ had an unremarkable \npost-operative course and was discharged to home on pod#4. He \npresented to an OSH with RAF and SOB and was transferred to \n___ for further management. He rec\'d Lopressor, Amiodarone, \nand diltiazem and was unable to be rate controlled. His CXR \nrevealed volume overload and he was treated with IV Lasix and \nnebs. EP service was consulted and recommended anticoagulation \nwith subsequent ___. He was started on a heparin drip, a TEE \nwas done with no obvious clot but "smoke" was noted in the Left \natrium in a low flow state. Once anticoagulated, he was \nsuccessfully cardioverted into sinus rhythm and started on \nEliquis for ongoing anticoagulation. He was maintained on \nLopressor and amiodarone. He was successfully diuresed with IV \nLasix and once in SR and adequately diuresed his symptoms \nimproved. On HD#4 he was cleared for discharge to home with ___ \nservices. All follow up appointments were advised.'}}
|
{'final_diagnoses': ['Rapid afib w/ SOB'], 'procedures': ['This admission: ___', 'prior admission: Mitral valve repair (28mm CE ___'], 'visit_summary': 'Mr. ___ underwent a MV repair on ___ had an unremarkable \npost-operative course and was discharged to home on pod#4. He \npresented to an OSH with RAF and SOB and was transferred to \n___ for further management. He rec\'d Lopressor, Amiodarone, \nand diltiazem and was unable to be rate controlled. His CXR \nrevealed volume overload and he was treated with IV Lasix and \nnebs. EP service was consulted and recommended anticoagulation \nwith subsequent ___. He was started on a heparin drip, a TEE \nwas done with no obvious clot but "smoke" was noted in the Left \natrium in a low flow state. Once anticoagulated, he was \nsuccessfully cardioverted into sinus rhythm and started on \nEliquis for ongoing anticoagulation. He was maintained on \nLopressor and amiodarone. He was successfully diuresed with IV \nLasix and once in SR and adequately diuresed his symptoms \nimproved. On HD#4 he was cleared for discharge to home with ___ \nservices. All follow up appointments were advised.', 'medications_prescribed': ['Acetaminophen ___ mg PO Q8H:PRN Pain - Mild ', 'Albuterol Inhaler ___ PUFF IH Q6H:PRN shortness of breath \nRX *albuterol sulfate [ProAir HFA] 90 mcg ___ puffs ih q6h prn \nDisp #*1 Inhaler Refills:*1 ', 'Amiodarone 400 mg PO DAILY Duration: 7 Days \nRX *amiodarone 200 mg 2 tablet(s) by mouth daily Disp #*14 \nTablet Refills:*0 ', 'Amiodarone 200 mg PO DAILY Duration: 3 Weeks \nRX *amiodarone 200 mg 1 tablet(s) by mouth daily Disp #*21 \nTablet Refills:*1 ', 'Apixaban 5 mg PO/NG BID Rapid AFib s/p MV repair \nRX *apixaban [Eliquis] 5 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*2 ', 'Aspirin EC 81 mg PO DAILY \nRX *aspirin [Adult Aspirin Regimen] 81 mg 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*1 ', 'Furosemide 40 mg PO DAILY Duration: 7 Days \nRX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*7 Tablet \nRefills:*0 ', 'GuaiFENesin ER 1200 mg PO Q12H \nRX *guaifenesin 1,200 mg 1 tablet(s) by mouth q 12 h prn Disp \n#*60 Tablet Refills:*1 ', 'Metoprolol Succinate XL 100 mg PO DAILY \nRX *metoprolol succinate [Toprol XL] 100 mg 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*1 ', 'Omeprazole 20 mg PO DAILY \nRX *omeprazole 20 mg 1 capsule(s) by mouth daily Disp #*30 \nCapsule Refills:*1 ', 'Simvastatin 20 mg PO QPM \nRX *simvastatin 20 mg 1 tablet(s) by mouth Q ___ Disp #*30 Tablet \nRefills:*1 ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 55, 'gender': 'M', 'symptoms': 'Morbid obesity', 'medical_history': ['DMII', 'migraines', 'fatty liver', 'kidney stones'], 'family_history': 'Her family history is noted for both parents living father age \n___ with diabetes, hyperlipidemia and prostate CA; mother age ___ \nwith thyroid disorder.', 'present_illness': 'The patient is a ___ woman complaining of obesity for ___ \nyears, history of multiple diets with a maximum of 10 to \n15-pound weight loss and regain. She has been evaluated by \n___ Bariatric Program and deemed to be good candidate for \nsurgical weight loss. She has demonstrated good understanding \nof the risks, benefits and alternatives to laparoscopic gastric \nsleeve. She understood\nthe risks including perforation, leak, bleeding and understood \nthe need for possible reoperation for persistent leak or \nobstruction. She understands that this procedure is new to \nsurgery in ___.', 'medications': [{'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': 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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', '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': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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}, {'medication': 'Vitamin B Complex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '116', 'valuenum': 116.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': 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': '11', 'valuenum': 11.0, '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': 10.2, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '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': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, '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': '33.7', 'valuenum': 33.7, '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': '176', 'valuenum': 176.0, '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': '4.41', 'valuenum': 4.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '122', 'valuenum': 122.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': 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.'}], 'exams': 'CONSTITUTIONAL: Appropriate, pleasant and cooperative. \nNEURO: Alert and oriented x4, NAD.\nCARDIAC: RRR, N S1, S2, NO MRG.\nRESPIRTORY: Lungs clear to auscultate bilaterally.\nABDOMEN: Obese, soft, slightly distended, minimal tenderness. 5 \nlap incisions clean/dry/intact. Denies nausea, vomiting. \nEXTREMITIES: + Pedal pulses, warm to touch. No cyanosis, \nclubbing, edema.', 'diagnoses': [{'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}], 'summary': "___ 03:51PM BLOOD Hct-35.7*\n___ 07:25AM BLOOD Hct-34.4*\n\nKUB:\nMs. ___ was admitted to ___ on ___ to undergo an \nelective laparoscopic sleeve gastrectomy after being evaluated \nby ___ Bariatric Program and deemed to be\ngood candidate for surgical weight loss. She was evaluated by \nanaesthesia and taken to the operating room for a laparoscopic \nsleeve gastrectomy. There were no adverse events in the \noperating room; please see the operative note for details. Pt \nwas extubated, taken to the PACU until stable, then transferred \nto the ward for observation. \n.\nNeuro: The patient was fatigued post operatively and on POD1, \nhowever was feeling well by POD2. She remained alert and \noriented throughout her hospitalization; pain was initially \ncontrolled with dilaudid PCA which was switched to IV morphine, \nand later Roxicet, with good effect. \n.\nCV: The patient was noted to have several hours of tachycardia \non POD 3 related to pain, but remained stable from a \ncardiovascular standpoint otherwise; vital signs were routinely \nmonitored. \n.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \n.\nEndo: Pt was noted to have persistently elevated blood glucose \nlevels post-operative (high 200s to 344). She was treated with \nan insulin sliding scale, and ___ \nconsultation was obtained. Ms. ___ insulin regimen was \nadjusted as needed and her blood sugars continued to downtrend. \nShe was educated regarding her blood glucose levels and at the \ntime of discharge, planned to follow up with a local \nendocrinologist for further evaluation and treatment of her DM. \n.\nGI/GU/FEN: She was initially kept NPO with NGT in place. NGT was \nremoved on POD2 after an UGI study was normal without evidence \nof leak. She was transitioned to a bariatric stage 1 diet on \nPOD3, which was advanced sequentially to stage 3, and well \ntolerated. Patient's intake and output were closely monitored. \nShe will remain on a stage 3 diet until her follow up \nappointment with Dr. ___. \n.\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\n.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay; she was encouraged to get \nup and ambulate as early as possible.\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."}}
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{'final_diagnoses': ['class III morbid obesity', 'BMI 40.2', 'DM type 2', 'fatty liver'], 'procedures': ['___: s/p lap sleeve gastrectomy'], 'visit_summary': "Ms. ___ was admitted to ___ on ___ to undergo an \nelective laparoscopic sleeve gastrectomy after being evaluated \nby ___ Bariatric Program and deemed to be\ngood candidate for surgical weight loss. She was evaluated by \nanaesthesia and taken to the operating room for a laparoscopic \nsleeve gastrectomy. There were no adverse events in the \noperating room; please see the operative note for details. Pt \nwas extubated, taken to the PACU until stable, then transferred \nto the ward for observation. \n.\nNeuro: The patient was fatigued post operatively and on POD1, \nhowever was feeling well by POD2. She remained alert and \noriented throughout her hospitalization; pain was initially \ncontrolled with dilaudid PCA which was switched to IV morphine, \nand later Roxicet, with good effect. \n.\nCV: The patient was noted to have several hours of tachycardia \non POD 3 related to pain, but remained stable from a \ncardiovascular standpoint otherwise; vital signs were routinely \nmonitored. \n.\nPulmonary: The patient remained stable from a pulmonary \nstandpoint; vital signs were routinely monitored. Good pulmonary \ntoilet, early ambulation and incentive spirometry were \nencouraged throughout hospitalization. \n.\nEndo: Pt was noted to have persistently elevated blood glucose \nlevels post-operative (high 200s to 344). She was treated with \nan insulin sliding scale, and ___ \nconsultation was obtained. Ms. ___ insulin regimen was \nadjusted as needed and her blood sugars continued to downtrend. \nShe was educated regarding her blood glucose levels and at the \ntime of discharge, planned to follow up with a local \nendocrinologist for further evaluation and treatment of her DM. \n.\nGI/GU/FEN: She was initially kept NPO with NGT in place. NGT was \nremoved on POD2 after an UGI study was normal without evidence \nof leak. She was transitioned to a bariatric stage 1 diet on \nPOD3, which was advanced sequentially to stage 3, and well \ntolerated. Patient's intake and output were closely monitored. \nShe will remain on a stage 3 diet until her follow up \nappointment with Dr. ___. \n.\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\n.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay; she was encouraged to get \nup and ambulate as early as possible.\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': ['insulin glargine [Lantus Solostar]', '52 units nightly nr insulin lispro [Humalog]', '100 unit/mL Cartridge', 'Cyanocobalamin (vitamin B-12) 1,000 mcg Tablet, Sublingual 3 \ntime weekly', 'Multivitamin with minerals Tablet once a day Recorded Only \n___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 77, 'gender': 'F', 'symptoms': 'diarrhea, hot flashes', 'medical_history': ['ONCOLOGIC HISTORY: (per OMR)\n1. Stage I nonsmall cell lung cancer (predominant histology:\nlarge cell carcinoma with neuroendocrine features) in \n___', '2. Stage I nonsmall cell lung cancer (adenocarcinoma with\nbronchioloalveolar features) in ___', '3. Stage IV nonsmall cell lung cancer (large cell carcinoma with\nneuroendocrine features) in ___ with liver metastasis\n(liver biopsy from ___ shows adenocarcinoma/large cell\ncarcinoma).', 'Treatment:\n1. Status post right lower lobe lobectomy on ___', '2. Status post left upper lobe lobectomy on ___', '3. Status post 4 cycles of carboplatin 6->4.5 AUC, paclitaxel \n200-> 180 mg/m2, bevacizumab 15 mg/kg. As part of clinical trial\n___ ___ with anamorelin HCl/placebo. Last dose ___.', '4. Status post 3 cycles of erlotinib 150 mg/day and ARQ\n197/placebo. Part of ___ ___. Started on ___. Off\ntreatment ___ due to disease progression.', '5. Status post 2 cycles of carboplatin 3 AUC D1 and etoposide\n80mg/m2 IV D1-3. Last dose on ___.', '6. Status post 6 cycles of pemetrexed 500 mg/m2. Last dose on\n___.', '7. Status post 1 cycle of gemcitabine 1000 mg/m2 D1, D8, D15 and\noral V1 inhibitor as part of phase I clinical trial ___ \n___. Last dose on ___.', 'OTHER MEDICAL HISTORY:\n# History of shingles diagnosed in ___.\n# History of recurrent pneumonia in ___ and\n___.\n# Osteoporosis of the spine diagnosed on bone mineral density\ntesting in addition to osteopenia of the femoral neck and hip\n# Mild pulmonary hypertension: R heart cath in late ___\nshowed normal left and right sided filling presures with an \nLVEDP\nof 6mmHg and RVEDP of 8mmHg. There was mild pulmonary\nhypertension with a PASP of 40mmHg. There was normal estimated\ncardiac index by Fick of 2.96 L/min/m2.'], 'family_history': 'Sister died from lung cancer.', 'present_illness': '___ woman with stage IV NSCLC not currently on chemo\npresents with several months of intermittent facial flushing and\nwarmth, diaphoresis, palpitations--lasting less than one\nhour--followed by diarrhea--lasting hours to 1 or 2 days--with\nepigastric abdominal pain. These symptoms usually happen a few\ntimes a week but at times on consecutive days for a few days in \na\nrow. The diarrhea is watery, nonbloody. She has been losing\nweight. Denies heat intolerance. No history of thyroid problems.\nDenies muscle rigidity. No SSRI. No sick contact or recent\ntravel.\n\nIn ___, when she was still on cancer treatment with a clinical\ntrial with oral V1 inhibitor, her diarrhea and facial flush were\nreportedly attributed to side effects from the study drug. \n\nPatient was most recently hospitalized in late ___ for diarrhea that then resolved without a cause\nbeing found. At that time she was also diagnosed with pulmonary\nhypertension.\n\nDespite multiple repeated questions via the interpreter, it is\nunclear why patient decided to re-present today.\n\nIn the ___ ED, T 99.9, HR 96, BP 123/56, RR 24, 97%. Torso CT\nrevealed known lobectomy and liver mets with any new acute\nprocess. Her ECG showed sinus rhythm without any acute ischemia\nchange. She was admitted for further work-up.', 'medications': [{'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': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Senna', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'Q 8H', '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': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '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': '87', 'valuenum': 87.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, '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': '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 = 48 if non African-American (mL/min/1.73 m2). Estimated GFR = 58 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': 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': 151.0, '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': '4.3', 'valuenum': 4.3, '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': '127', 'valuenum': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': 'POSITIVE TRICYCLIC RESULTS REPRESENT POTENTIALLY TOXIC LEVELS;THERAPEUTIC TRICYCLIC LEVELS WILL TYPICALLY HAVE NEGATIVE RESULTS.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '38.3', 'valuenum': 38.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.2', 'valuenum': 34.2, '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': '9', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': 'NORMAL.'}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, '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': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', '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': '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': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', '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': 'MOD.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, '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': '7', 'valuenum': 7.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '195', 'valuenum': 195.0, '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': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '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': 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': '254', 'valuenum': 254.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, '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': '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': '130', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '16', 'valuenum': 16.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '127', 'valuenum': 127.0, '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': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, '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': '33.7', 'valuenum': 33.7, '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': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': 0.4, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '15.8', 'valuenum': 15.8, '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': '34.3', 'valuenum': 34.3, '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': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '74.5', 'valuenum': 74.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '196', 'valuenum': 196.0, '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': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, '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': '126', 'valuenum': 126.0, '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': '59', 'valuenum': 59.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '186', 'valuenum': 186.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, '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': '208', 'valuenum': 208.0, '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': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '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': '8.8', 'valuenum': 8.8, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '___', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'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': '134', 'valuenum': 134.0, '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': 'VS: T 99.6, HR 98, BP 121/59, RR 20, 98%RA\nPain: none currently\nECOG performance status: 1\nGEN: Elderly woman in NAD, awake, alert\nHEENT: EOMI, sclera anicteric, conjunctivae clear, OP moist and\nwithout lesion\nNECK: Supple, no JVD\nCV: Reg rate, normal S1, S2. ___ systolic murmur with carotid \nm/r/g.\nCHEST: Resp unlabored, no accessory muscle use. CTAB, no\ncrackles, wheezes or rhonchi.\nABD: Soft, NT, ND, no HSM, bowel sounds present\nMSK: normal muscle tone and bulk\nEXT: No c/c/e, 2+ ___ bilaterally\nSKIN: No rash, warm skin\nNEURO: oriented x 3, normal attention, CN II-XII intact, ___\nstrength throughout, intact sensation to light touch, normal\nreflexes throughout\nPSYCH: appropriate, pleasant\nLYMPH: no cervical, axillary, inguinal LAD', 'diagnoses': [{'icd_code': '34839', 'desc': 'Other encephalopathy'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '56039', 'desc': 'Other impaction of intestine'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '7244', 'desc': 'Thoracic or lumbosacral neuritis or radiculitis, unspecified'}, {'icd_code': '70402', 'desc': 'Telogen effluvium'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V4364'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '5859', 'desc': 'Chronic kidney disease, unspecified'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'E9358', 'desc': 'Other specified analgesics and antipyretics causing adverse effects in therapeutic use'}], 'summary': "ADMISSION LABORATORY STUDIES:\n\n139 | 107 | 18\n--------------< \n3.4 21 1.0 \n\nCa: 10.2 Mg: 1.9 P: 3.9\nALT: 48 AP: 136 Tbili: 0.3 AST: 52 Lip: 137 \n\n7.8 >------< 356 \n 37.9 \nN:69.3 L:21.2 M:9.1 E:0.2 Bas:0.2 \n\n___: 12.1 PTT: 24.4 INR: 1.0 \n \nOTHER NOTABLE STUDIES:\n - ___:00PM BLOOD TSH-3.2\n - ___ 04:20PM BLOOD SEROTONIN-Pending\n - ___ 04:20PM BLOOD CHROMOGRANIN A-Pending\n - ___ 12:15AM URINE Blood-MOD Nitrite-NEG Protein-300 \nGlucose-70 Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-LG \nColor-AMBER Appear-Cloudy Sp ___ RBC-347* WBC-328* \nBacteri-NONE Yeast-NONE Epi-1\n - ___ 12:02AM 24 HOUR URINE COLLECTION FOR 5-HIAA-PENDING\n\nIMAGING:\n___ CT CHEST: The visualized portion of the thyroid \nappears unremarkable. There is no axillary, hilar, or \nmediastinal lymphadenopathy. Within the limits of a non-contrast \nstudy, the heart and great vessels appear normal. Dense linear \nsuture material in the bilateral hila is compatible with \npatient's known history of bilateral upper lobectomies. The \nremaining lungs are clear. There is no pericardial effusion. A \nsmall pleural effusion is seen on the right without appreciable \natelectasis.\n\n___ CT ABDOMEN: Large hypodense lesions are seen \nthroughout the liver, the largest of which is seen in the right \nlobe, measures 9 x 8 cm (2; 50) compatible with the patient's \nknown history of metastatic disease. The gallbladder shows no \nstones. The spleen is normal in size and appearance. The \npancreas shows no duct dilatation or masses. The adrenal glands \nshow no nodules. The kidneys show no evidence of hydronephrosis \nor stones. Small and large intestines show no signs of \nobstruction. Liquid stool is seen throughout the colon. There is \nno lymphadenopathy, free air, or free fluid. A small left lung \nherniation is \nstable compared to prior study (2; 27). PELVIS: The bladder is \ndecompressed around a Foley. The uterus and rectum appear \nunremarkable. BONES: Focal area of sclerosis in the right fourth \nrib is stable compared to prior study (3001B; 17). There is no \nevidence of fracture. \nMs. ___ was admitted for evaluation of several months of \nintermittent facial flushing, diaphoresis, palpitations, and \ndiarrhea. Her symptoms were suggestive of\ncarcinoid syndrome. Her lung cancer biopsies describe \nneuroendocrine features but carcinoid syndrome is not typically \nassociated with NSCLC.\n\nShe was admitted for observation and started on octreotide \ninjections. On the first day of admission she had multiple \nepisodes of symptoms. The palpitations were correlated with \nepisodes of sinus tachycardia on telemetry. No other arrhythmias \nwere observed. By the second hospital day her symptoms largely \nresolved including no further episodes of diarrhea.\n\nThe following evaluation was sent to evaluate for carcinoid \nsyndrome and was pending at discharge: serotonin level, \nchromogranin A level, and 24-hour urine collection for 5-HIAA. \nShe will follow-up with her oncologist, Dr. ___ \n___, in the week following discharge to discuss the \nresults and other management options.\n\nHer hospital course was complicated by a Foley \ncatheter-associated UTI. The Foley was placed in the ED and \nutilized for the 24-hour urine collection as she has urinary \nincontinence. She had a temperature of 100.0 degrees F the night \nprior to discharge and had a urine culture revealed gram \nnegative rods (speciation and sensitivities pending; this will \nbe followed up the discharging hospitalist). Her exam at \ndischarge was normal including no flank pain or suprapubic \ntenderness. She received 1 dose of ceftriaxone in the hospital \nand was discharged on 7 days of Bactrim.\n\nNo other changes were made to her medical regimen other than \nthat described above."}}
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{'final_diagnoses': ['Non-small cell lung cancer', 'Bacterial urinary tract infection'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ was admitted for evaluation of several months of \nintermittent facial flushing, diaphoresis, palpitations, and \ndiarrhea. Her symptoms were suggestive of\ncarcinoid syndrome. Her lung cancer biopsies describe \nneuroendocrine features but carcinoid syndrome is not typically \nassociated with NSCLC.\n\nShe was admitted for observation and started on octreotide \ninjections. On the first day of admission she had multiple \nepisodes of symptoms. The palpitations were correlated with \nepisodes of sinus tachycardia on telemetry. No other arrhythmias \nwere observed. By the second hospital day her symptoms largely \nresolved including no further episodes of diarrhea.\n\nThe following evaluation was sent to evaluate for carcinoid \nsyndrome and was pending at discharge: serotonin level, \nchromogranin A level, and 24-hour urine collection for 5-HIAA. \nShe will follow-up with her oncologist, Dr. ___ \n___, in the week following discharge to discuss the \nresults and other management options.\n\nHer hospital course was complicated by a Foley \ncatheter-associated UTI. The Foley was placed in the ED and \nutilized for the 24-hour urine collection as she has urinary \nincontinence. She had a temperature of 100.0 degrees F the night \nprior to discharge and had a urine culture revealed gram \nnegative rods (speciation and sensitivities pending; this will \nbe followed up the discharging hospitalist). Her exam at \ndischarge was normal including no flank pain or suprapubic \ntenderness. She received 1 dose of ceftriaxone in the hospital \nand was discharged on 7 days of Bactrim.\n\nNo other changes were made to her medical regimen other than \nthat described above.', 'medications_prescribed': ['1. octreotide acetate 50 mcg/mL Solution Sig: Fifty (50) \nmicrograms Injection Q8H (every 8 hours).\nDisp:*2 week supply* Refills:*2*', '2. Ativan 0.5 mg Tablet Sig: ___ Tablets PO at bedtime as needed \nfor insomnia or anxiety. ', '3. prochlorperazine maleate 5 mg Tablet Sig: One (1) Tablet PO \ntwice a day as needed for nasuea around chemotherapy doses. ', '4. acetaminophen 500 mg Tablet Sig: One (1) Tablet PO twice a \nday as needed for after chemotherapy. ', '5. Ensure Liquid Sig: One (1) can PO twice a day. ', '6. multivitamin Tablet Sig: One (1) Tablet PO once a day. ', '7. Bactrim DS 800-160 mg Tablet Sig: One (1) Tablet PO twice a \nday for 7 days.\nDisp:*14 Tablet(s)* Refills:*0*', '8. syringe (disposable) 3 mL Syringe Sig: One (1) syringe \nMiscellaneous three times a day for 2 weeks: for octreotide \ninjections.\nDisp:*2 week supply* Refills:*0*', '9. insulin needles (disposable) Needle Sig: One (1) needle \nMiscellaneous three times a day for 2 weeks: for use with 3cc \nsyringe for octreotide injections.\nDisp:*2 week supply* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 61, 'gender': 'M', 'symptoms': 'New-onset seizures', 'medical_history': ['HTN', '___ disease s/p surgical anastomosis (___)', 'chronic renal failure not on HD', 'GERD', 'anemia', 'gout, crystal-proven per patient report', 'history of diverticulitis (___)', 'osteoporosis'], 'family_history': 'Multiple family members with ___. No known family history \nof stroke or seizure.', 'present_illness': "per Dr. ___ note:\n___ is a ___ year-old woman with CKD not on HD \n(baseline Cr ___ ___ disease s/p surgical anastomosis, HTN, \nrecently admitted to Medicine ___ for uremia now \ntransferred from ___ intubated after she presented there \nwith new-onset seizures.\n\nAt baseline she lives at home with her husband, is fairly \nindependent aside from ambulating with a walker. No history of \nprior seizures. She was in her usual state of health this \nmorning, then around 1PM complained to her daughter (who was \nvisiting) that she had a severe right sided HA. There was no \nphoto/phonophobia, nausea, vision change or weakness. The \npatient's daughter left the patient for some time, then returned \naround 4PM. The headache continued and the patient complained \nthat she felt dehydrated. There was no change in speech or \nlevel of arousal at this point. Around 4:30PM however, she \ndeveloped bilateral arm flexion-convulsions with \nunresponsiveness. This progressed after 1 minute to foaming at \nthe mouth with eyes rolling to the back of her head. She may \nhave been turning onto her right side, but this is the only \nfocality noted. EMS was alerted with time of arrival within 10 \nminutes, the event had subsided. \n\nShe presented initially to ___ and reportedly had return \nof baseline consciousness, although was drowsy. She was \nconversant with her daughter, moving all extremities and \nfollowing commands. She was sent for urgent CT head to exclude \nstroke and records indicate she had a second seizure in the CT \nscan, likely generalized (unclear exact duration). She was \ngiven 2mg Ativan, then intubated for airway protection and \nconcern for status epilepticus. CT showed hyperdensity in the \nright temporal lobe that was inconclusive for SAH versus \nartifact and she was triaged to ___. On arrival here urgent \nrepeat CT showed no evidence of bleed and Neurology was \nconsulted for management of seizure. \n\nOf note, Ms. ___ was recently on the Medicine Service last \nweek with lethargy and elevated creatinine consistent with \nuremia (Cr 6.5) secondary to progression of underlying renal \ndisease. She was seen by Renal consult and considered for urgent \nHD which was ultimately deferred. She was treated with IVF, and \ncreatinine improved to 4.3 upon discharge with return of \nbaseline mental status.\n \nUnable to obtain detailed ROS due to mental status", 'medications': [{'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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: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': 'Gabapentin', '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', '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': 'Diazepam', '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': 'Discontinued via patient discharge', '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': 'Pravastatin', '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 via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Doxycycline Hyclate', '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': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, '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': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.4', 'valuenum': 10.4, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '53', 'valuenum': 53.0, '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '106', 'valuenum': 106.0, '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 148.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '580', 'valuenum': 580.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/9 .', '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': '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': '25.4', 'valuenum': 25.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, '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': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '212', 'valuenum': 212.0, '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': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, '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': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, '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': '229', 'valuenum': 229.0, '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': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '249', 'valuenum': 249.0, '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': '3.59', 'valuenum': 3.59, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '10.4', 'valuenum': 10.4, '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': '33.9', 'valuenum': 33.9, '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': '270', 'valuenum': 270.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '10.5', 'valuenum': 10.5, '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': '34.1', 'valuenum': 34.1, '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': '321', 'valuenum': 321.0, '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': '3.34', 'valuenum': 3.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM (___):\nVitals: 82, 162/88, 17, 100% \nGeneral: intubated, sedated. \nHEENT: NC/AT, no scleral icterus noted, + ET tube\nNeck: Some stiffness on attempted flexion, no carotid bruits\nPulmonary: Lungs CTA bilaterally without R/R/W\nCardiac: RRR, nl. S1S2, no M/R/G noted\nAbdomen: soft, NT/ND, normoactive bowel sounds, no masses or\norganomegaly noted.\nExtremities: No C/C/E bilaterally, 2+ radial, DP pulses \nbilaterally.\nSkin: no rashes or lesions noted.\n\nNeurologic: (off propafol 5 minutes)\n-Mental Status: intubated, sedated. No response to sternal rub \ninitially, after 5 minutes she moves both arms and grimaces to \nsternal rub. Moves RUE to grab tube. Not opening eyes or \nfollowing commands. \n \n-Cranial Nerves:\nII: PERRL 2.5-->2mm reactive. Poor BTT bilaterally \nIII, IV, VI: No spontaneous eye movement, +VOR with slow \nrecovery phase\nV: +corneals bilaterally\nVII: Facial musculature symmetric.\nIX, X: No cough/gag\nXII: Tongue +bite marks, dried blood, in midline.\n\n-Motor: Normal bulk, increased tone bilaterally.\nMoves RUE>LUE spontaneous antigravity but withdraws both equally \nto painful stim. Bilateral ___ brisk withdrawal to pain.\n\n-DTRs:\n Bi Tri ___ Pat Ach\nL 3 3 3 3 1\nR 3 3 3 3 1\nPlantar response was withdrawal bilaterally.\n\nTRANSFER OUT OF ICU EXAM (___):\nGeneral: Awake, pale, chronically ill-appearing \nHEENT: NC/AT, no scleral icterus noted, +conjunctival pallor, \n+EEG leads\nNeck: Supple \nPulmonary: Lungs CTA bilaterally \nCardiac: RRR \nAbdomen: soft, NT/ND, nl BS\nExtremities: +1 pitting edema at ankles bilaterally, +asterixis\nSkin: No rashes\nGU: +Foley \n\nNeurologic: \n-Mental Status: Alert and awake. Oriented to person and place, \nbut not time. Able to follow simple commands. Mild left-right \nagnosia. Able to repeat. Decreased attention. \n-Cranial Nerves:\nPERRL 3->2mm, EOMI, face symmetric, tongue midline\n-Motor: Decreased bulk, normal tone. Deltoids 5- bilaterally. R \nTriceps 5, L triceps 4+. B/L biceps 4+. B/L wrist extension 4+. \nB/L IP 2. B/L quads 4+. R gastroc 4. L gastroc 4+. B/L TA 4+.\n-Sensory: Intact to light touch in lower extremities \nbilaterally.\n-DTRs:\n Bi Tri ___ Pat Ach\nL 3 3 3 3 1\nR 3 3 3 3 1\nPlantar response was withdrawal bilaterally.\n\nDISCHARGE EXAM:\nVitals: 98.7/97.5; 145/68 (90-150/50-60) 86 (80-90) 18 97% RA\nI/Os: -600cc since midnight\nWeight: 51.9 kg <-- 52.3 kg (standing) <--55.7 kg (bed) <--58.1 \nkg (b) <--59.6 kg <---58.2 kg (___\nGeneral: Pleasant, sitting up, conversive, no acute distress. \nA+Ox3.\nHEENT: EOMI,PERRL. Oropharynx clear, without exudates. MM dry. \nJVD flat\nCV: Regular rate and rhythm. Normal S1/S2. No MRG. \nChest: Mild fine crackles present bilteral bases with good \nrespiratory effort. Pain in lower right chest on deep \ninspiration and cough.\nAbdomen: Soft, non tender, non distended. Negative ___ \nsign. +BS.\nSkin: Numerous ecchymoses on forearms and base of anterior neck \n \nExt: Warm, well perfused, with 2+ pulses bilaterally. R>L foot \ngreater warmth and tenderness to palpation. Dorsum of right foot \nwith light erythema that disappears with leg raise. Some \ntenderness in right ___ toe. Minimal edema b/l feet.\nNeurologic: Grossly intact. AAOx3.', 'diagnoses': [{'icd_code': '7213', 'desc': 'Lumbosacral spondylosis without myelopathy'}, {'icd_code': '99649', 'desc': 'Other mechanical complication of other internal orthopedic device, implant, and graft'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '99675', 'desc': 'Other complications due to nervous system device, implant, and graft'}, {'icd_code': 'E8781', 'desc': 'Surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation'}, {'icd_code': 'V454'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}, {'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': '28529', 'desc': 'Anemia of other chronic disease'}, {'icd_code': 'V4364'}], 'summary': '=======\nLABS\n=======\n\nAdmission Labs:\n___ 12:24AM BLOOD WBC-9.7# RBC-2.35* Hgb-7.2* Hct-21.3* \nMCV-91 MCH-30.5 MCHC-33.6 RDW-15.8* Plt Ct-79*\n___ 12:24AM BLOOD ___ PTT-22.8* ___\n___ 08:15AM BLOOD Ret Aut-1.2\n___ 12:24AM BLOOD Glucose-140* UreaN-34* Creat-3.3* Na-145 \nK-3.8 Cl-115* HCO3-21* AnGap-13\n___ 12:24AM BLOOD ALT-23 AST-28 LD(LDH)-330* AlkPhos-37 \nTotBili-0.4\n___ 12:24AM BLOOD Albumin-2.7* Calcium-6.1* Phos-2.7# \nMg-1.1* Cholest-107\n___ 08:15AM BLOOD calTIBC-191* VitB12-284 Folate-11.1 \nFerritn-428* TRF-147*\n___ 12:24AM BLOOD Triglyc-136 HDL-40 CHOL/HD-2.7 LDLcalc-40\n___ 08:08PM BLOOD Glucose-123* Lactate-1.2 Na-143 K-3.6 \nCl-113*\n___ 06:03AM BLOOD Phenyto-11.5\n\nPertinent Labs:\n___ 08:15AM BLOOD Ret Aut-1.2\n___ 09:10PM BLOOD CK-MB-4 cTropnT-0.17*\n___ 11:36AM BLOOD CK-MB-7 cTropnT-0.21*\n___ 12:24AM BLOOD CK-MB-6 cTropnT-0.39*\n___ 12:24AM BLOOD TSH-2.7\n___ 12:24AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 12:24AM BLOOD Triglyc-136 HDL-40 CHOL/HD-2.7 LDLcalc-40\n\nDischarge Labs:\n___ 08:00AM BLOOD WBC-3.7* RBC-2.27* Hgb-7.1* Hct-22.5* \nMCV-99* MCH-31.1 MCHC-31.5 RDW-15.5 Plt ___\n___ 08:00AM BLOOD Glucose-88 UreaN-47* Creat-4.3* Na-145 \nK-3.6 Cl-104 HCO3-27 AnGap-18\n___ 08:00AM BLOOD ALT-28 AST-38 AlkPhos-106* TotBili-0.3\n___ 08:00AM BLOOD Albumin-3.0* Calcium-8.1* Phos-4.3 Mg-1.7\n___ 08:00AM BLOOD Phenyto-1.0*\n\n===========\nIMAGING\n===========\nNCHCT (___):\nNo evidence of intracranial hemorrhage. Mild volume loss and \nsequela of \nchronic small vessel ischemic disease. \n\nMRI HEAD WITHOUT CONTRAST (___):\nNo focal lesions identified. Volume loss and findings of \nextensive chronic small vessel ischemic disease. \n\nEKG ___: Sinus rhythm with atrial premature beats. Poor R wave \nprogression, likely a normal variant but cannot exclude prior \nanterior wall myocardial infarction. Q-T interval cannot be \ncalculated since T waves are flattened thnroughout. Compared to \nthe previous tracing of ___ unclear if Q-T interval is \nprolonged. Diffuse T wave flattening. The rate has increased. \n \nCXR ___: Since ___, the patient has been \nextubated. Mild cardiomegaly is accompanied by pulmonary \nvascular congestion and a new mild to moderate pulmonary edema. \nSmall left pleural effusion has slightly increased insize, and a \nsmall right pleural effusion is new. \n\nECHO ___: The left atrium and right atrium are normal in \ncavity size. The estimated right atrial pressure is ___ mmHg. \nThere is mild symmetric left ventricular hypertrophy with normal \ncavity size. There is mild regional left ventricular systolic \ndysfunction with severe hypokinesis of the mid portion of the \ninferior septum, inferior, and inferolateral walls.. The \nremaining segments contract normally (LVEF = 45 %). The \nestimated cardiac index is normal (>=2.5L/min/m2). Right \nventricular chamber size and free wall motion are normal. The \ndiameters of aorta at the sinus, ascending and arch levels are \nnormal. The aortic valve leaflets (3) are mildly thickened but \naortic stenosis is not present. No aortic regurgitation is seen. \nThe mitral valve appears structurally normal with trivial mitral \nregurgitation. There is no mitral valve prolapse. There is \nmoderate pulmonary artery systolic hypertension. There is no \npericardial effusion. \nIMPRESSION: Normal left ventricular cavity size with mild \nregional systolic dysfunction in an atypical distribution \nsuggesting focal myocarditis or Takotsubo cardiomyopathy.\nIf clinically indicated, a cardiac MRI may be useful to confirm \nthe regional dysfunction and to determine the cause. \n\nCXR ___: In comparison with the study of ___, there is \nagain mild enlargement \nof the cardiac silhouette. There is persistent pulmonary \nvascular congestion with pulmonary edema, which may be slightly \nimproved compared to the previous study. Bilateral pleural \neffusions with compressive atelectasis are again seen. \n\nCXR ___: \nFINDINGS: \nModerate bilateral pleural effusions persist. Prominence of the \npulmonary vasculature appears improved. The heart and \nmediastinal structures are unchanged.\nIMPRESSION:\nEvidence for interval improvement in pulmonary vascular \ncongestion. \n\nRIB Film + AP Chest ___: \nFINDINGS: \nMarkers are seen adjacent to the right lower ribs. There is a \nnondisplaced fracture of the right seventh anterior rib. No \npneumothorax is appreciated. Bilateral pleural effusions are \ndecreased in size. The cardiomediastinal silhouette is normal. \nThere is mild vascular congestion but no CHF.\nIMPRESSION:\nNondisplaced right seventh anterior rib fracture. \n\n===========\nMicro:\n===========\n___ 12:21 am URINE Source: Catheter. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: NO GROWTH. \n\n___ 12:22 am SPUTUM Source: Endotracheal. \n\n **FINAL REPORT ___\n\n GRAM STAIN (Final ___: \n <10 PMNs and >10 epithelial cells/100X field. \n Gram stain indicates extensive contamination with upper \nrespiratory\n secretions. Bacterial culture results are invalid. \n PLEASE SUBMIT ANOTHER SPECIMEN. \n\nTime Taken Not Noted Log-In Date/Time: ___ 12:47 am\n BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\n RESPIRATORY CULTURE (Final ___: \n TEST CANCELLED, PATIENT CREDITED.\n___ is a ___ year-old woman with past medical history \nsignificant for chronic kidney disease not on \nhemodialysis(baseline Cr ___ and recent hospital admission \n___ for uremia who was transferred to ___ ED ___ \nafter presenting to an OSH with two new-onset GTC seizures where \nshe was emergently intubated for airway protection. She was \nloaded with phenytoin 20mg/kg. She was admitted to the \nneurologic ICU for further management. Patient was eventually \ntransferred to the floor to the General Medical Service and \nremained seizure free throughout the rest of her stay.\n\n# NEUROLOGY - seizure\nWhile in the neurologic ICU, pt was monitored on continuous \nvideo EEG and seizure precautions. EEG showed only generalized \nslowing and no electrographic seizures or epileptiform \ndischarges. Pt also did not have any clinical seizures. \nPost-dilantin load level was in the ___ so the dilantin \nmaintenance dose was started at 100mg BID. MRI brain did not \nshow any lesions but did show volume loss and findings of \nextensive chronic small vessel ischemic disease which could \npredispose for seizures. Family decline a lumbar puncture to \nassess for any underlying meningitis or encephalitis. Dilantin \nlater changed to 100 mg ER daily, but transitioned to Keppra 250 \nBID by discharge as Dilantin levels remained lowered throughout \nstay. The Keppra dose can be increased if patient develops \nbreakthrough seizure. She will follow-up with Neurology\n\n# CARDIOVASCULAR - acute systolic heart failure / stress \ncardiomyopathy / ___\'s cardiomyopathy\nPt was found to have a minor troponin elevation that peaked at \n0.4 and then trended down. Findings were attributed to demand \nischemia in the setting of seizure and CKD. Pt was monitored on \ntelemetry. Patient arrived to ICU on BiPAP in the setting of \nflash pulmonary edema. Had already recieved 40mg IV lasix on the \nfloor, and had put out 600cc by the time she arrived to the ICU \nand was quickly weaned to 3L NC. Given two episodes of flash \npulmonary edema with no prior history of heart failure, an \nechocardiogram was obtained. It showed an EF of 45% with an \natypical LV wall motion abnormality most consistent with \nTakosubo vs focal myocarditis. She was transitioned from \nlabetolol to metoprolol to optimize mangement of heart failure. \nShe recieved ___ IV Lasix daily, she was not transitioned to \nPO at the time of transfer from ICU. Patient had an additional \nepisode of desaturation to the 70\'s on ___. Repeat CXR \nshowed increased pulmonary edema, and patient was diuresed with \nLasix. Cardiology was consulted and recommended transition to PO \nlasix 40 mg PO every other day, carvedilol 3.125 mg BID, \nhydralazine 30 mg PO TID, and isosorbide dinitrate 30 mg TID. \nHydralazine decreased to 10 mg PO TID and isosorbide dinitrite \ndecreased to 10 mg PO TID after hypotensive episode. Lasix held \nafter patient appeared euvolemic ___ with stable BP. Dry weight \n51.9 kg. ACEi was not started for heart failure due to \nunderlying CKD / elevated creatinine.\n\n# HEMATOLOGY: \nPt with anemia and thrombocytopenia while in the hospital. \nAnemia was attributed to a combination of anemia of chronic \ndisease and renal disease. Patient declined transfusion until \nend of stay, when counts stabilized. Discharged with iron \nsupplementation per Renal recommendations.\n \n# RENAL: \nCreatinine was at baseline (around 3.4) at presentation; \nhowever, pt did exhibit signs of uremia including asterixis and \nencephalopathy. Seizure may have also been related to uremia. \nRenal was consulted to guide management. Pt was continued on \nhome sodium bicarbonate while in the hospital, but this was \ndiscontinued when a contraction alkalosis occurred in the \nsetting of diuresis. Creatinine trended up through admission and \nreached new 4.3 which may be new baseline. Renal consult service \noffered HD but patient declined, which has been consistent with \npatient\'s previous wishes.\n\n# Hypernatremia: Pt also became hypernatremic during hospital \nstay and was started on IV D5W for free water repletion. Her \nsodium gradually normalized and remained normal upon discharge.\n\n# Code status: Shortly after extubation, there were extensive \ndiscussion between patient\'s family members regarding her code \nstatus. On transfer from the MICU, she was DNR/DNI. However, on \n___, patient was made CMO in the setting of her acute SOB. The \nnext morning, patient reiterated that she "wanted to live" and \nthat she wanted aggressive management of her code status. As \nsuch, her code status was revised to DNR/DNI. Extensive code \nstatus discussion was had with family and patient throughout ICU \nstay; patient remained DNR/DNI, and she did not want any \naggresive interventions (including blood products), but was OK \nwith medical care. Palliative care consulted and repeat family \nmeeting occurred with confirmation of DNR/DNI but okay for \ninterventions up to that need, refusal to pursue hemodialysis, \nand resistance to blood transfusion unless absolutely necessary.\n\n# Rib fracture: patient complaining of inspiratory right sided \nchest pain for days with some tenderness in the area. rib film \nshowed non-displaced fracture of 7th rib on day of discharge. \nTreated with pain control.\n\n# Right foot pain: Complaining of R foot pain ___. Dorsum \nof foot with erythema confluent to ___ toe on right, with right \nfoot tenderness and warmth on dorsum. Swelling and erythema \ninitially thought to be ___ to compression stocking choking. \nSymptoms waxed and waned based on edema, foot was more red when \nedematous, less red when more euvolemic. Thought to be gout with \nsuperimposed venous stasis leading to erythema in the setting of \ndiuresis. Pt was afebrile, no leukocytosis, and erythema \ndiminished with elevation of leg so thought less likely to be \ncellulitis. Gout also a likely diagnosis, as patient reports \nrecent diagnosis of gout and in the setting of aggressive \ndiuresis, gout flare can be precipitated. Furthermore, she \nreported that her pain was similar to previous gout flare. Did \nnot give indomethacin or colchicine given CKD. Her symptoms \nwere mild and resolved quickly, so no prednisone given. Did not \ngive antibiotics, avoided NSAIDs because of kidney function, and \ndeferred prednisone treatment per patient request as it did not \nbother her that much. Consider allopurinol for uric acid \ncontrol for gout prevention.\n\nTransitional Issues:\n- pt with low vit d, high PTH, borderline low calcium, will need \nvitamin d supplementation/titration as outpatient\n- daily weights, diurese starting at 20mg Lasix PO if weight \nincrease >3 lbs overnight\n- f/u cbc, creatinine, trend alk phos\n- held ace inhibitor in setting of renal impairment\n- renal, cardiology, neurology f/u\n- neurology may titrate her Keppra dose\n- no driving for 6 months, no swimming, bathing, cooking, \nclimbing without supervision\n- evaluate chem 7 for resumption of bicarb tabs\n- evaluate cardiac meds for change to long acting agents\n- discuss need for persistent cholestyramine\n- please monitor for constipation given that we started iron \nsupplementation on discharge\n- please monitor for splinting and rib pain given her rib \nfracture\n- consider starting allopurinol\n# Dry weight 51.9 kg'}}
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{'final_diagnoses': ['Non-ischemic cardiomyopathy', 'Congestive Heart Failure', 'Rib fracture', 'Generalized tonic-clonic seizure', 'Acute on chronic kidney failure', 'Anemia', 'Hypertension', 'Gout'], 'procedures': ['Intubation', 'Long term EEG monitoring'], 'visit_summary': '___ is a ___ year-old woman with past medical history \nsignificant for chronic kidney disease not on \nhemodialysis(baseline Cr ___ and recent hospital admission \n___ for uremia who was transferred to ___ ED ___ \nafter presenting to an OSH with two new-onset GTC seizures where \nshe was emergently intubated for airway protection. She was \nloaded with phenytoin 20mg/kg. She was admitted to the \nneurologic ICU for further management. Patient was eventually \ntransferred to the floor to the General Medical Service and \nremained seizure free throughout the rest of her stay.\n\n# NEUROLOGY - seizure\nWhile in the neurologic ICU, pt was monitored on continuous \nvideo EEG and seizure precautions. EEG showed only generalized \nslowing and no electrographic seizures or epileptiform \ndischarges. Pt also did not have any clinical seizures. \nPost-dilantin load level was in the ___ so the dilantin \nmaintenance dose was started at 100mg BID. MRI brain did not \nshow any lesions but did show volume loss and findings of \nextensive chronic small vessel ischemic disease which could \npredispose for seizures. Family decline a lumbar puncture to \nassess for any underlying meningitis or encephalitis. Dilantin \nlater changed to 100 mg ER daily, but transitioned to Keppra 250 \nBID by discharge as Dilantin levels remained lowered throughout \nstay. The Keppra dose can be increased if patient develops \nbreakthrough seizure. She will follow-up with Neurology\n\n# CARDIOVASCULAR - acute systolic heart failure / stress \ncardiomyopathy / ___\'s cardiomyopathy\nPt was found to have a minor troponin elevation that peaked at \n0.4 and then trended down. Findings were attributed to demand \nischemia in the setting of seizure and CKD. Pt was monitored on \ntelemetry. Patient arrived to ICU on BiPAP in the setting of \nflash pulmonary edema. Had already recieved 40mg IV lasix on the \nfloor, and had put out 600cc by the time she arrived to the ICU \nand was quickly weaned to 3L NC. Given two episodes of flash \npulmonary edema with no prior history of heart failure, an \nechocardiogram was obtained. It showed an EF of 45% with an \natypical LV wall motion abnormality most consistent with \nTakosubo vs focal myocarditis. She was transitioned from \nlabetolol to metoprolol to optimize mangement of heart failure. \nShe recieved ___ IV Lasix daily, she was not transitioned to \nPO at the time of transfer from ICU. Patient had an additional \nepisode of desaturation to the 70\'s on ___. Repeat CXR \nshowed increased pulmonary edema, and patient was diuresed with \nLasix. Cardiology was consulted and recommended transition to PO \nlasix 40 mg PO every other day, carvedilol 3.125 mg BID, \nhydralazine 30 mg PO TID, and isosorbide dinitrate 30 mg TID. \nHydralazine decreased to 10 mg PO TID and isosorbide dinitrite \ndecreased to 10 mg PO TID after hypotensive episode. Lasix held \nafter patient appeared euvolemic ___ with stable BP. Dry weight \n51.9 kg. ACEi was not started for heart failure due to \nunderlying CKD / elevated creatinine.\n\n# HEMATOLOGY: \nPt with anemia and thrombocytopenia while in the hospital. \nAnemia was attributed to a combination of anemia of chronic \ndisease and renal disease. Patient declined transfusion until \nend of stay, when counts stabilized. Discharged with iron \nsupplementation per Renal recommendations.\n \n# RENAL: \nCreatinine was at baseline (around 3.4) at presentation; \nhowever, pt did exhibit signs of uremia including asterixis and \nencephalopathy. Seizure may have also been related to uremia. \nRenal was consulted to guide management. Pt was continued on \nhome sodium bicarbonate while in the hospital, but this was \ndiscontinued when a contraction alkalosis occurred in the \nsetting of diuresis. Creatinine trended up through admission and \nreached new 4.3 which may be new baseline. Renal consult service \noffered HD but patient declined, which has been consistent with \npatient\'s previous wishes.\n\n# Hypernatremia: Pt also became hypernatremic during hospital \nstay and was started on IV D5W for free water repletion. Her \nsodium gradually normalized and remained normal upon discharge.\n\n# Code status: Shortly after extubation, there were extensive \ndiscussion between patient\'s family members regarding her code \nstatus. On transfer from the MICU, she was DNR/DNI. However, on \n___, patient was made CMO in the setting of her acute SOB. The \nnext morning, patient reiterated that she "wanted to live" and \nthat she wanted aggressive management of her code status. As \nsuch, her code status was revised to DNR/DNI. Extensive code \nstatus discussion was had with family and patient throughout ICU \nstay; patient remained DNR/DNI, and she did not want any \naggresive interventions (including blood products), but was OK \nwith medical care. Palliative care consulted and repeat family \nmeeting occurred with confirmation of DNR/DNI but okay for \ninterventions up to that need, refusal to pursue hemodialysis, \nand resistance to blood transfusion unless absolutely necessary.\n\n# Rib fracture: patient complaining of inspiratory right sided \nchest pain for days with some tenderness in the area. rib film \nshowed non-displaced fracture of 7th rib on day of discharge. \nTreated with pain control.\n\n# Right foot pain: Complaining of R foot pain ___. Dorsum \nof foot with erythema confluent to ___ toe on right, with right \nfoot tenderness and warmth on dorsum. Swelling and erythema \ninitially thought to be ___ to compression stocking choking. \nSymptoms waxed and waned based on edema, foot was more red when \nedematous, less red when more euvolemic. Thought to be gout with \nsuperimposed venous stasis leading to erythema in the setting of \ndiuresis. Pt was afebrile, no leukocytosis, and erythema \ndiminished with elevation of leg so thought less likely to be \ncellulitis. Gout also a likely diagnosis, as patient reports \nrecent diagnosis of gout and in the setting of aggressive \ndiuresis, gout flare can be precipitated. Furthermore, she \nreported that her pain was similar to previous gout flare. Did \nnot give indomethacin or colchicine given CKD. Her symptoms \nwere mild and resolved quickly, so no prednisone given. Did not \ngive antibiotics, avoided NSAIDs because of kidney function, and \ndeferred prednisone treatment per patient request as it did not \nbother her that much. Consider allopurinol for uric acid \ncontrol for gout prevention.\n\nTransitional Issues:\n- pt with low vit d, high PTH, borderline low calcium, will need \nvitamin d supplementation/titration as outpatient\n- daily weights, diurese starting at 20mg Lasix PO if weight \nincrease >3 lbs overnight\n- f/u cbc, creatinine, trend alk phos\n- held ace inhibitor in setting of renal impairment\n- renal, cardiology, neurology f/u\n- neurology may titrate her Keppra dose\n- no driving for 6 months, no swimming, bathing, cooking, \nclimbing without supervision\n- evaluate chem 7 for resumption of bicarb tabs\n- evaluate cardiac meds for change to long acting agents\n- discuss need for persistent cholestyramine\n- please monitor for constipation given that we started iron \nsupplementation on discharge\n- please monitor for splinting and rib pain given her rib \nfracture\n- consider starting allopurinol\n# Dry weight 51.9 kg', 'medications_prescribed': ['Fluvoxamine Maleate 100 mg PO DAILY', 'Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN SOB', 'Bisacodyl 10 mg PR QHS:PRN Constipation', 'Carvedilol 3.125 mg PO BID', 'Ferrous Sulfate 325 mg PO HS', 'HydrALAzine 10 mg PO TID', 'Ipratropium Bromide Neb 1 NEB IH Q6H:PRN SOB', 'LeVETiracetam 250 mg PO BID', 'Cholestyramine 4 gm PO BID', 'Isosorbide Dinitrate 10 mg PO TID', 'Acetaminophen 500 mg PO Q8H', 'Lidocaine 5% Patch 1 PTCH TD QPM leave on 12 hours, keep off 12 hours. apply to area of rib pain']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 56, 'gender': 'F', 'symptoms': 'Lethargy', 'medical_history': ['Dementia of unclear etiology, previously thought to ___ body\ndementia, but per neurology evaluation ___, unlikely to be\nLBD', 'Subdural hematomas c/b residual b/l lower extremity weakness', 'DM2', 'Nephrolithiasis requiring left ureteral stent', 'Recurrent UTIs'], 'family_history': 'Non-contributory', 'present_illness': 'Mr. ___ is a ___ ___ gentleman \nwith\nPMH of dementia of unclear etiology, subdural hematomas c/b\nresidual b/l lower extremity weakness, DM2, nephrolithiasis\nrequiring left ureteral stent, and frequent UTIs, who presents\nwith altered mental status. \n\nThe patient lives at a nursing facility (___. He \nusually\nis able to engage in normal conversation with his family. He is\nwheelchair-bound, but is able to move around his facility on his\nown and feed and bathe himself. However, per the patient\'s\ndaughter, over the past several days he has been lethargic, not\ngetting out of bed. He also has not been eating or drinking\nanything. The daughter has also noticed that he has had\nfoul-smelling urine and is concerned that he has another UTI. \nShe\nendorses that he felt "cold", but is unsure whether he ever had\nfevers/chills. Based on these symptoms, the patient\'s daughter\nfelt that he should be brought to ___ ER for further\nevaluation. \n\nOf note, the patient has had multiple previous UTIs, including\nseveral with MDR organisms. On one occasion in ___, he \nwas\nhospitalized in the ICU at ___ for sepsis secondary to UTI\nrequiring intubation and pressors. He was found to have\nobstructive nephrolithiasis at that time, requiring left \nureteral\nstent placement.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', '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}, {'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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', '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}]}, 'clinical_findings': {'labs': [{'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 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '14', 'valuenum': 14.0, '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}], 'exams': '================================\nADMISSION PHYSICAL EXAM \n================================\n\nGeneral: Alert, oriented to person, and the fact that he is in a\nhospital\nHEENT: EOMs intact \nCV: Normal S1, S2 without murmurs, rubs, or gallops \nLungs: Clear to auscultation bilaterally\nAbdomen: Soft, non-tender, non-distended, bowel sounds present,\nno organomegaly, no rebound or guarding \nGU: Foley draining clear urine \nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or\nedema \nSkin: Warm, dry, no rashes or notable lesions. \nNeuro: face symmetric, EOMs intact, moving all four extremities\nwith purpose. \n\n================================\nDISCHARGE PHYSICAL EXAM \n================================\n\n24 HR Data (last updated ___ @ 730)\n Temp: 98.5 (Tm 98.6), BP: 108/65 (100-123/65-71), HR: 84\n(69-100), RR: 16 (___), O2 sat: 95% (93-97), O2 delivery: Ra \nGENERAL: Somnolent, difficult to rouse.\nCARDIAC: Regular rate and rhythm, no murmurs, rubs, or gallops.\nLUNG: Appears in no respiratory distress, clear to auscultation\nbilaterally, no crackles, wheezes, or rhonchi.\nABD: Normal bowel sounds.\nEXT: Warm, well perfused, no lower extremity edema.\nPULSES: 2+ radial pulses\nNEURO: Not able to participate in exam due to somnolence. Will\nmoan and briefly open eyes, and spontaneously move extremities. \nSKIN: Notable for bilateral superficial gluteal ulcers,\nsurrounded by an erythematous base. No purulence observed.', 'diagnoses': [{'icd_code': '44021', 'desc': 'Atherosclerosis of native arteries of the extremities with intermittent claudication'}, {'icd_code': '4404', 'desc': 'Chronic total occlusion of artery of the extremities'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}], 'summary': '================================\nADMISSION LABS\n================================\n\n___ 12:13AM BLOOD WBC-8.7 RBC-4.12* Hgb-13.0* Hct-39.1* \nMCV-95 MCH-31.6 MCHC-33.2 RDW-13.1 RDWSD-45.1 Plt ___\n___ 12:13AM BLOOD Neuts-50.4 ___ Monos-9.2 Eos-5.8 \nBaso-0.5 Im ___ AbsNeut-4.36 AbsLymp-2.93 AbsMono-0.80 \nAbsEos-0.50 AbsBaso-0.04\n___ 12:13AM BLOOD Glucose-189* UreaN-19 Creat-0.9 Na-141 \nK-4.1 Cl-106 HCO3-23 AnGap-12\n___ 12:13AM BLOOD ALT-9 AST-13 AlkPhos-87 TotBili-0.7\n___ 12:13AM BLOOD Lipase-9\n___ 12:13AM BLOOD cTropnT-<0.01\n___ 12:13AM BLOOD Albumin-3.5\n___ 09:50AM BLOOD Calcium-8.2* Phos-2.9 Mg-1.6\n___ 12:20AM BLOOD ___ pO2-22* pCO2-51* pH-7.33* \ncalTCO2-28 Base XS--1\n___ 12:20AM BLOOD Lactate-1.1\n\n___ 12:13AM URINE Color-Yellow Appear-Hazy* Sp ___\n___ 12:13AM URINE Blood-NEG Nitrite-POS* Protein-30* \nGlucose-150* Ketone-NEG Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-LG*\n___ 12:13AM URINE RBC-0 WBC-20* Bacteri-MANY* Yeast-NONE \nEpi-<1\n\n___ 02:00AM OTHER BODY FLUID FluAPCR-NEGATIVE \nFluBPCR-NEGATIVE\n\n================================\nIMPORTANT INTERVAL LABS\n================================\n\nNone. \n\n================================\nDISCHARGE LABS\n================================\n\n___ 06:23AM BLOOD WBC-12.4* RBC-4.09* Hgb-12.8* Hct-38.2* \nMCV-93 MCH-31.3 MCHC-33.5 RDW-13.1 RDWSD-44.6 Plt ___\n___ 06:23AM BLOOD Glucose-131* UreaN-9 Creat-0.7 Na-144 \nK-3.5 Cl-108 HCO3-22 AnGap-14\n___ 06:23AM BLOOD Calcium-8.2* Phos-3.2 Mg-1.9\n\n================================\nSTUDIES, IMAGING, PROCEDURES\n================================\n\n___ CXR\nBibasilar atelectasis without focal consolidation. Prominence \nof interstitial markings is consistent with age-related lung \nchanges. \n\n___ CT Head \n1. Small left hemispheric late subacute/chronic subdural \nhematoma, similar. \n2. Small right hemispheric chronic subdural hematoma, mildly \nmore prominent. \n3. No acute hemorrhage. \n4. Brain parenchymal atrophy. \n5. Consider acut paranasal e sinusitis. \n\n================================\nMICRO \n================================\n\n___ Urine \n ESCHERICHIA COLI. >100,000 CFU/mL OF TWO COLONIAL \nMORPHOLOGIES. \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--------- =>4 R\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- <=16 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\n___ 1:46 am BLOOD CULTURE\n\n Blood Culture, Routine (Preliminary): \n STAPHYLOCOCCUS, COAGULASE NEGATIVE. \n Isolated from only one set in the previous five days. \n SENSITIVITIES PERFORMED ON REQUEST..\n\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. \n Reported to and read back by ___ AT ___ \nON ___.\nMr. ___ is a ___ year old ___ speaking man, \nwheelchair dependent from lower extremity weakness/rigidity from \nprior subdural hematoma, dementia (dependent on IADLs and \npartially dependent with ADLs), nephrolithiasis s/p left \nureteral stent complicated by recurrent UTIs, and diabetes on \ninsulin who presents from his nursing facility with a 5 day \nhistory of progressive lethargy. \n\nHis encephalopathy worked up with routine labs, infectious \nworkup, and CT scan of the head and was ultimately attributed to \nan E. coli UTI (resistant only to ciprofloxacin), which was \ntreated with 4 days of ceftriaxone and he was ultimately \ndischarged with 7 days of Bactrim to complete a course. Patient \nalso grew coagulase-negative staph on a single blood culture \nthat was ultimately deemed a contaminant. His sacral wounds were \nalso assessed, but not felt to be infected. \n\nHis hospital course was complicated by nocturnal delirium which \nrequired Haldol to control his agitation, though we did not feel \nlike this was needed upon discharge as he was returning to a \nmore familiar environment. At the time of discharge, his mental \nstatus had largely returned to baseline per his family (awake, \nagitated at times, and communicates his basic needs in \n___.'}}
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{'final_diagnoses': ['Acute Complicated Cystitis', 'Toxic Metabolic Encephalopathy', 'Delirium', 'Coocyx Ulcers', 'Nutrition', 'TIIDM', 'Chronic Normocytic Anemia', 'Acute Hypercarbic Respiratory Failure'], 'procedures': ['None.'], 'visit_summary': 'Mr. ___ is a ___ year old ___ speaking man, \nwheelchair dependent from lower extremity weakness/rigidity from \nprior subdural hematoma, dementia (dependent on IADLs and \npartially dependent with ADLs), nephrolithiasis s/p left \nureteral stent complicated by recurrent UTIs, and diabetes on \ninsulin who presents from his nursing facility with a 5 day \nhistory of progressive lethargy. \n\nHis encephalopathy worked up with routine labs, infectious \nworkup, and CT scan of the head and was ultimately attributed to \nan E. coli UTI (resistant only to ciprofloxacin), which was \ntreated with 4 days of ceftriaxone and he was ultimately \ndischarged with 7 days of Bactrim to complete a course. Patient \nalso grew coagulase-negative staph on a single blood culture \nthat was ultimately deemed a contaminant. His sacral wounds were \nalso assessed, but not felt to be infected. \n\nHis hospital course was complicated by nocturnal delirium which \nrequired Haldol to control his agitation, though we did not feel \nlike this was needed upon discharge as he was returning to a \nmore familiar environment. At the time of discharge, his mental \nstatus had largely returned to baseline per his family (awake, \nagitated at times, and communicates his basic needs in \n___.', 'medications_prescribed': ['Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 7 Days \nto complete UTI treatment course based on micro sensitivities \nRX *sulfamethoxazole-trimethoprim 800 mg-160 mg 1 tablet(s) by \nmouth twice a day Disp #*14 Tablet Refills:*0', 'Glargine 9 Units Breakfast\nInsulin SC Sliding Scale using HUM Insulin', 'Ascorbic Acid ___ mg PO BID', 'MetFORMIN (Glucophage) 500 mg PO BID', 'Multivitamins W/minerals 1 TAB PO DAILY', 'TraZODone 25 mg PO QHS:PRN sleep']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 83, 'gender': 'F', 'symptoms': 'Fall', 'medical_history': ['CAD RISK FACTORS \n- Dyslipidemia', 'CARDIAC HISTORY \n- None known', 'OTHER PAST MEDICAL HISTORY \n- Gout', '- BPH'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death.', 'present_illness': '___ with no known cardiac history brought in after an \nunwitnessed fall with subsequent ECG concerning for atrial \nflutter.\n\nMr. ___ woke up this morning in his usual state of health. He \nwas walking around his home and at some point fell unwitnessed. \nHe denies any presyncopal symptoms of tunnel vision. He reported \nno nausea, vomiting or dysequilibrium. He fell forward and hit \nhis upper lip on the ground, yelled, and was soon after found by \nhis wife. Family states that he did not lose consciousness. He \nhimself is unclear whether he lost consciousness, but was \nresponsive within the time it took for his wife to walk to the \nroom that he was in. After the fall, he did not feel confused. \nHis wife states that he did not look pale, green, yellow or \nblue. He immediately felt lightheadeded, dysequilibrium, \npalpitation', 'medications': [{'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Propranolol LA', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Tiotropium Bromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Carbidopa-Levodopa CR (50-200)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Triamterene-Hydrochlorothiazide (37.5/25)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', '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': 'Acetaminophen', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', '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 via patient discharge', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Guaifenesin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Duloxetine', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QAM', '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': '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': '3', 'valuenum': 3.0, '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': '11', 'valuenum': 11.0, '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': '8.7', 'valuenum': 8.7, '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': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': 73.0, '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': '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': 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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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': '24.7', 'valuenum': 24.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '379', 'valuenum': 379.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission\nGENERAL: Elderly ___ Asian man in NAD, cachectic appearing\nTemp: 97.8 (Tm 97.8), BP: 114/51, HR: 64, RR: 18, O2 sat: 98%, \nO2 delivery: RA, Wt: 135.3 lb/61.37 kg\nHEENT: Normocephalic atraumatic. Sclera anicteric. PERRL. EOMI. \nConjunctiva were pink. No pallor or cyanosis of the oral mucosa.\nNECK: Supple. JVP flat.\nCARDIAC: PMI located in ___ intercostal space, mid-clavicular \nline. Regular rate and rhythm. Normal S1, S2. ___ systolic RUSB. \nNo thrills or lifts.\nLUNGS: Respiration is unlabored with no accessory muscle use. \nBibasilar crackles, but no wheezes or rhonchi.\nABDOMEN: Soft, non-tender, non-distended. No hepatomegaly. No \nsplenomegaly.\nEXTREMITIES: Warm, well perfused. No clubbing, cyanosis, or \nperipheral edema.\nSKIN: No significant skin lesions or rashes.\nPULSES: Distal pulses palpable and symmetric.\n\nAt discharge\nGeneral: Well appearing elderly man in NAD.\n___ 1154 BP: 99/58 Lying HR: 54 O2 sat: 98% \n___ 1155 BP: 95/63 Sitting HR: 67 O2 sat: 97% \n___ 1157 BP: 91/57 Standing HR: 71 O2 sat: 98% \nI/O: -2.4L net since admission\nWeight: 59 kg \nHEENT: Mucous membranes moist, NCAT\nLungs: CTAB, normal work of breathing on RA.\nCV: RRR, normal S1, S2; no murmurs, rubs, or gallops. JVP not \nelevated\nAbdomen: Soft, not distended, non-tender\nExt: Warm, well perfused, with 2+ distal pulses. No ___ edema.', 'diagnoses': [{'icd_code': '78650', 'desc': 'Chest pain, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': '71690', 'desc': 'Arthropathy, unspecified, site unspecified'}], 'summary': "___ 12:15PM BLOOD WBC-5.5 RBC-4.46* Hgb-13.5* Hct-41.6 \nMCV-93 MCH-30.3 MCHC-32.5 RDW-14.1 RDWSD-48.2* Plt ___\n___ 12:15PM BLOOD Neuts-64.4 ___ Monos-9.4 Eos-2.4 \nBaso-0.7 Im ___ AbsNeut-3.51 AbsLymp-1.25 AbsMono-0.51 \nAbsEos-0.13 AbsBaso-0.04\n___ 12:15PM BLOOD ___ PTT-33.7 ___\n\n___ 12:15PM BLOOD Glucose-83 UreaN-17 Creat-1.0 Na-137 \nK-4.4 Cl-101 HCO3-25 AnGap-11\n___ 12:15PM BLOOD ALT-19 AST-34 AlkPhos-59 TotBili-0.7\n\n___ 12:15PM BLOOD cTropnT-<0.01\n___ 04:25PM BLOOD cTropnT-<0.01\n\n___ 12:15PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n___ 07:15AM BLOOD %HbA1c-5.5 eAG-111\n___ 07:15AM BLOOD TSH-3.0\n\n___ 01:13PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 01:13PM URINE BLOOD-TR* NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 01:13PM URINE RBC-4* WBC-0 BACTERIA-FEW* YEAST-NONE \nEPI-0\n___ 01:13PM URINE URINE CULTURE (Final ___: < 10,000 \nCFU/mL. \n\n___ 01:13PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG oxycodn-NEG mthdone-NEG\n\nCXR ___\nHeart size and mediastinum are normal in appearance. \nPostsurgical/post infectious/post radiation changes in the right \nupper lobe are noted, with potential for pulmonary nodule versus \nrounded scar approximately 2 cm in diameter. Right lower lung \nand left lung are clear. No pleural effusion or pneumothorax.\nRECOMMENDATION(S): Chest CT is recommended for characterization \nof the right upper lobe changes on the non emergency basis. \n\nCT head noncontrast ___\n There is no evidence of territorial infarction,acute \nhemorrhage,edema,or mass effect. There is prominence of the \nventricles and sulci suggestive of involutional changes.\n Air locules are noted along the pterygoid and masseter muscles \non the right without evidence of acute fracture, likely venous. \nThere is mild mucosal thickening of the several ethmoidal air \ncells. Round calcifications measuring up to 5 mm are noted in \nthe superior aspect of the enlarged right mastoid air cells \ncompatible with an osteoma. Otherwise, the visualized portion of \nthe paranasal sinuses, mastoid air cells, and middle ear \ncavities are clear. The visualized portion of the orbits are \nunremarkable. No evidence of acute displaced calvarial fracture.\nIMPRESSION: \n1. No fracture or acute intracranial abnormality on noncontrast \nhead CT. Specifically no acute large territory infarct or \nintracranial hemorrhage. \n2. No acute displaced calvarial fracture. \n\nCT cervical spine ___\nMultilevel degenerative changes with loss of intervertebral disc \nheight most notable at C5-C6 and C6-C7 endplate sclerosis seen \nat C6-C7. There is a 3 mm anterolisthesis of C4 over C5 without \nassociated soft tissue swelling, almost certainly degenerative. \nOtherwise, alignment is anatomic.No acute displaced fractures \nare identified. There is mild spinal canal narrowing at C6-C7 \nassociated with posterior osteophytes. Moderate neural foraminal \nnarrowing is noted on the left at C4-C5 and on the right at \nC5-C6, bilaterally at C6-C7. There is no prevertebral soft \ntissue swelling. Pleuroparenchymal scarring with bronchiectasis \nis identified in the bilateral lung apices. Visualized \naerodigestive tract is unremarkable. There is no cervical \nlymphadenopathy by size criteria. \nIMPRESSION: Multilevel degenerative changes without definite \nevidence of acute fracture or traumatic malalignment. \n\nEchocardiogram ___\nThe left atrial volume index is normal. There is no evidence for \nan atrial septal defect by 2D/color Doppler. The estimated right \natrial pressure is ___ mmHg. There is normal left ventricular \nwall thickness with a normal cavity size. There is suboptimal \nimage quality to assess regional left ventricular function. \nOverall left ventricular systolic function is low normal. The \nvisually estimated left ventricular ejection fraction is 50-55%. \nThere is no resting left ventricular outflow tract gradient. \nNormal right ventricular cavity size with normal free wall \nmotion. The aortic sinus diameter is normal for gender with \nnormal ascending aorta diameter for gender. The aortic arch \ndiameter is normal. There is no evidence for an aortic arch \ncoarctation. The aortic valve leaflets (3) appear structurally \nnormal. There is no aortic valve stenosis. There is mild [1+] \naortic regurgitation. The mitral valve leaflets appear \nstructurally normal with no mitral valve prolapse. There is \ntrivial mitral regurgitation. The tricuspid valve leaflets \nappear structurally normal. There is trivial tricuspid \nregurgitation. The estimated pulmonary artery systolic pressure \nis normal. There is no pericardial effusion. \nIMPRESSION: Suboptimal image quality. Normal biventricular \ncavity sizes. Low normal global left ventricular systolic \nfunction. Normal right ventricular systolic function. No \nvalvular pathology or\npathologic flow identified. Normal estimated pulmonary artery \nsystolic pressure. No structural cardiac cause of syncope \nidentified. No prior TTE available for comparison.\n\nExercise stress test ___\nThis ___ year old man with a history of PAF with RVR, syncope and \nchest discomfort was referred to the lab for evaluation. The \npatient exercised for 8.5 minutes of a modified ___ protocol \nand stopped for fatigue. The estimated peak MET capacity was 6.5 \nwhich represents an average functional capacity for his age. No \narm, neck, back or chest discomfort was reported by the patient \nthroughout the study. There were no significant ST segment \nchanges during exercise or in recovery. The rhythm was sinus \nwith occasional isolated apbs. Appropriate hemodynamic response \nto exercise with hypotension while sitting that was asymptomatic \nin recovery (82/60).\nIMPRESSION: No anginal type symptoms or ischemic EKG changes. \nAppropriate SBP during exercise with asymptomatic orthostatic \nhypotension in late recovery.\nIMAGING: Left ventricular cavity size is normal Resting and \nstress perfusion images reveal uniform tracer uptake throughout \nthe left ventricular myocardium. Gated images reveal normal wall \nmotion. The calculated left ventricular ejection fraction is \n67%.\nIMPRESSION: 1. Normal myocardial perfusion. 2. Normal wall \nmotion with an ejection fraction of 67%.\n\nDISCHARGE LABS\n___ 08:20AM BLOOD WBC-4.4 RBC-4.49* Hgb-13.6* Hct-42.0 \nMCV-94 MCH-30.3 MCHC-32.4 RDW-13.9 RDWSD-47.7* Plt ___\n___ 08:20AM BLOOD ___ PTT-37.9* ___\n___ 08:20AM BLOOD Glucose-101* UreaN-13 Creat-0.7 Na-140 \nK-4.4 Cl-102 HCO3-29 AnGap-9*\n___ 08:20AM BLOOD Calcium-9.1 Phos-3.3 Mg-2.2\nMr. ___ is a ___ ___ man from ___ (who speaks ___ \nand has a ___ driver___s license) with H/O gout and BPH \npresenting with an unwitnessed fall of unclear etiology with \nsubsequent EKG showing atrial fibrillation with rapid \nventricular rate to the 150s, admitted for syncopal workup. \n\n# Pre-syncope, fall: Patient presented with unwitnessed fall \nwith preceding lightheadedness and palpitations consistent with \nnewly diagnosed symptomatic paroxysmal atrial fibrillation with \nrapid ventricular rate. Suspect fall related to symptomatic pAF \nas well as some volume depletion given increase in heart rates \nwith orthostatic vital signs. Echocardiogram showed normal LV \nsystolic function and normal valves. When working with physical \ntherapy, he was noted to have exertional hypotension with SBP \ndecreasing to ___. He exercised to peak HR 133 (sinus) and 6.5 \nMETs with no chest pain, or arrhythmia, but appropriate SBP \nduring exercise with asymptomatic orthostatic hypotension in \nlate recovery. Nuclear images showed uniform perfusion \nconsistent with no localized ischemia. He had no further \npre-syncopal symptoms since admission. Patient was discharged \nwith ___ of Hearts monitor and will need to review results \nwith his PCP and new cardiologist. He was also advised to \npurchase a machine to measure his blood pressure at home.\n\n# Newly diagnosed paroxysmal atrial fibrillation: After his \nfall, patient presented to his PCP's office, and EKG there \ndemonstrated atrial fibrillation with rapid ventricular rate. On \ntelemetry here, patient noted to have PACs leading to short \nburst of atrial fibrillation. He was also noted to have a \nresting HR in the ___ not on a rate control agent making control \nwith a nodal agent more difficult. We held off on starting an \nantiarrhythmic medication unless clearly symptomatic with better \nventricular rate or high burden of symptomatic atrial \nfibrillation. Given unknown duration of PAF, we would prefer \nadequate anticoagulation prior to initiating anti-arrhythmic \ntherapy (unless TEE excluded ___ thrombus). Patient was started \non low dose metoprolol tartrate 6.25 mg every 6 hours in the \nhospital but was not able to receive several doses as became \nhypotensive with SBP in ___ with a single dose. Given \nhypotension (to ___ mm Hg asymptomatic) and clear orthostasis (8 \nmm Hg drop, 17 bpm rise supine to standing), decision was made \nto hold all beta-blockade at discharge and provided clear \ninstructions to patient to return to ED if develops tachycardia \nor recurrent symptoms of palpitations or pre-syncope at home. In \nterms of anticoagulation, CHADs2-Vasc score of 2 (age) and was \nstarted on apixaban 5 mg BID.\n\n# 2 cm RUL nodule incidentally found on CXR on admission. Given \nremote smoking history, should have CT scan of chest as \noutpatient to further evaluate.\n\n# Asymptomatic bactiuria: Patient had 0 epis, 4 RBCs, no WBCs, \nand few bacteria per high powered field on urinalysis. He was \nasymptomatic, and urine culture returned negative, so \nantibiotics were not begun empirically."}}
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{'final_diagnoses': ['# Pre-syncope with fall', '# Paroxysmal Atrial fibrillation', '# Orthostatic hypotension', '# 2 centimeter right upper lobe lung nodule', '# Asymptomatic bactiuria', '# Gout', '# Benign prostatic hypertrophy', '# Anemia'], 'procedures': ['Nuclear exercise stress test (___)'], 'visit_summary': "Mr. ___ is a ___ ___ man from ___ (who speaks ___ \nand has a ___ driver___s license) with H/O gout and BPH \npresenting with an unwitnessed fall of unclear etiology with \nsubsequent EKG showing atrial fibrillation with rapid \nventricular rate to the 150s, admitted for syncopal workup. \n\n# Pre-syncope, fall: Patient presented with unwitnessed fall \nwith preceding lightheadedness and palpitations consistent with \nnewly diagnosed symptomatic paroxysmal atrial fibrillation with \nrapid ventricular rate. Suspect fall related to symptomatic pAF \nas well as some volume depletion given increase in heart rates \nwith orthostatic vital signs. Echocardiogram showed normal LV \nsystolic function and normal valves. When working with physical \ntherapy, he was noted to have exertional hypotension with SBP \ndecreasing to ___. He exercised to peak HR 133 (sinus) and 6.5 \nMETs with no chest pain, or arrhythmia, but appropriate SBP \nduring exercise with asymptomatic orthostatic hypotension in \nlate recovery. Nuclear images showed uniform perfusion \nconsistent with no localized ischemia. He had no further \npre-syncopal symptoms since admission. Patient was discharged \nwith ___ of Hearts monitor and will need to review results \nwith his PCP and new cardiologist. He was also advised to \npurchase a machine to measure his blood pressure at home.\n\n# Newly diagnosed paroxysmal atrial fibrillation: After his \nfall, patient presented to his PCP's office, and EKG there \ndemonstrated atrial fibrillation with rapid ventricular rate. On \ntelemetry here, patient noted to have PACs leading to short \nburst of atrial fibrillation. He was also noted to have a \nresting HR in the ___ not on a rate control agent making control \nwith a nodal agent more difficult. We held off on starting an \nantiarrhythmic medication unless clearly symptomatic with better \nventricular rate or high burden of symptomatic atrial \nfibrillation. Given unknown duration of PAF, we would prefer \nadequate anticoagulation prior to initiating anti-arrhythmic \ntherapy (unless TEE excluded ___ thrombus). Patient was started \non low dose metoprolol tartrate 6.25 mg every 6 hours in the \nhospital but was not able to receive several doses as became \nhypotensive with SBP in ___ with a single dose. Given \nhypotension (to ___ mm Hg asymptomatic) and clear orthostasis (8 \nmm Hg drop, 17 bpm rise supine to standing), decision was made \nto hold all beta-blockade at discharge and provided clear \ninstructions to patient to return to ED if develops tachycardia \nor recurrent symptoms of palpitations or pre-syncope at home. In \nterms of anticoagulation, CHADs2-Vasc score of 2 (age) and was \nstarted on apixaban 5 mg BID.\n\n# 2 cm RUL nodule incidentally found on CXR on admission. Given \nremote smoking history, should have CT scan of chest as \noutpatient to further evaluate.\n\n# Asymptomatic bactiuria: Patient had 0 epis, 4 RBCs, no WBCs, \nand few bacteria per high powered field on urinalysis. He was \nasymptomatic, and urine culture returned negative, so \nantibiotics were not begun empirically.", 'medications_prescribed': ['Apixaban 5 mg PO BID', 'Allopurinol ___ mg PO DAILY', 'Colchicine 0.6 mg PO ONCE', 'dutasteride 0.5 mg oral EVERY OTHER DAY', 'Tamsulosin 0.4 mg PO BID', 'Medical Equipment\nICD-10: I48.0\nEQUIPMENT: Automatic blood pressure cuff\nINSTRUCTIONS: Please check your blood pressure and heart rate \nonce a day at the same time each day. Notify your doctor if your \nblood pressure is less than 90']}
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