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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': 'Back pain', 'medical_history': ['Pancreatic Cancer, Stage IV (detailed below)', 'GERD', 'HTN', 'Depression'], 'family_history': 'Family with throat CA, no other FHx of malignancy.', 'present_illness': '___ year old man with metastatic pancreatic cancer who is \ncurrently enrolledin a clinical trial of PEGPH20(PEGylated \nRecombinant Human\nHyaluronidase) combined with nab-Paclitaxel plus gemcitabine\ncompared with nab-Paclitaxel plus gemcitabine, who presented to \nOSH with back pain and was found to have bilateral PEs. \n\nThe patient was in his usual state of health until the day prior \nto admission, at which point he awoke with lower back pain. The \npain progressed throughout the day, and soon involved his entire \nback, shoulders, and hips. The pain was severe enough to limit \nhis movement, which is why he went to the ___ ED. \nNo weakness, numbness, bowel or bladder incontinence, headache, \nconfusion. Also denies SOB, chest pain, palpitations, fever, \nchills, cough, abdominal pain, nausea/vomiting, diarrhea, \ndysuria. \n\n CT imaging at ___ did not show any lumbar spine imaging, \nbut did show bilateral PEs, and he was started on a heparin \ndrip. He was given dilaudid x 2 for his pain. \n\nPer his report this AM, his back pain is improved and he is now \nasymptomatic. \n\nIn the ED, initial VS were: \n97.9 63 128/74 18 95% RA \nLabs were notable for: pancytopenia\nImaging included: Bilateral hip xray, CT chest\n\nOn arrival to the floor, patient was asymptomatic and in no \ndistress. He is continued on the heparin drip.', 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': '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 Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocerin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', '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': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', '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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', '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': '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.8', 'valuenum': 16.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '573', 'valuenum': 573.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.34', 'valuenum': 2.34, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '81', 'valuenum': 81.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '7.8', 'valuenum': 7.8, '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': '___', 'valuenum': 15.0, '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': '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': 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': '356', 'valuenum': 356.0, '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': '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': '4.7', 'valuenum': 4.7, '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, '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': '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': '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '37.2', 'valuenum': 37.2, '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': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '590', 'valuenum': 590.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.71', 'valuenum': 2.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', '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': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '584', 'valuenum': 584.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '1 NRBC PER 100 WBCS.'}, {'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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n========================\nVS: 98.8 142 / 70 59 16 97% RA \nGENERAL: Alert, pleasant, NAD\nHEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, \nsupraclavicular, or axillary LAD \nCards: RR S1/S2 normal. no murmurs/gallops/rubs. \nPulm: CTAB no crackles or wheezes \nAbd: BS+, soft, NT, no rebound/guarding, no HSM, no ___ \nsign \nExtremities: Legs appear symmetric. 1+ edema up to mid shins \nbilaterally. Mild erythema on the medial surfaces of bilateral \ncalves without warmth or tenderness to palpation. DPs, PTs 2+. \nSkin: no rashes or bruising \nNeuro: AOx3, CNs II-XII intact. ___ strength in U/L extremities. \n\nDTRs 2+ ___. sensation intact to LT, cerebellar fxn intact (FTN, \nHTS). gait WNL. \n\nDISCHARGE PHYSICAL EXAM\n=========================\nVS: 98.4Axillary 138/70 L 56 18 96 RA \nGENERAL: Alert, pleasant, NAD\nHEENT: PERRLA. MMM. no LAD. no JVD. neck supple. No cervical, \nsupraclavicular, or axillary LAD \nCards: RR S1/S2 normal. no murmurs/gallops/rubs. \nPulm: CTAB no crackles or wheezes \nAbd: BS+, soft, NT, no rebound/guarding, no HSM, no ___ \nsign \nExtremities: Legs appear symmetric. 1+ edema up to mid shins \nbilaterally. Mild erythema on the medial surfaces of bilateral \ncalves without warmth or tenderness to palpation. DPs, PTs 2+. \nSkin: no rashes or bruising \nNeuro: AOx3, CNs II-XII intact. ___ strength in U/L extremities. \n\nDTRs 2+ ___. sensation intact to LT, cerebellar fxn intact (FTN, \nHTS). gait WNL.', 'diagnoses': [{'icd_code': '38611', 'desc': 'Benign paroxysmal positional vertigo'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '4373', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '1963', 'desc': 'Secondary and unspecified malignant neoplasm of lymph nodes of axilla and upper limb'}, {'icd_code': '1970', 'desc': 'Secondary malignant neoplasm of lung'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '1985', 'desc': 'Secondary malignant neoplasm of bone and bone marrow'}, {'icd_code': '1976', 'desc': 'Secondary malignant neoplasm of retroperitoneum and peritoneum'}, {'icd_code': '4239', 'desc': 'Unspecified disease of pericardium'}, {'icd_code': '29630', 'desc': 'Major depressive affective disorder, recurrent episode, unspecified'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '4580', 'desc': 'Orthostatic hypotension'}, {'icd_code': '28522', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '73390', 'desc': 'Disorder of bone and cartilage, unspecified'}, {'icd_code': '3899', 'desc': 'Unspecified hearing loss'}, {'icd_code': '3559', 'desc': 'Mononeuritis of unspecified site'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': 'V1255', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'V103'}, {'icd_code': 'V4571', 'desc': 'Acquired absence of breast and nipple'}, {'icd_code': 'V8741', 'desc': 'Personal history of antineoplastic chemotherapy'}, {'icd_code': 'V1082', 'desc': 'Personal history of malignant melanoma of skin'}, {'icd_code': 'V1083', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '23871', 'desc': 'Essential thrombocythemia'}], 'summary': 'ADMISSION LABS\n=======================\n___ 05:00AM BLOOD WBC-3.2* RBC-3.08* Hgb-8.9* Hct-28.9* \nMCV-94 MCH-28.9 MCHC-30.8* RDW-15.2 RDWSD-52.0* Plt Ct-61*#\n___ 05:00AM BLOOD Neuts-58 Bands-2 ___ Monos-2* Eos-3 \nBaso-0 Atyps-1* Metas-1* Myelos-0 NRBC-1* AbsNeut-1.92 \nAbsLymp-1.09* AbsMono-0.06* AbsEos-0.10 AbsBaso-0.00*\n___ 05:00AM BLOOD ___ PTT-41.1* ___\n___ 05:00AM BLOOD Glucose-95 UreaN-12 Creat-0.9 Na-140 \nK-4.0 Cl-106 HCO3-28 AnGap-10\n___ 04:58PM BLOOD ALT-17 AST-20 AlkPhos-70 TotBili-0.2\n___ 05:41AM BLOOD Calcium-8.1* Phos-4.3 Mg-1.7\n\nDISCHARGE LABS\n========================\n___ 06:51AM BLOOD WBC-3.6* RBC-3.22* Hgb-9.3* Hct-29.2* \nMCV-91 MCH-28.9 MCHC-31.8* RDW-15.3 RDWSD-50.3* Plt Ct-62*\n___ 06:51AM BLOOD Glucose-104* UreaN-11 Creat-1.0 Na-142 \nK-4.0 Cl-104 HCO3-28 AnGap-14\n\nIMAGING\n=========================\nIMPRESSION:\n1. No evidence of pulmonary embolism or aortic abnormality.\n2. Numerous bilateral indeterminate pulmonary nodules are \nstable. .\n3. Stable right hilar adenopathy.\n4. Indeterminate ___ lytic rib lesions, stable.\n___ year old man with metastatic pancreatic cancer who is \ncurrently enrolledin a clinical trial of PEGPH20(PEGylated \nRecombinant Human Hyaluronidase) combined with nab-Paclitaxel \nplus gemcitabine\ncompared with nab-Paclitaxel plus gemcitabine, who presented to \nOSH with back pain and was found to have bilateral PEs. Upon \ntransfer to ___, patient was asymptomatic and hemodynamically \nstable. He was started on a heparin drip with plan to transition \nto BID lovenox, but repeat CTA showed no evidence of pulmonary \nemboli. Heparin drip was stopped and the patient was discharged \non his previous regimen of daily lovenox. \n\n#Pulmonary emboli: Patient with report of incidentally \ndiscovered PE without evidence of right heart strain on CT chest \nfrom ___. No hypotension, tachycardia, hypoxia. \nPatient was on preventative dose of enoxaparin prior to this \nepisode as part of a clinical trial, with known \nhypercoagulability ___ pancreatic cancer. Patient was started on \na heparin drip until repeat CTA showed no pulmonary emboli, and \nhe wad discharged on his prior dose of lovenox.\n\n#Back pain: Patient initially presented for diffuse back pain \nlimiting his movement, treated with dilaudid at ___ \n___, which had resolved upon transfer. Imaging at ___ \n___ also without lytic lesions or fracture. Quick \nresolution of pain was likely inconsistent with bony mets, and \nthe patient had no concerning neurological symptoms. Pain could \nhave been consistent with musculoskeletal irritation ___ cancer \ntherapy.\n\n#Thrombocytopenia: During this admission, platelets nadir 48; \nsubsequently improved to 62. Likely ___ chemotherapy. Patient \nhad no symptoms of bleeding or infection. Before repeat CTA \nshowed no PE, re-initiation of lovenox was delayed until the \nplatelets rebounded >50.\n\n#Metastatic pancreatic CA: Patient with known pulmonary \nmetastasis, previously a part of PEGPH20 trial. Patient can \ncontinue nab-Paclitaxel plus gemcitabine therapy, and he will \nlikely be re-enrolled in the trial as he had no disqualifying \nVTE event. \n\n#Depression: continued citalopram\n\n#Atrial fibrillation: Patient documented to have Afib during \nprevious hospitalization, so was started on metoprolol, which \nwas continued during admission.\n\n#Lower extremity edema: Patient presented with increased edema \nfrom his baseline, without asymmetric swelling or calf pain. \nFurosemide was increased to 40 mg PO daily.\n\n***TRANSITIONAL ISSUES***\n# Patient discharged on ___ 80mg SC daily after he was \ndetermined not to have PEs on CTA; this was communicated to the \npatient on AM of ___\n# Patient with ongoing thrombocytopenia; please follow-up as an \noutpatient and monitor for signs of bleeding; should have labs \nrechecked as written on ___. \n# Lasix increased to 40mg po daily; please follow-up \nelectrolytes and kidney function on ___. \n# Code: Full\n# Contact: Daughter (___) ___'}}
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{'final_diagnoses': ['Primary Diagnosis:', 'Back Pain', 'Question Pulmonary Embolism', 'Secondary Diagnosis:', 'Metastatic Pancreatic Cancer'], 'procedures': ['None'], 'visit_summary': '___ year old man with metastatic pancreatic cancer who is \ncurrently enrolledin a clinical trial of PEGPH20(PEGylated \nRecombinant Human Hyaluronidase) combined with nab-Paclitaxel \nplus gemcitabine\ncompared with nab-Paclitaxel plus gemcitabine, who presented to \nOSH with back pain and was found to have bilateral PEs. Upon \ntransfer to ___, patient was asymptomatic and hemodynamically \nstable. He was started on a heparin drip with plan to transition \nto BID lovenox, but repeat CTA showed no evidence of pulmonary \nemboli. Heparin drip was stopped and the patient was discharged \non his previous regimen of daily lovenox. \n\n#Pulmonary emboli: Patient with report of incidentally \ndiscovered PE without evidence of right heart strain on CT chest \nfrom ___. No hypotension, tachycardia, hypoxia. \nPatient was on preventative dose of enoxaparin prior to this \nepisode as part of a clinical trial, with known \nhypercoagulability ___ pancreatic cancer. Patient was started on \na heparin drip until repeat CTA showed no pulmonary emboli, and \nhe wad discharged on his prior dose of lovenox.\n\n#Back pain: Patient initially presented for diffuse back pain \nlimiting his movement, treated with dilaudid at ___ \n___, which had resolved upon transfer. Imaging at ___ \n___ also without lytic lesions or fracture. Quick \nresolution of pain was likely inconsistent with bony mets, and \nthe patient had no concerning neurological symptoms. Pain could \nhave been consistent with musculoskeletal irritation ___ cancer \ntherapy.\n\n#Thrombocytopenia: During this admission, platelets nadir 48; \nsubsequently improved to 62. Likely ___ chemotherapy. Patient \nhad no symptoms of bleeding or infection. Before repeat CTA \nshowed no PE, re-initiation of lovenox was delayed until the \nplatelets rebounded >50.\n\n#Metastatic pancreatic CA: Patient with known pulmonary \nmetastasis, previously a part of PEGPH20 trial. Patient can \ncontinue nab-Paclitaxel plus gemcitabine therapy, and he will \nlikely be re-enrolled in the trial as he had no disqualifying \nVTE event. \n\n#Depression: continued citalopram\n\n#Atrial fibrillation: Patient documented to have Afib during \nprevious hospitalization, so was started on metoprolol, which \nwas continued during admission.\n\n#Lower extremity edema: Patient presented with increased edema \nfrom his baseline, without asymmetric swelling or calf pain. \nFurosemide was increased to 40 mg PO daily.\n\n***TRANSITIONAL ISSUES***\n# Patient discharged on ___ 80mg SC daily after he was \ndetermined not to have PEs on CTA; this was communicated to the \npatient on AM of ___\n# Patient with ongoing thrombocytopenia; please follow-up as an \noutpatient and monitor for signs of bleeding; should have labs \nrechecked as written on ___. \n# Lasix increased to 40mg po daily; please follow-up \nelectrolytes and kidney function on ___. \n# Code: Full\n# Contact: Daughter (___) ___', 'medications_prescribed': ['1. Enoxaparin Sodium 80 mg SC DAILY OR Q12H pending CTA read \nStart: ___, First Dose: Next Routine Administration Time ', '2. Furosemide 40 mg PO DAILY \nRX *furosemide 40 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0 ', '3. Citalopram 20 mg PO DAILY ', '4. Metoprolol Succinate XL 25 mg PO DAILY ', '5. Pantoprazole 40 mg PO Q24H ', '6. Prochlorperazine 10 mg PO Q6H:PRN nausea ', '7.Outpatient Lab Work\nPlease check CBC and CHEM7 on ___ and fax to Dr. ___ \nat ___']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 46, 'gender': 'M', 'symptoms': 'Diarrhea and Vomiting', 'medical_history': ['1. HTN', '2. Hyperlipidemia', "3. GERD with Schatzki's ring", '4. Borderline DM', '5. hx of c-section x3', '6. s/p appendectomy', '7. s/p cholecystectomy', '8. s/p total hysterectomy', '9. hx of dizziness - on Meclizine as needed'], 'family_history': 'Mother died of uterine cancer in her ___ - no early stroke or \nCAD', 'present_illness': "___ history of GERD, hypertension, osteopenia, \nhypercholesterolemia, shoulder osteoarthritis, cervical DJD, \nsent to ED from PCP's office with symptoms of nausea, vomitting, \ndiarrhea for four days. She was previously seen in ED ___ with \nthe same complaints, had a CT abdomen which showed a small \nhiatal hernia and no acute process, and she tolerated PO \nchallenge. She was discharged with SL ondansetron, but returns \ntoday with persistent symptoms, completely intolerant of PO.", 'medications': [{'medication': 'Fluconazole', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', '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': 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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', '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': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', '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': 0.0}, {'medication': 'Ambisome', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Dapsone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', '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': 'Ondansetron ODT', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID: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': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '2X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron ODT', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ambisome', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H: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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', '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': 'TID W/MEALS', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Ambisome', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', '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': 'Potassium Chloride', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Acetate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Efavirenz', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': '1X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Flucytosine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'AVAILABLE AT THE ___ LAB.'}, {'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': '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': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, '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': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', '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': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 92.0, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '669', 'valuenum': 669.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 152.0, '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': '420', 'valuenum': 420.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '261', 'valuenum': 261.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 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'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. 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'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '4.27', 'valuenum': 4.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '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': '58', 'valuenum': 58.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '263', 'valuenum': 263.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '150', 'valuenum': 150.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.24', 'valuenum': 4.24, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, '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': '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': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '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': '107', 'valuenum': 107.0, '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': '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': '16', 'valuenum': 16.0, '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': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', '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': '3.3', '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 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'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': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '31.2', 'valuenum': 31.2, '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': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 38.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '17.5', 'valuenum': 17.5, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '36', 'valuenum': 36.0, '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': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '1.7', 'valuenum': 1.7, '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 1.7,. Estimated GFR = 44 if non African-American (mL/min/1.73 m2). Estimated GFR = 53 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': 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': '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': '6.0', 'valuenum': 6.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '358', 'valuenum': 358.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '462', 'valuenum': 462.0, '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': 'NEGATIVE NO EOS SEEN.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 149.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 185.0, 'valueuom': '#/uL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'mg/dL', 'ref_range_lower': 15.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '6.1', 'valuenum': 6.1, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, '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': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, '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': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '18.9', 'valuenum': 18.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 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': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 335.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1375', 'valuenum': 1375.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '224', 'valuenum': 224.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '203', 'valuenum': 203.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '172', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '409', 'valuenum': 409.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'specimen lipemic.'}, {'value': '___', 'valuenum': 16.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LIPEMIC.'}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 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'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '6', 'valuenum': 6.0, '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': 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2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '177', 'valuenum': 177.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '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': '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': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '216', 'valuenum': 216.0, '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': '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': '3.5', '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': '19.7', 'valuenum': 19.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.21', 'valuenum': 3.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 10.3, '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': '1.2', '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 = 66 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': 130.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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': '193', 'valuenum': 193.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.4', 'valuenum': 2.4, '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': '3.5', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, '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': '138', 'valuenum': 138.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.1', 'valuenum': 20.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '419', 'valuenum': 419.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 37.1, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'DESIRABLE PH GREATER THAN 6.5; INTERPRET RESULTS ACCORDINGLY.'}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '36.7', 'valuenum': 36.7, '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': '144', 'valuenum': 144.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.2', 'valuenum': 36.2, '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': '133', 'valuenum': 133.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20.6', 'valuenum': 20.6, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '224', 'valuenum': 224.0, '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': '41', 'valuenum': 41.0, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, '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': '302', 'valuenum': 302.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION:\nVS: 98, 157/58, 67, 18, 96% RA\nGENERAL - obese woman in NAD, comfortable, appropriate\nHEENT - NC/AT, PERRLA, EOMI, sclerae anicteric, MMM, OP clear\nNECK - supple, no thyromegaly, no JVD, no carotid bruits\nLUNGS - CTA bilat, no r/rh/wh, good air movement, resp \nunlabored, no accessory muscle use\nHEART - PMI non-displaced, RRR, ___ systolic murmur, nl S1-S2\nABDOMEN - NABS, soft/NT/ND, no masses or HSM, no \nrebound/guarding\nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses (radials, DPs)\nSKIN - no rashes or lesions\nLYMPH - no cervical, axillary, or inguinal LAD\nNEURO - awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout\n.\nDISCHARGE:\nVS: 98.0, 140/79, 68, 98%RA\nGEN: Hispanic female laying in bed, comfortable Alert, oriented, \nno acute distress, breakfast at bed \nHEENT NCAT MMM EOMI sclera anicteric, OP clear \nNECK: large, supple, no JVD\nPULM: Good aeration, CTAB no wheezes, rales, ronchi \nCV: RRR normal S1/S2, no mrg\nABD: obese, soft, NT ND normoactive bowel sounds, no r/g \nEXT: no ___ edema, 2+ pulses palpable bilaterally, no c/c/e\nNEURO: CNs2-12 intact, motor function grossly normal \nSKIN: no ulcers or lesions', 'diagnoses': [{'icd_code': '042', 'desc': 'Human immunodeficiency virus [HIV] disease'}, {'icd_code': '32341', 'desc': 'Other encephalitis and encephalomyelitis due to other infections classified elsewhere'}, {'icd_code': '1175', 'desc': 'Cryptococcosis'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2536', 'desc': 'Other disorders of neurohypophysis'}, {'icd_code': '2867', 'desc': 'Acquired coagulation factor deficiency'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '1120', 'desc': 'Candidiasis of mouth'}, {'icd_code': '2630', 'desc': 'Malnutrition of moderate degree'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': 'E9300', 'desc': 'Penicillins causing adverse effects in therapeutic use'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '79029', 'desc': 'Other abnormal glucose'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': 'E9319', 'desc': 'Other and unspecified anti-infectives causing adverse effects in therapeutic use'}, {'icd_code': '78321', 'desc': 'Loss of weight'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}], 'summary': "ADMISSION:\n\n___ 04:25PM BLOOD WBC-4.7 RBC-4.30 Hgb-13.0 Hct-38.8 MCV-90 \nMCH-30.3 MCHC-33.6 RDW-13.8 Plt ___\n___ 04:25PM BLOOD Neuts-54.9 ___ Monos-11.8* \nEos-2.3 Baso-0.4\n___ 04:25PM BLOOD Plt ___\n___ 04:25PM BLOOD Glucose-104* UreaN-8 Creat-0.6 Na-142 \nK-3.5 Cl-105 HCO3-25 AnGap-16\n___ 04:25PM BLOOD ALT-21 AST-27 AlkPhos-89 TotBili-0.3\n___ 04:25PM BLOOD Lipase-27\n___ 04:25PM BLOOD Albumin-4.1\n___ 06:00AM BLOOD Calcium-8.6 Phos-3.7 Mg-1.8\n.\nIMAGING: \n(___) CT ABD - 1. Small hiatal hernia 2. No acute \nintra-abdominal process. \n.\nMICRO:\nUCx - none\n.\nDISCHARGE:\n\n___ 06:00AM BLOOD WBC-4.9 RBC-4.10* Hgb-12.2 Hct-37.0 \nMCV-90 MCH-29.7 MCHC-33.0 RDW-13.4 Plt ___\n___ 06:00AM BLOOD Glucose-89 UreaN-8 Creat-0.6 Na-142 K-3.3 \nCl-107 HCO3-26 AnGap-___\n&P: ___ history of GERD, hypertension, osteopenia, \nhypercholesterolemia, shoulder OA, cervical DJD, sent to ED from \n___'s office with symptoms of nausea, vomitting, diarrhea for \nfour days.\n.\n# N/V/D: pt's symptoms most consistent with viral \ngastroenteritis. No history of travel, exotic exposures. No \nevidence of infectious colitis or dysentery. No fever, no \nleukocytosis. Normal CT abdomen on ___, chemistry panel, LFTs, \nlipase all reassuring. Patient started on clears after admission \nto floor. No events overnight and tolerated regular diet in the \nmorning and lunch. She did not require further anti-nausea \nmedication, and did not have further diarrhea, nausea, or \nemesis. Last emesis/diarrhea was on ___ in AM. Pt is safe to \nreturn to work on ___. \n.\n-------\nCHRONIC\n-------\n# Hypertension: Patient was normotensive on her home lisinopril \nand hctz\n.\n# hypercholesterolemia: we continued the patient's home statin\n.\n# GERD: we continued the patient's home omeprazole, calcium \ncarbonate\n.\nTRANSITIONAL:\n- monitor diarrhea/emesis\n- Full Code"}}
|
{'final_diagnoses': ['Gastroenteritis'], 'procedures': ['none'], 'visit_summary': "&P: ___ history of GERD, hypertension, osteopenia, \nhypercholesterolemia, shoulder OA, cervical DJD, sent to ED from \n___'s office with symptoms of nausea, vomitting, diarrhea for \nfour days.\n.\n# N/V/D: pt's symptoms most consistent with viral \ngastroenteritis. No history of travel, exotic exposures. No \nevidence of infectious colitis or dysentery. No fever, no \nleukocytosis. Normal CT abdomen on ___, chemistry panel, LFTs, \nlipase all reassuring. Patient started on clears after admission \nto floor. No events overnight and tolerated regular diet in the \nmorning and lunch. She did not require further anti-nausea \nmedication, and did not have further diarrhea, nausea, or \nemesis. Last emesis/diarrhea was on ___ in AM. Pt is safe to \nreturn to work on ___. \n.\n-------\nCHRONIC\n-------\n# Hypertension: Patient was normotensive on her home lisinopril \nand hctz\n.\n# hypercholesterolemia: we continued the patient's home statin\n.\n# GERD: we continued the patient's home omeprazole, calcium \ncarbonate\n.\nTRANSITIONAL:\n- monitor diarrhea/emesis\n- Full Code", 'medications_prescribed': ['1. Calcium Carbonate 500 mg PO TID W/MEALS', '2. Hydrochlorothiazide 25 mg PO DAILY', '3. Lisinopril 40 mg PO DAILY', 'hold for sbp < 90', '4. Omeprazole 40 mg PO QAM', '5. Simvastatin 10 mg PO DAILY', '6. Vitamin D 800 UNIT PO DAILY']}
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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': 'Urinary Incontinence', 'medical_history': ['seizures, possibly alcohol withdrawal', 'alcohol dependence', 'depression', 'arthritis', 'gout', 'gastric bypass', 'diabetes prior to gastric bypass', 'HTN'], 'family_history': 'Brother with seizures, attributed to alcohol. Both parents with \nstroke.', 'present_illness': "___ w/history of seizures esp. in the setting of EtOH withdrawal \n(in ___ and ___ for which he has been on levetiracetam, \nnow presenting with urinary incontinence in the setting of EtOH \nintoxication. Per patient's girlfriend/fiance, he was found at 9 \nam on ___ he was intoxicated with a drink in his hand. He \nthen had three episodes of urinary incontinence 10 am, 12 pm and \n2 pm. No convulsive movement with noted then, and he appeared to \nbe at his baseline mental status, but somewhat confused with \nslurred speech. He fell en route to the bathroom during the \nthird episode, but there was no noted head trauma. Patient's \ngirlfriend called ___, \n___ denies aureas, including flashing lights, particular memories \nor dejavus, lip smacking, other stereotypies. In past seizures \nfamily has reported pt walking around in circles. However, at \nthis time, this episode was not witnessed. ___ was only noted to \nbe on ground and incontinent. \n\nIN the ED: initial VS were: 98.2 ___ 20 100%RA. \n___ had CT head with no acute bleed and no significant trauma. ___ \nwas seen by neurology due to seizures and felt that it was due \nto ETOH w/drawal. ___ initial ETOH level was 468. ___ placed in \nthe observation unit overnight until sober. During the morning \npt HR peaked at 150 and he was tremulous. ___ was giving 4 mg \nlorazepam and ___s his home dose of Keppra. Pt \nreceived a total of 3.5 IVF while in the ED. He was transferred \nto the MICU for closer monitoring.", 'medications': [{'medication': 'CloNIDine', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Lidocaine Viscous 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'benzocaine', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID: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}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Propranolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CloNIDine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Prazosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acamprosate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Methylphenidate SR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QAM', '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': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'QAM', 'doses_per_24_hrs': 1.0}, {'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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Citalopram', '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', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'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': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Buprenorphine-Naloxone Tablet (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Methylphenidate SR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Buprenorphine-Naloxone Tablet (8mg-2mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Methylphenidate SR', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Diazepam', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM:PRN', 'doses_per_24_hrs': None}, {'medication': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', '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': 'Divalproex (DELayed Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MethylPHENIDATE (Ritalin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prazosin', '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', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Perphenazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 5.7, '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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '5.0', 'valuenum': 5.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '64', 'valuenum': 64.0, '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': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '3.3', 'valuenum': 3.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, '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': '176', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 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': 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': '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': 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': 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': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mIU/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 100000.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<5. Values <5 are negative. values 5-25 are Equivocal. values >25 are Positive.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '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': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '33.9', 'valuenum': 33.9, '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': '204', 'valuenum': 204.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.29', 'valuenum': 4.29, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION EXAM:\nVitals: T: BP: 156/106 P:123 R: 18 O2:100 \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, \nSwollen R jaw with contusion ( from previous fall) \nNeck: supple, JVP not elevated, no LAD \nCV: Tachy rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nAbdomen: soft, non-tender, non-distended, bowel sounds present, \nno organomegaly \nGU: no foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro: CNII-XII intact, ___ strength upper/lower extremities, \ngrossly normal sensation, 2+ reflexes bilaterally, gait \ndeferred, finger-to-nose intact, tremulous \n\nDISCHARGE EXAM:\nVS: 98.6 93 122/80 20 98%\nGENERAL - Alert, interactive, well-appearing in NAD \nHEENT - PERRLA, EOMI, sclerae anicteric, MMM, OP clear \nHEART - RRR, nl S1-S2, no MRG \nLUNGS - CTAB, no murmurs, rub, gallops \nABDOMEN - NABS, soft/NT/ND, no masses or HSM \nEXTREMITIES - WWP, no c/c/e, 2+ peripheral pulses \nNEURO - awake, A&Ox3, CNs II-XII grossly intact', 'diagnoses': [{'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'R440', 'desc': 'Auditory hallucinations'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'F4310', 'desc': 'Post-traumatic stress disorder, unspecified'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}, {'icd_code': 'F1021', 'desc': 'Alcohol dependence, in remission'}, {'icd_code': 'F1190', 'desc': 'Opioid use, unspecified, uncomplicated'}, {'icd_code': 'G40909', 'desc': 'Epilepsy, unspecified, not intractable, without status epilepticus'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'G8929', 'desc': 'Other chronic pain'}, {'icd_code': 'M549', 'desc': 'Dorsalgia, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}, {'icd_code': 'F909', 'desc': 'Attention-deficit hyperactivity disorder, unspecified type'}, {'icd_code': 'K0889', 'desc': 'Other specified disorders of teeth and supporting structures'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'R441', 'desc': 'Visual hallucinations'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z62810', 'desc': 'Personal history of physical and sexual abuse in childhood'}, {'icd_code': 'Z590', 'desc': 'Homelessness'}, {'icd_code': 'Z915', 'desc': 'Personal history of self-harm'}, {'icd_code': 'Z8619', 'desc': 'Personal history of other infectious and parasitic diseases'}], 'summary': 'ADMISSION LABS:\n\n___ 08:55PM WBC-5.1 RBC-3.89*# HGB-12.8*# HCT-38.0*# \nMCV-98 MCH-32.8* MCHC-33.6 RDW-15.9*\n___ 08:55PM NEUTS-58.7 ___ MONOS-5.2 EOS-0.2 \nBASOS-0.5\n___ 08:55PM PLT COUNT-120*\n___ 08:55PM ASA-NEG ___ ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 08:55PM CALCIUM-8.6 PHOSPHATE-2.2* MAGNESIUM-1.6\n___ 08:55PM GLUCOSE-134* UREA N-12 CREAT-0.7 SODIUM-136 \nPOTASSIUM-3.9 CHLORIDE-96 TOTAL CO2-21* ANION GAP-23*\n\nIMAGING:\nCT HEAD ___:\nIMPRESSION: No intracranial hemorrhage or mass effect. Small \nright vertex scalp hematoma is likely residual from ___. \n___. ___ \n___. ___\n\nCXR ___:\nFINDINGS: As compared to the previous radiograph, there is no \nrelevant \nchange. Low lung volumes. Borderline size of the cardiac \nsilhouette without evidence of pulmonary edema. No pleural \neffusions. No pneumonia. No atelectasis. No pneumothorax. \n \n___. ___\n\nCT C-SPINE ___:\nFINDINGS: No acute cervical spine fracture or malalignment is \ndetected. The prevertebral soft tissues are normal. No \nsignificant spinal canal stenosis or neural foraminal narrowing \nis seen. Mild disc bulge is seen at C5-C6 level. The imaged \nportion of the thyroid gland and lung apices are unremarkable. \n\nIMPRESSION: No cervical spine fracture or malalignment. \n___. ___ \n___. ___\n\n___ HEAD ___:\nIMPRESSION: No acute intracranial pathology. Resolving right \nparietal \nsubgaleal hematoma. \n___. ___ \n___. ___\n\n___ ABDOMEN/PELVIS ___:\nIMPRESSION: No acute intra-abdominal or thoracic traumatic \ninjury. Mild \nbruising in the left gluteal soft tissues. \n___. ___ \n___. ___\n\n___ CHEST ___:\nIMPRESSION: No acute intra-abdominal or thoracic traumatic \ninjury. Mild \nbruising in the left gluteal soft tissues. \n___. ___ \n___. ___\n\n___ LABS:\n\n___ 06:10AM BLOOD WBC-4.5 RBC-2.77* Hgb-9.1* Hct-28.9* \nMCV-104* MCH-32.8* MCHC-31.4 RDW-16.5* Plt ___\n___ 06:10AM BLOOD Plt ___\n___ 06:10AM BLOOD Glucose-73 UreaN-11 Creat-0.6 Na-143 \nK-4.1 Cl-108 HCO3-28 AnGap-11\n___ 06:10AM BLOOD ALT-64* AST-88* AlkPhos-204* TotBili-1.0\n___ 06:10AM BLOOD Calcium-8.6 Phos-2.5* Mg-1.9\n___ 08:10AM BLOOD TSH-6.9*\n___ 06:10AM BLOOD %HbA1c-5.0 eAG-\n___ PMH seizures ___ alcohol withdrawal), alcohol dependence, \ndepression, HTN, OA, gout, s/p gastric bypass, DM (prior to \ngastric bypass) presented to the ED after drinking and passing \nout and incontinent of urine and thought to be having a seizure \nby girlfriend.\n\n#Seizure- Most likly due to ETOH withdrawal with pt history of \ndrinking and prior seizures. ___ was supposed to see neuro on \n___ due to seizures, was seen by Neuro in ED who was unsure \nthat he had a seizure prior to admission, but recommended \ncontinuing Keppra with outpatient follow-up. He was monitored \non CIWA continuously in MICU and on the floor. After 72h his \nmental status drastically improved, he was no long agitated and \nCIWA was discontinued. He was seen by social work and pt. \naccepted list of all AA meetings in ___ area. He was \nalso treated with MV, Thiamine and folate.\n\n#Transaminitis: likely acute alcoholic hepatitis given AST/ALT \nratio ~2:1. His transaminases were trended during his hospital \nstay and trended down prior to admission.\n\n#HTN: stable, he was continued on home lisinopril\n\n#Depression: he was continued on home sertaline \n\n#arthritis- causes chronic pain, he was treated with Tylenol prn\n\n#gout- no sxs of acute gout flare, he was monitored for acute \nflair while hospitalized. \n\n#diabetes- prior to gastric bypass, fingerstick BG 180s this \nmorning on. A1c on this admission was 5.0. His glucose was \nmonitored and he was covered with Insulin SCC.'}}
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{'final_diagnoses': ['Acute Alcohol Withdrawal'], 'procedures': ['None'], 'visit_summary': '___ PMH seizures ___ alcohol withdrawal), alcohol dependence, \ndepression, HTN, OA, gout, s/p gastric bypass, DM (prior to \ngastric bypass) presented to the ED after drinking and passing \nout and incontinent of urine and thought to be having a seizure \nby girlfriend.\n\n#Seizure- Most likly due to ETOH withdrawal with pt history of \ndrinking and prior seizures. ___ was supposed to see neuro on \n___ due to seizures, was seen by Neuro in ED who was unsure \nthat he had a seizure prior to admission, but recommended \ncontinuing Keppra with outpatient follow-up. He was monitored \non CIWA continuously in MICU and on the floor. After 72h his \nmental status drastically improved, he was no long agitated and \nCIWA was discontinued. He was seen by social work and pt. \naccepted list of all AA meetings in ___ area. He was \nalso treated with MV, Thiamine and folate.\n\n#Transaminitis: likely acute alcoholic hepatitis given AST/ALT \nratio ~2:1. His transaminases were trended during his hospital \nstay and trended down prior to admission.\n\n#HTN: stable, he was continued on home lisinopril\n\n#Depression: he was continued on home sertaline \n\n#arthritis- causes chronic pain, he was treated with Tylenol prn\n\n#gout- no sxs of acute gout flare, he was monitored for acute \nflair while hospitalized. \n\n#diabetes- prior to gastric bypass, fingerstick BG 180s this \nmorning on. A1c on this admission was 5.0. His glucose was \nmonitored and he was covered with Insulin SCC.', 'medications_prescribed': ['1. Lisinopril 5 mg PO DAILY', '2. FoLIC Acid 1 mg PO DAILY \nRX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', '3. LeVETiracetam 1000 mg PO BID \nRX *levetiracetam [Keppra] 1,000 mg 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*0', '4. Multivitamins 1 TAB PO DAILY \nRX *multivitamin [Daily Multiple] 1 tablet(s) by mouth daily \nDisp #*30 Tablet Refills:*0', '5. Sertraline 50 mg PO DAILY \nRX *sertraline 50 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0', '6. Thiamine 100 mg PO DAILY \nRX *thiamine HCl 100 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'hypotension/Tachycardia.', 'medical_history': ['T2N0M0 SCC of the lateral tongue', 'T1N0M0 SCC of the esophagus', 'Hypertension', 'GERD', 'Polymyalgia rheumatica: Diagnosed about ___ years ago for the \nsymptoms of hand swelling/stiffness. Started on steroid ___ mg \ndaily and was slowly tapered off over couple years. Pt was on \n1mg prednisone until ___ - then recently re-started last \n___ admission.'], 'family_history': 'No family history of oral or GI cancers.', 'present_illness': '___ male with h/o of SCC of the tongue and mid-esophagus s/p \nhemiglossectomy and modified lateral neck resection now getting \npost-OP RT who presents with diarrhea, inability to take PO, and \nshortness of breath. He initially presented to radiation for \ntreatment ___ today. He was noted to be orthostatic and \ntachycardic with O2 sats in the ___ and sent to the ED. The \npatient reports diarrhea which started the night priot to \nadmission. \n. \nIn the ED, initial vitals were 99.4 99 111/53 24 97% 6L NC. He \nreceived 2500 cc IVF total. CXR showed multifocal PNA. ECG \nshowed lateral ST depression in V5/V6 and AVL and he was given \naspirin and started on a heparin gtt at 700 units/hr. Guaiac \nnegative. Lactate 3.8, unchanged after 3L IVF. CTA showed no PE. \nHe was given CTX and Azithro for CAP. T max: 103. Vitals prior \nto transfer: 99.3 87-130/65-77, NRB mask w/ sats 96-98%. 130/65, \nwas not initally hypotensive in the ED, however developed \nhypotension with systolics in the ___. An IJ was placed and he \nwas started on levophed and last bp 92/47. He was expanded to \nlevofloxacin prior to transfer to ___ MICU. \n. \nUpon arrival to the MICU, patient feels well with no complaints. \nHe is on NRB with appropriate saturations. \n. \n(+) Per HPI\n(-) Denies chills, night sweats, recent weight loss or gain. \nDenies headache, sinus tenderness, rhinorrhea or congestion. \nDenied cough, shortness of breath. Denied chest pain or \ntightness, palpitations. Denied nausea, vomiting, constipation \nor abdominal pain. No recent change in bladder habits. No \ndysuria. Denied arthralgias or myalgias.', 'medications': [{'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', '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': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Losartan Potassium', '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:PRN', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '332', 'valuenum': 332.0, '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': '3.18', 'valuenum': 3.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '8.6', 'valuenum': 8.6, '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': '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': '50', 'valuenum': 50.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '287', 'valuenum': 287.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '3.4', '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': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '221', 'valuenum': 221.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, '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': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission:\nVitals: T:96.4 BP:116/66 P:101 R: 18 O2: 92% NRB \nGeneral: Alert, oriented, no acute distress \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNeck: supple, JVP not elevated, no LAD \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nAbdomen: soft, non-tender, mildly distended, bowel sounds \npresent, no rebound tenderness or guarding, no organomegaly, G \ntube in place with bandage c/d/i \nGU: foley \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema', 'diagnoses': [{'icd_code': '38611', 'desc': 'Benign paroxysmal positional vertigo'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '2449', 'desc': 'Unspecified acquired hypothyroidism'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': "On admission:\n___ 03:45PM BLOOD WBC-11.5* RBC-4.53* Hgb-14.6 Hct-43.4 \nMCV-96 MCH-32.2* MCHC-33.6 RDW-14.3 Plt ___\n___ 03:45PM BLOOD Neuts-84* Bands-4 Lymphs-4* Monos-4 Eos-0 \nBaso-0 ___ Metas-2* Myelos-2*\n___ 03:45PM BLOOD Glucose-159* UreaN-21* Creat-1.4* Na-143 \nK-4.0 Cl-101 HCO3-26 AnGap-20\n___ 02:45AM BLOOD Albumin-3.3* Calcium-7.7* Phos-4.1# \nMg-1.5*\n___ 03:45PM BLOOD ALT-14 AST-28 LD(LDH)-338* AlkPhos-54 \nTotBili-0.9\n.\n___ 03:45PM BLOOD cTropnT-<0.01 \n___ 02:45AM BLOOD CK-MB-3 cTropnT-0.01 CK(CPK)-201\n___ 08:13AM BLOOD CK-MB-5 cTropnT-<0.01 08:13AM BLOOD \nCK(CPK)-196\n___ 03:45PM BLOOD proBNP-4386*\n___ 03:45PM BLOOD D-Dimer-2479*\n___ 03:56PM BLOOD Lactate-3.8* \n___ 05:33PM BLOOD Lactate-1.6\n.\n___ Blood cultures x 2: ********** \n___ Urine culture: ********** \n___ 2:46 am URINE Source: Catheter. \n Legionella Urinary Antigen (Final ___: \n NEGATIVE FOR LEGIONELLA SEROGROUP 1 ANTIGEN. \n.\n___ CXR: \n1. Multifocal pneumonia or aspiration. \n2. Emphysema. \n.\n___ CTA Chest:\n1. Multifocal pneumonia. \n2. Emphysema and mild cardiomegaly. \n3. No evidence of PE. \n.\n___ CT head:\n1. No acute intracranial process. Chronic involutional changes. \n2. No significant mass effect identified. If there is clinical \nconcern for intracranial metastases, MR would be a more \nsensitive examination. \n.\n___ TTE: The left atrium is markedly dilated. The right \natrium is moderately dilated. Left ventricular wall thickness, \ncavity size and regional/global systolic function are normal \n(LVEF >55%). Right ventricular chamber size and free wall motion \nare normal. The ascending aorta is mildly dilated. The aortic \nvalve leaflets (3) are mildly thickened but aortic stenosis is \nnot present. Trace aortic regurgitation is seen. The mitral \nvalve leaflets are mildly thickened. Mild (1+) mitral \nregurgitation is seen. The pulmonary artery systolic pressure \ncould not be determined. IMPRESSION: Normal global and regional \nbiventricular systolic function. Mild mitral regurgitation. Mild \naortic dilation. Mild to moderate tricuspid regurgitation.\n.\n___ M w/hx of ___ s/p XRT who presents with shortness of \nbreath, hypoxia and multifocal PNA. \n\n# Multifocal pneumonia: Pt started on vancomycin, unasyn, and \nlevofloxacin to cover CAP v. aspiration pneumonia in an \nimmunocompromised patient. Unable to obtain sputum for culture; \nurine legionella Ag neg. PCP considered due to prednisone use \nsince ___ but distribution of infiltrates on imaging not \nconsistent. Pt was initially maintained on face mask overnight \nbut weaned easily to NC, satting 92% on 4L on transfer to the \nfloor.On the floor had episodes of desaturation to 80's. Repeat \ncxr showed development of pleural effusions,rt>lt and worsening \nof consolidation.Unasyn was switched to zosyn and pt also \nunderwent a diagnostic and therapeutic rt sided thoracentesis. 1 \nlit of fluid was drained which was c/w a non-complicated \nparapneumonitic effusion. Speech & swallow consulted to evaluate \naspiration risk he also underwent a video assisted swallow \nstudy. S&S services recommended a a diet of thin liquids and \nground solids.\nOn d/c pt started on bactrim prophylaxis as he is continued on \nprednisone 30 mg daily for PMR.\n.\n# Hypoxic Respiratory Failure: Attributed to multifocal PNA as \nabove as well as volume overload which developed after INF \nhydration for hypotension. No PE seen on CTA chest. Initial \nconcern for ACS leading to acute CHF (see below) but ruled out; \necho showing normal EF. Hypoxia improved with treatment of \npneumonia, thoracentesis and diureses.On d/c pt'd O2 sat 99 on 3 \nlit per NC.Pt also likely has COPD and was treated with nebs and \nstarted on advair.\n \n#. Shock: Likely combination of septic and hypotensive shock. Pt \ntreated for pneumonia as above; cultures were all negative.He \nwas also fluid-resuscitated and weaned off low-dose \nnorepinephrine. Stress dose steroids were not needed. As above, \nno evidence of cardiogenic shock. However, other etiologies \ninclude cardiogenic in setting of NSTEMI. Also, hypovolemic from \ndiarrhea. Right IJ pulled prior to floor transfer.On th efloor \nblood remained stable.\n\n#. NSTEMI: ECG with lateral ST depressions and mild ST elevation \nin v1/v2. Pt started on ASA and heparin gtt. However, Cards \nfellow felt this was more consistent with early repolarization \nfrom LVH. EKG normalized in AM and cardiac enzymes neg x 2. Echo \nwith no wall motion abnormality and normal EF. Heparin gtt \ndiscontinued but aspirin continued.\n \n# New onset atrial fibrillation: Did not aggresively rate \ncontrol for HR in low 100\x92s initially given underlying \nhypotension. No evidence of PE on CTA. Left atrium markedly \ndilated and right atrium moderately dilated on TTE. Thought \nlikely due to increased sympathetic tone in setting of illness \nand hypovolemia. Pt spontaneously converted back to a sinus \nrhythm in the MICU.On the floor pt had asymptomatic episodes of \na.fib with RVR. He was initially treated with restarting \nmetoprolol, however,given recurrent episodes of RVR and COPD , \nmetoprolol was discontinued and pt started on a low dose of \ndiltiazam. Therafter, pt converted back to sinus and remained in \nsinus.\n\n# Acute Renal Failure: Pre-renal in setting of hypovolemia and \nshock. Cr peaked at 1.4 but returned to baseline and remained \nstable. On d/c crea 1.2.\n \n#. Diarrhea: Unclear precipitant. Guaiac negative. Stool studies \nordered, but pt without further diarrhea while in-house...\n\n#. SCC of tongue/esophagus: Stable. XRT held on day of admission \nbut resumed ___ to continue radiation treatment adn f/u \nwith Dr ___. \n\n#. GERD: Continued on omeprazole."}}
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{'final_diagnoses': ['Multilobar pneumonia', 'Sepsis', 'Pleural effusion', 'Acute renal failure', 'Squamous cell cancer of the tongue-on radiation treatment', 'Early stage cancer of teh esophagus s/p resection', 'Atrial fibrillation', 'Polymyalgia rheumatica-on ___ term prednisone'], 'procedures': ['RIJ placement', 'rt thoracentesis ___'], 'visit_summary': "___ M w/hx of ___ s/p XRT who presents with shortness of \nbreath, hypoxia and multifocal PNA. \n\n# Multifocal pneumonia: Pt started on vancomycin, unasyn, and \nlevofloxacin to cover CAP v. aspiration pneumonia in an \nimmunocompromised patient. Unable to obtain sputum for culture; \nurine legionella Ag neg. PCP considered due to prednisone use \nsince ___ but distribution of infiltrates on imaging not \nconsistent. Pt was initially maintained on face mask overnight \nbut weaned easily to NC, satting 92% on 4L on transfer to the \nfloor.On the floor had episodes of desaturation to 80's. Repeat \ncxr showed development of pleural effusions,rt>lt and worsening \nof consolidation.Unasyn was switched to zosyn and pt also \nunderwent a diagnostic and therapeutic rt sided thoracentesis. 1 \nlit of fluid was drained which was c/w a non-complicated \nparapneumonitic effusion. Speech & swallow consulted to evaluate \naspiration risk he also underwent a video assisted swallow \nstudy. S&S services recommended a a diet of thin liquids and \nground solids.\nOn d/c pt started on bactrim prophylaxis as he is continued on \nprednisone 30 mg daily for PMR.\n.\n# Hypoxic Respiratory Failure: Attributed to multifocal PNA as \nabove as well as volume overload which developed after INF \nhydration for hypotension. No PE seen on CTA chest. Initial \nconcern for ACS leading to acute CHF (see below) but ruled out; \necho showing normal EF. Hypoxia improved with treatment of \npneumonia, thoracentesis and diureses.On d/c pt'd O2 sat 99 on 3 \nlit per NC.Pt also likely has COPD and was treated with nebs and \nstarted on advair.\n \n#. Shock: Likely combination of septic and hypotensive shock. Pt \ntreated for pneumonia as above; cultures were all negative.He \nwas also fluid-resuscitated and weaned off low-dose \nnorepinephrine. Stress dose steroids were not needed. As above, \nno evidence of cardiogenic shock. However, other etiologies \ninclude cardiogenic in setting of NSTEMI. Also, hypovolemic from \ndiarrhea. Right IJ pulled prior to floor transfer.On th efloor \nblood remained stable.\n\n#. NSTEMI: ECG with lateral ST depressions and mild ST elevation \nin v1/v2. Pt started on ASA and heparin gtt. However, Cards \nfellow felt this was more consistent with early repolarization \nfrom LVH. EKG normalized in AM and cardiac enzymes neg x 2. Echo \nwith no wall motion abnormality and normal EF. Heparin gtt \ndiscontinued but aspirin continued.\n \n# New onset atrial fibrillation: Did not aggresively rate \ncontrol for HR in low 100\x92s initially given underlying \nhypotension. No evidence of PE on CTA. Left atrium markedly \ndilated and right atrium moderately dilated on TTE. Thought \nlikely due to increased sympathetic tone in setting of illness \nand hypovolemia. Pt spontaneously converted back to a sinus \nrhythm in the MICU.On the floor pt had asymptomatic episodes of \na.fib with RVR. He was initially treated with restarting \nmetoprolol, however,given recurrent episodes of RVR and COPD , \nmetoprolol was discontinued and pt started on a low dose of \ndiltiazam. Therafter, pt converted back to sinus and remained in \nsinus.\n\n# Acute Renal Failure: Pre-renal in setting of hypovolemia and \nshock. Cr peaked at 1.4 but returned to baseline and remained \nstable. On d/c crea 1.2.\n \n#. Diarrhea: Unclear precipitant. Guaiac negative. Stool studies \nordered, but pt without further diarrhea while in-house...\n\n#. SCC of tongue/esophagus: Stable. XRT held on day of admission \nbut resumed ___ to continue radiation treatment adn f/u \nwith Dr ___. \n\n#. GERD: Continued on omeprazole.", 'medications_prescribed': ['prednisone 10 mg Tablet Sig: Three (3) Tablet PO DAILY \n(Daily).', 'omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', 'guaifenesin 100 mg/5 mL Syrup Sig: ___ MLs PO Q6H (every 6 \nhours) as needed for cough for 7 days.', 'senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.', 'acetaminophen 325 mg Tablet Sig: ___ Tablets PO Q6H (every 6 \nhours) as needed for fever, pain for 7 days.', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).', 'aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day).', 'ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation \nQ6H (every 6 hours) as needed for shortness of breath or \nwheezing.', 'diltiazem HCl 30 mg Tablet Sig: 0.5 Tablet PO QID (4 times a \nday).']}
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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': 'dyspnea, back pain, urinary frequency', 'medical_history': ['HIV', 'Diastolic CHF', 'Hepatitis B and C', 'Hepatic steatosis', 'Reported syphilis', 'Recurrent UTIs', 'Recurrent cystitis', 'Asthma', 'OSA', 'Ovarian cancer', 'Morbid obesity', 'Chronic back pain', 'Osteoarthritis', 'Prolonged QTc', 'H/o DVT', 'Osteomyelitis', 'H/o alcohol dependence', 'H/o IVDA', 'H/o opioid dependence', 'Anxiety disorder', 'Depression', '?Bipolar disorder', 'Migraine Headaches'], 'family_history': 'Father: CAD, HTN\nMother: ESRD, multiple CVAs, CHF, HTN \nAunt: ___', 'present_illness': ' Ms. ___ is ___ year-old lady with history of stable HIV on \nHAART, HBV, HCV, chronic LBP/former opioid dependency on \nmethadone presenting with multiple complaints including \nright-sided lumbar pain, worsening dyspnea, subjective fevers \nand urinary frequency. Given UA with pyuria and previous hx of \nresistant UTIs she got levofloxacin x1 and meropenem x1 in ED. \nShe had negative CT Abdomen/Pelvis, LENIs and CXR significant \nfor pulmonary edema. \n Subjective: Clarifying symptom chronology: \n -Dyspnea/Lower extremity edema: chronic but worsened over last \n2 weeks \n -Urinary frequency / subjective fevers: 1 month \n -Right sided lumbar pain: "months" \n ROS: Denies chills, productive cough, dysuria, ', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H: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': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone Cream 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID: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}]}, 'clinical_findings': {'labs': [{'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': '20', 'valuenum': 20.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': 'ON ADMISSION:\n\nVS: 98.3 | 106 / 65 | 81 | 18 | 91 3L NC \n GENERAL: Chronically ill-appearing, morbidly obese female in no \nacute distress \n HEENT - no conjunctival pallor or scleral icterus, EOMI, OP \nclear. \n NECK: Supple, could not asses JVP. \n CARDIAC: Distant heart sounds, but RRR, normal S1/S2, no \nmurmurs \n PULMONARY: + Wheezes anteriorly and posteriorly, moderate air \nmovement, no crackles \n ABDOMEN: Normal bowel sounds, soft, non-tender. Mild TTP in \nright lumbar region, unable to assess CVAT fully. \n EXTREMITIES: Warm, well-perfused, +2 bilateral ___ edema \n SKIN: Without rash. \n NEUROLOGIC: A&Ox3, grossly normal \n\nON DISCHARGE:\n99.2 114 / 61 78 18 95 RA \n GENERAL: Chronically ill-appearing, morbidly obese female in no \nacute distress \n HEENT - no conjunctival pallor or scleral icterus, EOMI, OP \nclear. \n NECK: Supple, could not asses JVP. \n CARDIAC: Distant heart sounds, but RRR, normal S1/S2, no \nmurmurs \n PULMONARY: + Wheezes anteriorly and posteriorly, moderate air \nmovement, no crackles \n ABDOMEN: Normal bowel sounds, soft, non-tender. Mild TTP in \nright lumbar region, unable to assess CVAT fully. \n EXTREMITIES: Warm, well-perfused, +2 bilateral ___ edema \n SKIN: Without rash. \n NEUROLOGIC: A&Ox3, grossly normal ', 'diagnoses': [{'icd_code': '29620', 'desc': 'Major depressive affective disorder, single episode, unspecified'}, {'icd_code': '6929', 'desc': 'Contact dermatitis and other eczema, unspecified cause'}, {'icd_code': '6262', 'desc': 'Excessive or frequent menstruation'}, {'icd_code': 'V623'}], 'summary': "Provider ___ ___) with access to WebOMR, please see \nWebOMR\n___ F with hx of morbid obesity HIV on HAART, HBV, HCV, chronic \nlow-back pain / former opioid abuse on methadone who presented \nwith 1)dyspnea 2)right lumbar pain 3)subjective fevers 4)urinary \nfrequency. \n\n#Dyspnea - hypoxia: SaO2 on admission 83%RA, was diuresed with \nLasix 20mg iv bid for 2 days with resulting 48h fluid balance of \n-6.5L. Dyspnea resolved and edema improved. O2sat on RA up to \n86-91% depending on sleep/wake cycle. OSA and \nobesity-hypoventilation syndrome are likely contributors to her \nbaseline hypoxia as well as her asthma. Given unclear O2 \nbaseline and recent lower extremity trauma, PE was ruled out by \nlow probability V/Q scan (CT not feasible given iodinated \ncontrast allergy - hives, dyspnea). Was previously on home O2 as \noutpatient but then declined, declined again during this \nadmission. Admission weight 178.49kg. Discharge weight 171kg.\n\n#Low back pain: Chronic but exacerbated during this admission. \nRestricted mobility due to edema as well as morbid obesity. CT \nAbdomen/Pelvis negative for lithiasis, pyelonephritis. \nIncidentally worsened degenerative changes in lumbar spine. \nDeferred further work-up and titration of narcotics to \noutpatient care.\n\n#Subjective fevers: received one dose of meropenem in ED but \nthen was off antibiotics given lack of clear evidence for \ninfection. Did not have any fevers or low grade temperatures \ninpatient. \n\n#Urinary frequency: Going on for at least one month. Per Dr. \n___ reported similar symptoms in the past ___ years. We \nconsidered her abnormal UA asymptomatic bacteriuria. \n\nTRANSITIONAL ISSUES\n#Foley: Given need for diuretic therapy and patient's immobility \nkept Foley at discharge. She is aware of the risks and potential \nbenefit. Please revisit need for this. \n#?Cirrhosis: Certainly at risk given HCV and HBV. CT Abdomen and \nPelvis in ED incidentally showed nodular liver contour. Consider \nHCV treatment. "}}
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{'final_diagnoses': ['Diastolic heart failure, decompensated', 'Obesity-hypoventilation syndrome', 'Chronic low-back pain'], 'procedures': ['None'], 'visit_summary': "___ F with hx of morbid obesity HIV on HAART, HBV, HCV, chronic \nlow-back pain / former opioid abuse on methadone who presented \nwith 1)dyspnea 2)right lumbar pain 3)subjective fevers 4)urinary \nfrequency. \n\n#Dyspnea - hypoxia: SaO2 on admission 83%RA, was diuresed with \nLasix 20mg iv bid for 2 days with resulting 48h fluid balance of \n-6.5L. Dyspnea resolved and edema improved. O2sat on RA up to \n86-91% depending on sleep/wake cycle. OSA and \nobesity-hypoventilation syndrome are likely contributors to her \nbaseline hypoxia as well as her asthma. Given unclear O2 \nbaseline and recent lower extremity trauma, PE was ruled out by \nlow probability V/Q scan (CT not feasible given iodinated \ncontrast allergy - hives, dyspnea). Was previously on home O2 as \noutpatient but then declined, declined again during this \nadmission. Admission weight 178.49kg. Discharge weight 171kg.\n\n#Low back pain: Chronic but exacerbated during this admission. \nRestricted mobility due to edema as well as morbid obesity. CT \nAbdomen/Pelvis negative for lithiasis, pyelonephritis. \nIncidentally worsened degenerative changes in lumbar spine. \nDeferred further work-up and titration of narcotics to \noutpatient care.\n\n#Subjective fevers: received one dose of meropenem in ED but \nthen was off antibiotics given lack of clear evidence for \ninfection. Did not have any fevers or low grade temperatures \ninpatient. \n\n#Urinary frequency: Going on for at least one month. Per Dr. \n___ reported similar symptoms in the past ___ years. We \nconsidered her abnormal UA asymptomatic bacteriuria. \n\nTRANSITIONAL ISSUES\n#Foley: Given need for diuretic therapy and patient's immobility \nkept Foley at discharge. She is aware of the risks and potential \nbenefit. Please revisit need for this. \n#?Cirrhosis: Certainly at risk given HCV and HBV. CT Abdomen and \nPelvis in ED incidentally showed nodular liver contour. Consider \nHCV treatment. ", 'medications_prescribed': ['1. Albuterol Inhaler 2 PUFF IH Q4H:PRN SOB', '2. ALPRAZolam 0.5 mg PO TID:PRN anxiety \nRX *alprazolam 0.5 mg 1 tablet(s) by mouth three times a day \nDisp #*6 Tablet Refills:*0', '3. Cyclobenzaprine 10 mg PO TID:PRN muscle spasm', '4. Docusate Sodium 100 mg PO BID:PRN constipation', '5. DULoxetine 30 mg PO DAILY', '6. Fluticasone Propionate 110mcg 2 PUFF IH BID', '7. Fluticasone Propionate NASAL 2 SPRY NU DAILY', '8. Gabapentin 300 mg PO TID', '9. Guaifenesin ER 600 mg PO Q12H', '10. HydrOXYzine 25 mg PO BID', '11. Methadone 10 mg PO TID', '12. Metoprolol Succinate XL 25 mg PO DAILY', '13. Senna 8.6 mg PO BID:PRN constipation', '14. Stribild (elviteg-cobi-emtric-tenofo dis) ___ mg \nORAL DAILY', '15. Sumatriptan Succinate 100 mg PO DAILY:PRN migraine', '16. Furosemide 20 mg PO DAILY \nRX *furosemide 20 mg 1 tablet(s) by mouth daily Disp #*7 Tablet \nRefills:*0', '17. Potassium Chloride 25 mEq PO DAILY \nRX *potassium chloride [Klor-Con/25] 25 mEq 1 packet(s) by mouth \ndaily Disp #*7 Packet Refills:*0', '18. DiphenhydrAMINE 25 mg PO Q6H:PRN allergy', '19. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain']}
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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': ['S/P aortic valve replacement', 'COPD', 'Hyperlipidemia', 'Hypothyroidism', 'Depression', 'H/O posterior-inferior pancreatico-duodnal artery \npseudoaneurym, S/P coiling by vascular surgery'], 'family_history': 'Patient unable to recall family history', 'present_illness': '___ with reported h/o CAD, hypertension, hyperlipidemia, "CHF", \ns/p AVR (per patient in ___ presenting with chest pain and \nshortness of breath. \n\nChest pain was described as a retrosternal pressure without \nradiation that started acutely the day prior to admission \nassociated with shortness of breath and ? hypotension. Pain \nimproved and completely went away when given NTG. Pain made \nworse with position changes. Prior to this event, he said he \nfelt fine. He denies worsening of the chest discomfort on \nexertion, any recent or current chest pain, lightheadedness, \ndizziness, orthopnea, paroxysmal nocturnal dyspnea, \npalpitations, pre-syncope, or syncope. He has had recent dyspnea \nand was admitted for a COPD exacerbation, currently on \nprednisone with improvement. He denies any localizing infectious \nsymptoms, including no increase in cough, dyspnea, or sputum \nproduction.', 'medications': [{'medication': 'FoLIC Acid', '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': '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': 'Heparin', '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': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', 'frequency': 'ONCE', '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': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem Extended-Release', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', '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': 'Heparin', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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 = 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 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.5', 'valuenum': 15.5, 'valueuom': 'sec', 'ref_range_lower': 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': '35.7', 'valuenum': 35.7, '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': '31.2', 'valuenum': 31.2, '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': '162', 'valuenum': 162.0, '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': '3.74', 'valuenum': 3.74, '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}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 99.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'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': '8.6', 'valuenum': 8.6, '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': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', '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': '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': '147', 'valuenum': 147.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': 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': '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': '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': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, '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': '___', 'valuenum': 104.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '___', 'valuenum': 139.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '24.2', 'valuenum': 24.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74.6', 'valuenum': 74.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, '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': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, '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': '16.0', 'valuenum': 16.0, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61.4', 'valuenum': 61.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', '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': '24.3', 'valuenum': 24.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '72.5', 'valuenum': 72.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '4.3', 'valuenum': 4.3, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.0', 'valuenum': 87.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, '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': '32.9', 'valuenum': 32.9, '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': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'On admission\nGENERAL: WDWN middle aged white man in NAD. Oriented x3. Mood, \naffect appropriate.\nVS: T 98.4 BP 98/63 HR 68 RR 20 O2 SAT 95% on RA\nAdmission weight: 83.2 kg\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma.\nNECK: Supple with JVP of 6 cm.\nCARDIAC: RRR, Loud ___ SEM with no S2. Delayed carotid pulsation\nLUNGS: CTAB.\nABDOMEN: Soft, non-tender, not distended. No HSM or tenderness. \nEXTREMITIES: No clubbing, cyanosis or edema. No femoral bruits.\nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas.\nPULSES: Distal pulses delayed and symmetric\n\nAt discharge\nGENERAL: Well appearing, in NAD\nVITALS: Tc 98.2 BP 100s/50s HR ___ RR 20\nWEIGHT: 81 kg <- 82.2 kG\nWEIGHT ON ADMISSION: 83.2 kg\nTELEMETRY: NSR\nHEENT: Poor dentition\nLUNGS: CTAB\nHEART: JVP 7 cm. Loud ___ SEM with audible S2. Delayed carotid \npulsation \nABDOMEN: Soft non-tender, not distended\nEXTREMITIES: warm and well perfused, no peripheral edema', 'diagnoses': [{'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}, {'icd_code': '5184', 'desc': 'Acute edema of lung, unspecified'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': 'V433'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '79902', 'desc': 'Hypoxemia'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4240', 'desc': 'Mitral valve disorders'}, {'icd_code': '3970', 'desc': 'Diseases of tricuspid valve'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V173'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}], 'summary': '___ 05:00PM WBC-22.5*# RBC-4.77# HGB-13.9# HCT-42.0# \nMCV-88 MCH-29.1 MCHC-33.1 RDW-14.3 RDWSD-46.2\n___ 05:00PM GLUCOSE-86 UREA N-13 CREAT-0.8 SODIUM-138 \nPOTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-24 ANION GAP-16\n___ 05:00PM cTropnT-0.02*\n___ 09:28PM CK-MB-6 cTropnT-0.02*\n\nCXR ___\nSternotomy, valve prosthesis. Normal heart size, pulmonary \nvascularity. Trace left pleural effusion or thickening. Chronic \nrib fractures. Lungs are clear. No pneumothorax.\nIMPRESSION: Trace pleural effusion or thickening.\n\nEchocardiogram ___\nThe left atrial volume index is mildly increased. There is \nmoderate symmetric left ventricular hypertrophy. The left \nventricular cavity size is normal. Regional left ventricular \nwall motion is normal. Overall left ventricular systolic \nfunction is normal (LVEF>55%). Right ventricular chamber size \nand free wall motion are normal. The ascending aorta is mildly \ndilated. A bioprosthetic aortic valve prosthesis is present. The \nprosthetic aortic valve leaflets are thickened. The transaortic \ngradient is higher than expected for this type of prosthesis. \nThe effective orifice area/m2 is severely decreased (0.6 cm2/m2; \nnl >0.9 cm2/m2) No aortic regurgitation is seen. The mitral \nvalve appears structurally normal with trivial mitral \nregurgitation. There is mild pulmonary artery systolic \nhypertension. There is no pericardial effusion.\nIMPRESSION: Prominent LVH with normal global and regional \nbiventricular systolic function. Thickened aortic valve \nbioprosthesis with high gradients, functionally equivalent to \nmoderate to severe stenosis. Mild pulmonary hypertension. \n\nExercise Nuclear Stress Test ___\nThis ___ year old man with a h/o AS, HTN, HLD, smoking and \npresumed CAD s/p AVR with recent TTE (___) showing ___ 1.2 \ncm2 and peak gradient of 45 mmHg and question of NSTEMI was \nreferred to the lab for evaluation of chest discomfort. The \npatient exercised for 5.5 minutes of a modified Gervino protocol \nand stopped for leg fatigue. The estimated peak MET capacity is \n2.5, representing a poor functional capacity for his age. There \nwere no chest, neck, arm or back discomforts reported by the \npatient throughout the study. ECG: sb, borderline short PR, wide \nQRS, slurred upstroke upstroke consider IVCD lbbb block type \nand/or WPW pattern. At peak exercise there appeared to be an \nadditional 0.5 mm downsloping ST segment depression in the \ninferolateral leads, which returned to baseline by 3 minutes of \nrecovery. The rhythm was sinus with three isolated, somewhat \ndifferent wide complex beats A and/or VPDs during exercise. \nThere was blunted blood pressure and heart rate responses to \nexercise in the setting of beta blockade. There was test \ntermination for leg fatigue.\nIMPRESSION: No anginal type symptoms with an uninterpretable EKG \nfor ischemia in the setting of wide QRS with prominent voltage \nand repolarization abnormalities. Blunted hemodynamic response \nto exercise. Poor functional capacity. \nIMAGING: Left ventricular cavity size is mildly enlarged. \nResting and stress perfusion images reveal uniform tracer uptake \nthroughout the left ventricular myocardium. Gated images reveal \nnormal wall motion. The calculated left ventricular ejection \nfraction is 51%.\nIMPRESSION: Mild left ventricular enlargement with normal \nperfusion, wall\nmotion and systolic function.\n\nDISCHARGE LABS\n___ 05:40AM BLOOD WBC-16.5* RBC-4.47* Hgb-13.0* Hct-40.1 \nMCV-90 MCH-29.1 MCHC-32.4 RDW-14.6 RDWSD-48.1* Plt ___\n___ 05:40AM BLOOD Glucose-84 UreaN-18 Creat-0.9 Na-139 \nK-3.8 Cl-99 HCO3-28 AnGap-16\n___ 05:40AM BLOOD Calcium-8.3* Phos-4.0 Mg-1.9\nThis is a ___ with a reported h/o CAD (unknown anatomy), \nhypertension, hyperlipidemia, "CHF," s/p AVR (severe stenosis of \na bicuspid AV that was repaired at ___ ___ with a 19 mm \n___ Pericardial Magna Ease valve) who presented with \nchest pain and shortness of breath with concern for worsening \nprosthetic aortic stenosis. An echocardiogram revealed LVEF 70%, \nAV peak gradient of 45 mm Hg, mean of 25 mm Hg and valve area of \n1.2 cm2 consistent with moderate to severe prosthetic aortic \nstenosis (vs. ___ ___ 0.8 cm2 with peak gradient \n42 and mean gradient 28). Given level of AS so early after SAVR, \nthere is concern for early valve failure. Plan at discharge was \nfor the patient to follow up with outpatient cardiologist for \nplanning of revision/replacement at ___ of his bio-prosthetic \naortic valve.\n\nTroponin-T 0.02 twice followed by 2 normal values with normal \nCK-MB consistent with a tiny NSTEMI. Exercise MIBI provoked no \nsymptoms and showed no perfusion defects, but poor functional \ncapacity to only ___ METs. Based on patient\'s course and \nexercise stress, patient\'s chest pain was deemed to be unlikely \na result of his aortic stenosis. Patient was discharged without \ncoronary angiography as there was no objective evidence of \nresidual ischemia. Dose of atrovastatin was increased from 40 mg \nto 80 mg in light of his history and risk factors for CAD.\n\nSTABLE/CHRONIC ISSUES:\n# H/O EtOH withdrawal: CIWA protocol, did not score on the scale \nand require medications\n# COPD: Prednisone taper, down to 20 mg for 3 days ___, \nthen 10 mg for 2 days, then off. Home inhalers.\n# Leukocystosis: Attributed to recent prednisone use\n# Depression: Continued FLUoxetine 40 mg PO DAILY \n# Hypothyroid: Continued Levothyroxine Sodium 75 mcg PO DAILY \n# H/O posterior-inferior pancreatico-duodnal artery \npseudoaneurym, S/P coiling by vascular surgery\n\nTRANSITIONAL ISSUES: \nCHANGED MEDICATION:\n-Increased atorvastatin from 40mg to 80mg daily\nCODE STATUS: Full Code\nCONTACT: HCP - ___, sister ___'}}
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{'final_diagnoses': ['Moderate to severe stenosis of bio-prosthetic aortic valve', 'Non-ST segment elevation myocardial infarction', 'Chronic obstructive pulmonary disease', 'Depression', 'Hypothyroidism', 'Leukocytosis'], 'procedures': ['None'], 'visit_summary': 'This is a ___ with a reported h/o CAD (unknown anatomy), \nhypertension, hyperlipidemia, "CHF," s/p AVR (severe stenosis of \na bicuspid AV that was repaired at ___ ___ with a 19 mm \n___ Pericardial Magna Ease valve) who presented with \nchest pain and shortness of breath with concern for worsening \nprosthetic aortic stenosis. An echocardiogram revealed LVEF 70%, \nAV peak gradient of 45 mm Hg, mean of 25 mm Hg and valve area of \n1.2 cm2 consistent with moderate to severe prosthetic aortic \nstenosis (vs. ___ ___ 0.8 cm2 with peak gradient \n42 and mean gradient 28). Given level of AS so early after SAVR, \nthere is concern for early valve failure. Plan at discharge was \nfor the patient to follow up with outpatient cardiologist for \nplanning of revision/replacement at ___ of his bio-prosthetic \naortic valve.\n\nTroponin-T 0.02 twice followed by 2 normal values with normal \nCK-MB consistent with a tiny NSTEMI. Exercise MIBI provoked no \nsymptoms and showed no perfusion defects, but poor functional \ncapacity to only ___ METs. Based on patient\'s course and \nexercise stress, patient\'s chest pain was deemed to be unlikely \na result of his aortic stenosis. Patient was discharged without \ncoronary angiography as there was no objective evidence of \nresidual ischemia. Dose of atrovastatin was increased from 40 mg \nto 80 mg in light of his history and risk factors for CAD.\n\nSTABLE/CHRONIC ISSUES:\n# H/O EtOH withdrawal: CIWA protocol, did not score on the scale \nand require medications\n# COPD: Prednisone taper, down to 20 mg for 3 days ___, \nthen 10 mg for 2 days, then off. Home inhalers.\n# Leukocystosis: Attributed to recent prednisone use\n# Depression: Continued FLUoxetine 40 mg PO DAILY \n# Hypothyroid: Continued Levothyroxine Sodium 75 mcg PO DAILY \n# H/O posterior-inferior pancreatico-duodnal artery \npseudoaneurym, S/P coiling by vascular surgery\n\nTRANSITIONAL ISSUES: \nCHANGED MEDICATION:\n-Increased atorvastatin from 40mg to 80mg daily\nCODE STATUS: Full Code\nCONTACT: HCP - ___, sister ___', 'medications_prescribed': ['Atorvastatin 80 mg PO QPM \nRX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'PredniSONE 20 mg PO DAILY Duration: 3 Doses \nRX *prednisone 10 mg 2 tablet(s) by mouth daily Disp #*6 Tablet \nRefills:*0', 'PredniSONE 10 mg PO DAILY Duration: 2 Days', 'Acetaminophen 325-650 mg PO Q6H:PRN Pain - Mild', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN wheezing', 'Aspirin 81 mg PO DAILY', 'FLUoxetine 40 mg PO DAILY', 'FoLIC Acid 1 mg PO DAILY', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Metoprolol Succinate XL 25 mg PO DAILY', 'Multivitamins 1 TAB PO DAILY', 'Nicotine Patch 21 mg TD DAILY', 'Symbicort (budesonide-formoterol) 160-4.5 mcg/actuation \ninhalation 2 puffs BID for wheezing', 'Thiamine 100 mg PO DAILY', 'Tiotropium Bromide 1 CAP IH DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 40, 'gender': 'M', 'symptoms': 'fall', 'medical_history': ['HTN', 'NIDDM', 'ETOH abuse', 'cardiac ablation for unknown etiology'], 'family_history': 'CAD', 'present_illness': '___ year old gentleman found down by his parents at 6am this \nmorning after they had initially heard a "thump" at 3am. Upon \nbeing found EMS was called and he was transported to ___ \n___ for evalaution. There a head CT was performed \nwhich showed SAH and SDH. Following the CT he was intubated for \nairway protection and trasnferred to ___ for further care. \nUpon arrival to the ED he was heavily sedated and once sedation \nwas off he was examined. He underwent CT of his torso, and X-ray \nof his right knee per trauma service and he had a CTA of the \nhead to rule out vascular injury at our request. He is currently \nintubated so exam and review of systems are limited.', 'medications': [{'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', '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': '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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': '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': 0.0}, {'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': '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': '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS: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': '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': '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lovastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', '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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.021', 'valuenum': 1.021, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, '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': 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': '30.5', 'valuenum': 30.5, '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': '89', 'valuenum': 89.0, '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': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '0.1', 'valuenum': 0.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 81.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW RISK <1.0, AVERAGE RISK 1.0-3.0, HIGH RISK >3.0 (BUT <10).'}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '175', 'valuenum': 175.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '383', 'valuenum': 383.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '460', 'valuenum': 460.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '10.1', 'valuenum': 10.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.8', 'valuenum': 4.8, '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '418', 'valuenum': 418.0, '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': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 184.0, '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': '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': '4.1', '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '___ and ___ Fisher: 3 GCS 9T E:2 V:1T Motor:6\nGen: WD/WN, comfortable, NAD.\nHEENT: Pupils: PERRL EOMs unable to assess\nNeck: Hard Cervical Collar in place, Supple.\nLungs: CTA bilaterally.\nCardiac: RRR. S1/S2.\nAbd: Soft, NT, BS+\nExtrem: Warm and well-perfused. No C/C/E.\n\nNeuro:\nMental status: opens eyes to noxious, follows commands with\nuppers\nOrientation: unable to assess\nLanguage: nonverbal and intubated\n\nCranial Nerves:\nI: Not tested\nII: Pupils equally round and reactive to light, 2mmto\n1mm bilaterally. \nIII-XII: unable to accurately assess at time of consult given\nclinical status\n\nMotor: Spontaneously moves all extremities, follows commands \nwith\nbilateral uppers, withdraws lowers to stimuli as well\n\nSensation: unable to fully assess secondary to clinical stauts\n\nToes upgoing\n\nCoordination: unable to assess secodnary to sedation and\nintubation', 'diagnoses': [{'icd_code': '73027', 'desc': 'Unspecified osteomyelitis, ankle and foot'}, {'icd_code': '3577', 'desc': 'Polyneuropathy due to other toxic agents'}, {'icd_code': '70715', 'desc': 'Ulcer of other part of foot'}, {'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': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '9095', 'desc': 'Late effect of adverse effect of drug, medicinal or biological substance'}, {'icd_code': 'E9331', 'desc': 'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}, {'icd_code': 'V1089', 'desc': 'Personal history of malignant neoplasm of other sites'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '4439', 'desc': 'Peripheral vascular disease, unspecified'}, {'icd_code': 'V4971', 'desc': 'Great toe amputation status'}], 'summary': 'NCHCT ___: Right vertex contusion with frontal SAH. Subdural \nblood\ntracks along the tentorial leafs and the falx. Right occiput\nsubgaleal hematoma. Minimal change since the prior imported scan\n(3 hours). \n------------------ \nCT Chest/Abdomen/Pelvis ___ \n1.Bilateral subsegmental atelectasis as described above. \n2.Segmental consolidation in the superior segment of the right \nlower lobe is concerning for aspiration or pneumonia in the \nappropriate clinical setting. \n3. No acute traumatic pathology. \nCTA ___: No dissection, aneurysm, or AVM detected. No focus \nof active\nextravasation.\n--------------------\nRepeat NCHCT ___: stable appearance \n------------------\nCT Head ___. Stable to slightly decreased diffuse subarachnoid hemorrhage. \n\n2. Stable parenchymal contusions. \n3. Stable parafalcine subdural hemorrhage. \n4. Prominent bifrontal extra-axial spaces. \n5. No evidence for ventriculomegaly or shift of normally midline \nstructures.\n-----------------\nLumbar xrays ___: No radiographic evidence of acute lumbar \nspine fracture \nCT Head ___. Stable appearance of right frontal and temporal hemorrhagic \ncontusions. \n \n2. Stable parafalcine SDH and left frontal SAH. \n \n3. Mild reduction in the subarachnoid hemorrhage along the \nquadrigeminal and ambient cisterns. \n-----------------\nEEG ___:\nThis is an abnormal routine EEG, due to the presence of a \nsignificant portion of the record spent in sleep and mild \nslowing of the \nposterior dominant rhythm. This pattern is consistent with an \nearly \ndiffuse encephalopathy, commonly seen with medication effect, \nmetabolic \ndisturbance, or infection. However, there were no focal \nabnormalities \nor epileptiform features seen. \n\n___ ___\nNo DVT in either lower extremity.\n--------------\nMRI brain ___:\n1. Diffuse axonal injury within the splenium of the corpus \ncallosum and \nposterior mid brain, with mild swelling and effacement of the \nleft aspect of the quadrageminal cistern. \n2. Right vertex, pericallosal, and temporal contusion injuries, \nas seen on \nthe prior CT examination \nCXR ___:\nFeeding tube passes to the mid stomach and out of view. Lung \nvolumes are low,but there is no pneumonia or pulmonary edema. \nMild cardiomegaly is \nexaggerated by low lung volumes but probably real and unchanged \nover the past ten days. \nCXR ___:\nLow inspiratory volumes with patchy retrocardiac and left \nsuprahilar opacity, ?due to atelectasis. \n------------\n \nCOMPLETE BLOOD COUNT WBC RBC Hgb Hct MCV MCH MCHC RDW \nPlt Ct \n___ 13:32 16.8* 4.07* 13.4* 38.9* 96 33.1* 34.6 12.8 \n389 \n\n Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 13:32 146 11 0.6 134 4.2 98 29 11 \n\n ALT AST LD(LDH) AlkPhos TotBili\n___ 13:33 64* 84* 282* 167* 0.8 \n\n___ TSH 3.5\nPt was admitted to the ICU and monitored closely with q1h neuro \nchecks. He developed hypertension and tachycardia and was \nstarted on delerium tremens prophylaxis. He developed fever and \nhad thick secretions and was started on antibiotics for presumed \npneumonia possibly aspiration related. He was in a hard collar \nwhich was removed by the ICU team for a negative cervical CT \ndone at ___. Serial imaging of the head was \nontained on ___ and ___ which showed improvement of his SAH and \nstable SDH. He was extubated in the ICU and placed on face mask \nwith good results. On ___ his ability to follow commands was \ngreatly improved with the exception of his LLE. The leg would \nwithdraw briskly to minimal noxious but no commands. He had no \npalpable step-offs or point tenderness. X-ray of the lumbar and \nsacral spine were obtained which showed no acute fracture. His \nexam remained stable and he was transferred to the neuro \nstepdown unit. An MRI of the cervical and lumbar spine was \nattempted but patient was unable to tolerate the study without \nsignificant sedation that would have required intubation. \nMedication was continued for ETOH withdrawl/agitation. His WBC \ncount increased on ___ to 16.8 and a urinalysis was obtained \nwhich was negative. Doboff was placed ___ and tube feeding \nstarted and meds changed to via NGT. His sodium which was \nslowly decreasing was followed closely and maintained within \nnormal levels through tube feedings and free water bolus \nadjustments. Psychiatry consultation was requested ___ for \nassitance with withdrawal/agitation medication - they \nrecommended haldol and to add pain medication. The also \nsuggested EEG which was obtained and results showed early \ndiffuse encephalopathy and no epileptiform activity. He was also \nintubated in order to obtain MRI of the brain which showed \ndiffuse axonal injury; MRI of spine was considered but not done \nas pt was moving all extremities with no motor deficits and the \ninformation to be gained from doing this study would not change \ncurrent management. Speech and swallow continued to follow but \nhe was unable to take PO so PEG was placed in the OR on ___. \nTube feedings were started and increased to goal. All meds were \nchanged to PO and his home meds were started. He finished up \nhis course of antibiotics for aspiration pneumonia and his \nprophylactic seizure medication and these were both \ndiscontinued. He had high WBC that was slowly decreasing and \nall fever work up including cultures were negative. WBC ___ was \n16.1. Foley was removed but had to be replaced due to retention. \nBlood glucoses were mildly elevated throughout his \nhospitalization but better controlled once on tube feedings and \nresumed usual home meds. Prolonged QT was found on EKG and \nhaldol was discontinued.'}}
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{'final_diagnoses': ['Traumatic brain injury/ diffuse axonal injury', 'cerebral edema', 'aspiration pneumonia', 'acute hyponatremia', 'alcohol withdrawal', 'dysphagia', 'diabetes', 'delerium', 'urinary retention'], 'procedures': ['PEG placement'], 'visit_summary': 'Pt was admitted to the ICU and monitored closely with q1h neuro \nchecks. He developed hypertension and tachycardia and was \nstarted on delerium tremens prophylaxis. He developed fever and \nhad thick secretions and was started on antibiotics for presumed \npneumonia possibly aspiration related. He was in a hard collar \nwhich was removed by the ICU team for a negative cervical CT \ndone at ___. Serial imaging of the head was \nontained on ___ and ___ which showed improvement of his SAH and \nstable SDH. He was extubated in the ICU and placed on face mask \nwith good results. On ___ his ability to follow commands was \ngreatly improved with the exception of his LLE. The leg would \nwithdraw briskly to minimal noxious but no commands. He had no \npalpable step-offs or point tenderness. X-ray of the lumbar and \nsacral spine were obtained which showed no acute fracture. His \nexam remained stable and he was transferred to the neuro \nstepdown unit. An MRI of the cervical and lumbar spine was \nattempted but patient was unable to tolerate the study without \nsignificant sedation that would have required intubation. \nMedication was continued for ETOH withdrawl/agitation. His WBC \ncount increased on ___ to 16.8 and a urinalysis was obtained \nwhich was negative. Doboff was placed ___ and tube feeding \nstarted and meds changed to via NGT. His sodium which was \nslowly decreasing was followed closely and maintained within \nnormal levels through tube feedings and free water bolus \nadjustments. Psychiatry consultation was requested ___ for \nassitance with withdrawal/agitation medication - they \nrecommended haldol and to add pain medication. The also \nsuggested EEG which was obtained and results showed early \ndiffuse encephalopathy and no epileptiform activity. He was also \nintubated in order to obtain MRI of the brain which showed \ndiffuse axonal injury; MRI of spine was considered but not done \nas pt was moving all extremities with no motor deficits and the \ninformation to be gained from doing this study would not change \ncurrent management. Speech and swallow continued to follow but \nhe was unable to take PO so PEG was placed in the OR on ___. \nTube feedings were started and increased to goal. All meds were \nchanged to PO and his home meds were started. He finished up \nhis course of antibiotics for aspiration pneumonia and his \nprophylactic seizure medication and these were both \ndiscontinued. He had high WBC that was slowly decreasing and \nall fever work up including cultures were negative. WBC ___ was \n16.1. Foley was removed but had to be replaced due to retention. \nBlood glucoses were mildly elevated throughout his \nhospitalization but better controlled once on tube feedings and \nresumed usual home meds. Prolonged QT was found on EKG and \nhaldol was discontinued.', 'medications_prescribed': ['bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) \nTablet, Delayed Release (E.C.) PO DAILY (Daily).', 'ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation \nQ6H (every 6 hours) as needed for SOB/wheezing.', 'heparin (porcine) 5,000 unit/mL Solution Sig: One (1) \nInjection TID (3 times a day).', 'clonidine 0.2 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly \nTransdermal QSAT (every ___. ', 'docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 \ntimes a day).', 'magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO Q6H (every 6 hours) as needed for no BM>24hr.', 'nicotine 14 mg/24 hr Patch 24 hr Sig: One (1) Patch 24 hr \nTransdermal DAILY (Daily).', 'senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).', 'clobetasol 0.05 % Ointment Sig: One (1) Appl Topical BID (2 \ntimes a day).', 'nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day) as needed for oral candidiasis.', 'famotidine 20 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', 'multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'atenolol 50 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', 'amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', 'metformin 500 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', 'glyburide 5 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).', 'heparin, porcine (PF) 10 unit/mL Syringe Sig: One (1) ML \nIntravenous PRN (as needed) as needed for line flush.']}
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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': 'Cough', 'medical_history': ['-DM2', '-HTn', '-HLD', '-asthma', '-hypothyroidism', '-GERD', '-chronic shoulder pain'], 'family_history': 'unknown', 'present_illness': '___ yo F with hx of HTN, HLD, T2DM, asthma with hospitalization \nfor asthma exacerbation ___ yr ago, now presenting with 7 days of \ncough and HA, referred from PCP for failure to repond to \nduonebs. \n\nIn the ED, initial vitals were: 97.6 70 135/73 26 98% RA. She \nwas treated with nebs, methylprednisolone, azithromycin for \nbronchitis/asthma exacerbation, and obs\'d. She was given her \nhome meds of metformin, statin, amlodipine, levothyroxine, \nmetoprolol, valsartan. She continued to have coughing fits \nthroughout the night and was therefore admitted. Labs on \ntransfer were 97.8 72 153/86 18 100% RA. Flu was negative\n\nOn the floor, denies SOB previously or currently. States she \nhasn\'t had a BM in 5 days. Has not been taking flovent \nregularly at home. Non-productive, cough persists but seems to \nbe improving. Pt has a "burning" HA with cough but not present \ncurrently. Previously had sore throat but this has also since \nresolved. Denies fevers/chills. Pt unable to confirm if she \nuse albuterol at home and unable to confirm insulin dose.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Neutra-Phos', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Naloxone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', '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}]}, 'clinical_findings': {'labs': [{'value': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, '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': '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': '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': '8.5', '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = 75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, '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': '34.5', 'valuenum': 34.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '222', 'valuenum': 222.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 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': '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': '4.9', 'valuenum': 4.9, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, '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': '33.5', 'valuenum': 33.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '254', 'valuenum': 254.0, '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': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.6', 'valuenum': 16.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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}], 'exams': 'ADMISSION EXAM:\nVitals: 97.6 144/92 74 18 97RA\nGeneral: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear, EOMI, PERRL, \npharynx not errythematous\nNeck: Supple, JVP not elevated, no LAD\nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops\nLungs: Clear to auscultation bilaterally, however cough with \ndeep inspiration\nAbdomen: Soft, non-tender, mildly distended, bowel sounds \npresent, no organomegaly, no rebound or guarding\nGU: No foley\nExt: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema\nNeuro: CNII-XII and strength grossly intact', 'diagnoses': [{'icd_code': '55321', 'desc': 'Incisional hernia without mention of obstruction or gangrene'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}], 'summary': 'ADMISSION LABS:\n___ 12:45PM GLUCOSE-217* UREA N-13 CREAT-0.8 SODIUM-140 \nPOTASSIUM-4.0 CHLORIDE-100 TOTAL CO2-29 ANION GAP-15\n___ 12:45PM estGFR-Using this\n___ 12:45PM WBC-8.6 RBC-4.59 HGB-12.7 HCT-39.9 MCV-87 \nMCH-27.7 MCHC-31.8*# RDW-13.4 RDWSD-41.9\n___ 12:45PM NEUTS-46.9 ___ MONOS-10.1 EOS-3.4 \nBASOS-0.5 IM ___ AbsNeut-4.05 AbsLymp-3.36 AbsMono-0.87* \nAbsEos-0.29 AbsBaso-0.04\n___ 12:45PM PLT COUNT-284\n\nIMAGING:\nCXR \nNo acute cardiopulmonary process. \n\nDISCHARGE LABS:\n___ 06:40AM BLOOD WBC-10.8* RBC-4.69 Hgb-13.2 Hct-41.0 \nMCV-87 MCH-28.1 MCHC-32.2 RDW-13.7 RDWSD-43.8 Plt ___\n___ 06:40AM BLOOD Glucose-328* UreaN-22* Creat-0.9 Na-135 \nK-4.6 Cl-101 HCO3-25 AnGap-14\n___ 06:40AM BLOOD Calcium-9.3 Phos-4.1 Mg-2\n___ year old female with history of asthma, hypertension, \nhyperlipidemia, diabetes, presents with cough, wheezing, \nheadache concerning for bronchitis/asthma exacerbation. \n\n# Asthma exacerbation/bronchitis: given duration of symptoms, \nwas reasonable to treat with antibiotics for bronchitis, as well \nas steroids for asthma exacerbation, which was likely triggered \nby infection. Patient was not using home inhalers, and the \nimportance of this was stressed. Patient improved with \ntreatment, though her peak flow measurements were slow to \nimprove, and ranged from 150-200 by the time of discharge. She \nfinished five days of steroids and levofloxacin by the time of \ndischarge. She should likely have PFTs as an outpatient. The \npatient should follow up with her PCP within five days of \ndischarge for further maintenance.\n\n# Constipation: patient was continued on her home bowel regimen.\n\n# Hypothyroidism: continued home levothyroxine\n\n# Diabetes: continued home Lantus, and patient was placed on \nsliding scale insulin. She was quite hyperglycemic during \npresentation, owing to likely steroid effect, which is expected \nto improve now that steroids have been stopped.\n\n# Hypertension: continued beta blocker, amlodipine, aspirin, \nvalsartan\n\n# Chronic shoulder pain: continued Tylenol\n\n# GERD: continued omeprazole\n\n# CODE: full, confirmed\n# CONTACT: ___granddaughter) ___'}}
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{'final_diagnoses': ['Brochitis', 'Asthma exacerbation'], 'procedures': ['None'], 'visit_summary': '___ year old female with history of asthma, hypertension, \nhyperlipidemia, diabetes, presents with cough, wheezing, \nheadache concerning for bronchitis/asthma exacerbation. \n\n# Asthma exacerbation/bronchitis: given duration of symptoms, \nwas reasonable to treat with antibiotics for bronchitis, as well \nas steroids for asthma exacerbation, which was likely triggered \nby infection. Patient was not using home inhalers, and the \nimportance of this was stressed. Patient improved with \ntreatment, though her peak flow measurements were slow to \nimprove, and ranged from 150-200 by the time of discharge. She \nfinished five days of steroids and levofloxacin by the time of \ndischarge. She should likely have PFTs as an outpatient. The \npatient should follow up with her PCP within five days of \ndischarge for further maintenance.\n\n# Constipation: patient was continued on her home bowel regimen.\n\n# Hypothyroidism: continued home levothyroxine\n\n# Diabetes: continued home Lantus, and patient was placed on \nsliding scale insulin. She was quite hyperglycemic during \npresentation, owing to likely steroid effect, which is expected \nto improve now that steroids have been stopped.\n\n# Hypertension: continued beta blocker, amlodipine, aspirin, \nvalsartan\n\n# Chronic shoulder pain: continued Tylenol\n\n# GERD: continued omeprazole\n\n# CODE: full, confirmed\n# CONTACT: ___granddaughter) ___', 'medications_prescribed': ['1. Acetaminophen 500 mg PO BID:PRN pain ', '2. Amlodipine 5 mg PO DAILY ', '3. Atorvastatin 80 mg PO QPM ', '4. Docusate Sodium 100 mg PO BID ', '5. Fluticasone Propionate 110mcg 2 PUFF IH BID ', '6. Fluticasone Propionate NASAL 2 SPRY NU DAILY ', '7. Glargine 62 Units Breakfast', '8. Levothyroxine Sodium 150 mcg PO 6X/WEEK (___) ', '9. Levothyroxine Sodium 75 mcg PO 1X/WEEK (___) ', '10. Metoprolol Succinate XL 75 mg PO DAILY ', '11. Multivitamins 1 TAB PO DAILY ', '12. Omeprazole 20 mg PO DAILY ', '13. Valsartan 320 mg PO DAILY ', '14. Aspirin 325 mg PO DAILY ', '15. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath \nRX *albuterol sulfate [ProAir HFA] 90 mcg 2 puffs IH every four \n(4) hours Disp #*1 Inhaler Refills:*0', '16. Guaifenesin ___ mL PO Q6H:PRN cough \nRX *guaifenesin 100 mg/5 mL 5 mL by mouth every six (6) hours \nRefills:*0']}
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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': 'Perianal abscess', 'medical_history': ['HTN', 'HLD', 'DM', 'Lower back pain', 'urolithiasis', 'obesity', 'NASH', 'umbilical hernia repair'], 'family_history': 'Diabetes, atherosclerotic cardiovascular disease and \nhypertension.', 'present_illness': "HPI:\n___ w/hx of Diabetes, NASH, p/w his third episode perianal pain,\nwhich started 2 days ago. His first episode was ___ years ago, \nwith\na prior episode on ___, both requiring bed side I and D. He \nnotes\nthat this pain is located at the right side of his anus, which\nwas in a similar location as his last episode. He denies fevers,\nchills, abdominal pain, endorses flatus, drainage, obstipation \nor\ndiarrhea, but notes a fear of defecating secondary to pain. He\ndenies chronic constipation, anal fissures, blood in the stool,\nCrohn's disease, UC or any other fistulizing disease. He had his\nlast colonoscopy in ___ and had a benign polyp removed\nat that time.", 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '39.7', 'valuenum': 39.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Exam\nPhysical Exam:\nVitals: Temp: 97.6 HR: 100 BP: 109/57 Resp: 18 O(2)Sat: 99\n\nGEN: A&Ox3, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l \nABD: Soft, nondistended, nontender, no rebound or guarding,\nnormoactive bowel sounds, no palpable masses\nDRE: normal tone, no gross or occult blood, moderate induration\nat right posterior aspect of anus, with palpable fluctuance (1x2\ncm), no drainage \nExt: No ___ edema, ___ warm and well perfused\n\nDischarge Physical Exam\nVitals: WNL\nGen: A&O x3, NAD\nHEENT: No scleral icterus, mucus membranes moist\nCV: RRR, No M/G/R\nPULM: Clear to auscultation b/l \nABD: Soft, nondistended, nontender, no rebound or guarding,\nnormoactive bowel sounds, no palpable masses\nRectal Exam: Normal tone, no dressings in place, fistulotomy \nsite at right side of anus, appears healthy\nExt: No CCE', 'diagnoses': [{'icd_code': 'D251', 'desc': 'Intramural leiomyoma of uterus'}, {'icd_code': 'D252', 'desc': 'Subserosal leiomyoma of uterus'}, {'icd_code': 'N393', 'desc': 'Stress incontinence (female) (male)'}, {'icd_code': 'N946', 'desc': 'Dysmenorrhea, unspecified'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}], 'summary': "___ MR rectal\nIMPRESSION: \n \n3.9 cm right perianal abscess centered in the intersphincteric \nspace,\nextending below the sphincter to the skin of the right gluteal \ncleft,\nappearing to arise from a thin right intersphincteric perianal \nfistula tract\nat the 8 o'clock position.\n\n___ 03:20PM BLOOD WBC-16.2* RBC-5.12 Hgb-15.9 Hct-46.6 \nMCV-91 MCH-31.1 MCHC-34.1 RDW-12.3 RDWSD-40.6 Plt ___\n\n___ 05:05AM BLOOD WBC-10.7* RBC-4.68 Hgb-14.4 Hct-43.6 \nMCV-93 MCH-30.8 MCHC-33.0 RDW-12.2 RDWSD-41.8 Plt ___\n\n___ 07:25PM BLOOD ___ PTT-30.3 ___\n\n___ 05:05AM BLOOD Glucose-292* UreaN-12 Creat-0.7 Na-136 \nK-4.4 Cl-98 HCO3-29 AnGap-13\n\n___ 05:05AM BLOOD Calcium-9.1 Phos-3.5 Mg-1.9\nGeneral:\nThe patient presented to pre-op/Emergency Department on ___ \n. Pt was evaluated and was found to have a right perianal \nabscess with area of fluctuance, confirmed on rectal MR imaging. \n Given findings, the patient was admitted and taken to the \noperating room on ___ for incision and drainage of the area \nalong with fistulotomy. 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. He recovered well, and was stable \nfor discharge on POD 1. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was managed with oral pain medication. \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 spirometry were \nencouraged throughout hospitalization. \nGI/GU/FEN: The patient was initially kept NPO prior to surgery. \nPost-operatively, the diet was advanced sequentially to a \nRegular diet, which was well tolerated. Patient's intake and \noutput were closely monitored.\nEndo: Pt was noted to have post-prandial blood sugar into 400s \non POD 1, was asymptomatic. Pt stated this was not atypical, \nindicated he did not monitor blood sugars optimally at home. \nGiven additional insulin with minimal response, instructed to \nfollow up with PCP to optimized glucose control after discharge.\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\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."}}
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{'final_diagnoses': ['Perianal abscess'], 'procedures': ['Incision and drainage of perianal abscess', 'fistulotomy'], 'visit_summary': "General:\nThe patient presented to pre-op/Emergency Department on ___ \n. Pt was evaluated and was found to have a right perianal \nabscess with area of fluctuance, confirmed on rectal MR imaging. \n Given findings, the patient was admitted and taken to the \noperating room on ___ for incision and drainage of the area \nalong with fistulotomy. 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. He recovered well, and was stable \nfor discharge on POD 1. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was managed with oral pain medication. \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 spirometry were \nencouraged throughout hospitalization. \nGI/GU/FEN: The patient was initially kept NPO prior to surgery. \nPost-operatively, the diet was advanced sequentially to a \nRegular diet, which was well tolerated. Patient's intake and \noutput were closely monitored.\nEndo: Pt was noted to have post-prandial blood sugar into 400s \non POD 1, was asymptomatic. Pt stated this was not atypical, \nindicated he did not monitor blood sugars optimally at home. \nGiven additional insulin with minimal response, instructed to \nfollow up with PCP to optimized glucose control after discharge.\nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\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.", 'medications_prescribed': ['1. Atenolol 50 mg PO DAILY', '2. Lisinopril 40 mg PO DAILY', '3. Omeprazole 20 mg PO DAILY', '4. Simvastatin 20 mg PO QPM', '5. Tamsulosin 0.4 mg PO QHS', '6. Acetaminophen 650 mg PO Q6H:PRN pain \nRX *acetaminophen 650 mg 1 tablet(s) by mouth every six (6) \nhours Disp #*40 Tablet Refills:*0', '7. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*60 Capsule Refills:*0', '8. Psyllium Powder 1 PKT PO BID \nRX *psyllium husk (aspartame) [Natural Daily Fiber] 3.4 gram/5.8 \ngram 1 powder(s) by mouth twice a day Refills:*0', '9. Polyethylene Glycol 17 g PO DAILY \n___ temporarily stop for loose stool \nRX *polyethylene glycol 3350 17 gram/dose 1 powder(s) by mouth \ntwice a day Refills:*0', '10. OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth every four (4) hours \nDisp #*10 Tablet Refills:*0', '11. Aspirin 81 mg PO DAILY', '12. Flovent HFA (fluticasone) 220 mcg/actuation inhalation BID', '13. GlipiZIDE XL 5 mg PO DAILY', '14. Ibuprofen 800 mg PO BID:PRN pain', '15. Lantus Solostar (insulin glargine) 100 unit/mL (3 mL) \nsubcutaneous DAILY', '16. MetFORMIN (Glucophage) 1000 mg PO BID']}
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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': 's/p seizure', 'medical_history': ['depression/anxiety', '# hypothyroidism', '# mitral regurgitation - no documented murmur in notes, no ECHO', '# hypercholesterolemia', '# s/p TAH-BSO ___', '# s/p appendectomy', '# seizure disorder', '- last seizure ___', 'Oncologic History:', '# left frontal grade II oligodendroglioma', '- s/p craniotomy on ___ ___ at ___', '- hospitalized ___ for hemorrhage at the tumor site', '- hospitalized ___ to ___ for doxycycline reaction', '- hospitalized ___ to ___ at ___ for seizure', '- hospitalized ___ to ___ to ___ for body pain', '- hospitalized ___ to ___ at ___ for HA/numbness', '- hospitalized from ___ to ___ at ___ for\nseizure', '- s/p stereotaxic brain biopsy by ___, M.D. on\n___', '- s/p surgical resection of a left frontal recurrence grade\nIII astrocytoma on ___ by ___, M.D., Ph.D.,', '- hospitalized from ___ to ___ for headache and\nlightheadedness, and', '- started involved-field cranial irradiation with temozolomide\non ___.'], 'family_history': 'FAM: (per OMR)\nHer father has back pain and had a laminectomy. Her mother has \nmultiple sclerosis. Her brother has ___ muscular \ndystrophy. Her maternal grandmother had DVT, coronary artery \ndisease, and colon cancer. Her maternal grandfather had \ncirrhosis of the liver and lung cancer.', 'present_illness': 'Ms. ___ is a ___ with PMH depression, anxiety, \noligodendroglioma s/p resection and currently undergoing \nXRT/Temodar, and seizure disorder who presented after waking up \non the ground yesterday after a presumed seizure. She is \nactively undergoing Temodar/XRT and had her last XRT on ___ \n(per pt, but per OMR, last note was ___. She describes her \nprior seizure episodes as passing out with associated urinary \nincontinence. She reports her last seizure in ___. They have \nnot been witnessed and she does not know if she has shaking or \nother manifestations. Denies tongue biting. The patient was in \nher usual state of health, without complaint on ___. She \nremembers watching television (unclear the time, she believes it \nwas after 8 pm), then she woke up in morning (unsure what time) \non the floor and having had urinary incontinence. She reports \nsome mild confusion when she woke up and generalized discomfort. \nShe did not have any localizing pain. She got up off the floor, \nsat in the chair for a few minutes, had breakfast and took her \nmedications including her Temodar and then called her ___. Her \n___ came to see her and checked her BP, the patient recalls a \n100/60 reading, and she was referred to the ED. She thinks her \nBP was low the day before 80/60 but did not notice any symptoms \nassociated with this.\n.\nOf note, the patient reported a severe headache in ___ and \nwas evaluated by Dr. ___. It was thought she had a migraine and \nshe was prescribed Midrin and continued on her steroids. She had \ncomplete relief from this regimen. She was eating and drinking \nat home, though less than normal. She reported general \nfatiuge/malaise since her therapy started.\n.\nOn arrival to the ER, VS were 97.3 BP 114/70 HR 72 RR 18 100% \nRA. ___ was 112. She was given 1 L NS and 2 mg IV morphine X 2. \nCT head report with increase in vasogenic edema. She was \nadmitted for further workup.\n.\nROS: denies fever, chills, sweats, night sweats, change in \nvision, change in hearing, difficulty speaking, \nweakness/numbness/tingling, chest pain, palpitations, shortness \nof breath, abdominal pain, nausea, vomiting, diarrhea. She has \nhad a mild headache since the seizure but denies dizziness, \nlightheadedness, doube vision. Felt weak this am with walking. \nShe has not missed any doses of her medications.\n.', 'medications': [{'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', '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': 'Memantine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenazopyridine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenazopyridine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'ALPRAZolam', '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 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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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}]}, 'clinical_findings': {'labs': [], 'exams': 'VS - T 97.5, BP 110/70, HR 72, RR 18, sats 98% on RA.\nGen: well appearing, speaks fluently and in complete sentences. \nA/O X 3.\nHEENT: craniotomy incisions c/d/i, left frontal bald area, \nPERRL, EOMI, OP clear, MMM moist, no lesions\nNeck: No LAD\nCar: RRR. No m/r/g appreciated\nResp: CTAB\nAbd: s/nt/nd/nabs, no HSM\nExt: No ___ edema\nNeuro: A/O X 3, relays coherent/clear history, and speech \nfluent. Face symmetric, PERRL, extraocular movements intact, \nfacial strength symmetric, Uvula midline, tongue midline, palate \nelevates symmetrically, shoulder shrug normal. strength ___ \nthroughout. Gait not tested.', 'diagnoses': [{'icd_code': 'N400', 'desc': 'Benign prostatic hyperplasia without lower urinary tract symptoms'}, {'icd_code': 'N359', 'desc': 'Urethral stricture, unspecified'}, {'icd_code': 'R339', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'N3289', 'desc': 'Other specified disorders of bladder'}, {'icd_code': 'Z8042', 'desc': 'Family history of malignant neoplasm of prostate'}, {'icd_code': 'G4733', 'desc': 'Obstructive sleep apnea (adult) (pediatric)'}, {'icd_code': 'G301', 'desc': "Alzheimer's disease with late onset"}, {'icd_code': 'F0280', 'desc': 'Dementia in other diseases classified elsewhere, unspecified severity, without behavioral disturbance, psychotic disturbance, mood disturbance, and anxiety'}, {'icd_code': 'M1A9XX1', 'desc': 'Chronic gout, unspecified, with tophus (tophi)'}], 'summary': "___ 02:10PM BLOOD WBC-7.0 RBC-4.72 Hgb-14.6 Hct-42.5 MCV-90 \nMCH-31.0 MCHC-34.4 RDW-13.7 Plt ___\n___ 02:10PM BLOOD ___ PTT-21.6* ___\n___ 07:30AM BLOOD WBC-5.7 Lymph-20 Abs ___ CD3%-79 \nAbs CD3-896 CD4%-65 Abs CD4-746 CD8%-13 Abs CD8-148* \nCD4/CD8-5.05*\n___ 02:10PM BLOOD Glucose-108* UreaN-11 Creat-0.9 Na-142 \nK-4.0 Cl-107 HCO3-27 AnGap-12\n___ 02:10PM BLOOD ALT-35 AST-31 CK(CPK)-119 AlkPhos-87 \nTotBili-0.4\n___ 02:10PM BLOOD Albumin-4.3\n___ 06:50AM BLOOD Glucose-93 UreaN-16 Creat-0.9 Na-141 \nK-3.9 Cl-108 HCO3-28 AnGap-9\n___ 07:30AM BLOOD WBC-5.7 Lymph-20 Abs ___ CD3%-79 \nAbs CD3-896 CD4%-65 Abs CD4-746 CD8%-13 Abs CD8-148* \nCD4/CD8-5.05*\n___ 06:50AM BLOOD ___ PTT-22.4 ___\n___ 06:50AM BLOOD WBC-6.5 RBC-4.36 Hgb-14.0 Hct-40.0 MCV-92 \nMCH-32.2* MCHC-35.0 RDW-13.8 Plt ___\n\nMRI Brain: IMPRESSION: Status post left frontovertex craniotomy \nand chemoradiotherapy\nfor known anaplastic oligodendroglioma, with expected \npost-surgical changes.\nHowever, the nodular plaque-like focus of enhancement at the \ncaudal aspect of\nthe resection cavity, which corresponds to focal enhancement at \nthe site on\nthe early post-operative study, is suspicious for residual tumor \nat this site.\nThis is in accord with the slight increase in associated \nvasogenic edema,\nparticularly at the dorsal margin of the resection bed. If \nwarranted\nclinically, further specificity might be conferred by perfusion \nimaging and MR\nspectroscopy.\n\nCXR:No acute CP process\n\nHead CT:IMPRESSION:\n1. Continued evolution of surgical changes from left frontal \ncraniotomy and\nmass resection, with underlying encephalomalacia. Adjacent \nvasogenic edema\nmay be slightly increased from prior study, and if desired, MRI \ncould be\nconsidered for further characterization and evaluation for tumor \nrecurrence.\n2. No hemorrhage, mass effect or other acute intracranial \nprocess seen on\nthis noncontrast CT scan.\nPatient is a ___ year old female with a PMH of depression, \nanxiety, oligodendroglioma s/p resection, and seizure disorder \nadmitted after having a seizure at home.\n.\n# SEIZURES: Most likely etiology for the current presentation is \nseizure given her history of seizure disorder and underlying \ndisease and treatment as well as patient's report that this \nepisode was typical for her. Zonisamide continued at home \ndosing and Keppra increased to 1250 mg twice daily. MRI obtained \nfor concern for increased vasogenic edema on CT ___ findings as \nabove, no acute change per Dr. ___. She was continued on \nher home dose Dexamethasone and Temodar although missed 2 doses \nas an inpatient. She also received her previously scheduled XRT \non ___. ___ cleared her for home.\n.\n# Anaplastic oligodendroglioma: On Temodar/XRT as outpatient. \nHad MRI as above. Will follow up with Dr. ___. \n.\n# Elevated INR: Normal on repeat labs. \n.\n# Pain: Pt reported all over body pain but unable to localize. \nPain has been present since seizure and not improved with \npercocet. Morphine Sulfate ___ tried and pt... She was continued \non her home gabapentin. \n.\n#Hypothyroidism: Continued outpatient levothyroxine dose.\n.\n# Depression/Anxiety: Continued home Paxil\n.\nFULL CODE"}}
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{'final_diagnoses': ['Seizure', 'Oligodendroglioma', 'Secondary Diagnosis', 'Depression/Anxiety', 'Hypothyroidism', 'Thrush'], 'procedures': ['None'], 'visit_summary': "Patient is a ___ year old female with a PMH of depression, \nanxiety, oligodendroglioma s/p resection, and seizure disorder \nadmitted after having a seizure at home.\n.\n# SEIZURES: Most likely etiology for the current presentation is \nseizure given her history of seizure disorder and underlying \ndisease and treatment as well as patient's report that this \nepisode was typical for her. Zonisamide continued at home \ndosing and Keppra increased to 1250 mg twice daily. MRI obtained \nfor concern for increased vasogenic edema on CT ___ findings as \nabove, no acute change per Dr. ___. She was continued on \nher home dose Dexamethasone and Temodar although missed 2 doses \nas an inpatient. She also received her previously scheduled XRT \non ___. ___ cleared her for home.\n.\n# Anaplastic oligodendroglioma: On Temodar/XRT as outpatient. \nHad MRI as above. Will follow up with Dr. ___. \n.\n# Elevated INR: Normal on repeat labs. \n.\n# Pain: Pt reported all over body pain but unable to localize. \nPain has been present since seizure and not improved with \npercocet. Morphine Sulfate ___ tried and pt... She was continued \non her home gabapentin. \n.\n#Hypothyroidism: Continued outpatient levothyroxine dose.\n.\n# Depression/Anxiety: Continued home Paxil\n.\nFULL CODE", 'medications_prescribed': ['1. Nystatin 100,000 unit/mL Suspension Sig: Five (5) ML PO QID \n(4 times a day).\nDisp:*600 ML(s)* Refills:*0*', '2. Levetiracetam 1,000 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day): total dose 1250 mg twice daily.\nDisp:*60 Tablet(s)* Refills:*2*', '3. Keppra 250 mg Tablet Sig: One (1) Tablet PO twice a day: \ntotal dose 1250 mg twice daily.\nDisp:*60 Tablet(s)* Refills:*2*', '4. Dexamethasone 2 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '5. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO Q8H (every \n8 hours). ', '6. Paroxetine HCl 20 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '7. Levothyroxine 100 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '8. Quetiapine 25 mg Tablet Sig: Three (3) Tablet PO QHS (once a \nday (at bedtime)). ', '9. Zonisamide 100 mg Capsule Sig: Four (4) Capsule PO HS (at \nbedtime). ', '10. Calcium Carbonate 500 mg Tablet, Chewable Sig: Two (2) \nTablet, Chewable PO TID (3 times a day). ', '11. Multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ']}
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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': 'dyspnea', 'medical_history': ['CARDIAC RISK FACTORS: Diabetes - , Dyslipidemia - , \nHypertension - ', 'OTHER PAST MEDICAL HISTORY: \nBilateral stage I lobular carcinoma (see below)\ngoiter, which is being followed\nBasal cell cancer ___ years ago'], 'family_history': 'A brother who was diagnosed with breast cancer at age ___, metastatic disease at age ___. She has a sister who was diagnosed\nwith breast cancer at age ___ and died at age ___ from metastatic\ndisease. She has another sister recently diagnosed with breast\ncancer in ___. Genetic testing for BRCA 1 or 2 mutations was\nperformed and was negative.', 'present_illness': 'Ms. ___ is a ___ year old transferred from OSH w/pericardial \neffusion found on CT which was associated with early tamponade \nphysiology and pleural effusions. She presented to ___ \n___ this afternoon for increasing dyspnea and nausea x 1 \nweek. Additionally, she noted ankle edema, and continued chest \npain. Ms. ___ had presented for chest pain to ___ \napproximately 1 week ago where she ruled out for an MI and was \ndischarged home with GERD treatment. Upon presentation to the \nOSH today, she was found on CT to have a large pericardial \neffusion with pleural effusion as well as axillary \nlymphadenopathy. Cardiology saw her at the OSH and recommened \ntransfer for possible pericardial window.\n Seen by cards at OSH and sent for poss pericardial window. \nh/o breast CA s/p bilat mastectomy, per report adenopathy on CT \nscan.', 'medications': [{'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', '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': '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': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q48H', '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': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', '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': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'HS: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': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS: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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OLANZapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mirtazapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 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'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 760.0, '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': '30', 'valuenum': 30.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.44, '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': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.06', 'valuenum': 3.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, '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': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, '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': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 635.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 70.0, '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.52, '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': '111', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 542.0, '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': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.51, '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': 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': 'LG.'}, {'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': '6.0', '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 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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': '6.2', 'valuenum': 6.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.2', 'valuenum': 82.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '337', 'valuenum': 337.0, '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': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': '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': '8.2', '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 155.0, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 142.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '549', 'valuenum': 549.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '328', 'valuenum': 328.0, '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': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 130.0, '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': '4.0', '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': '59', 'valuenum': 59.0, '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': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '304', 'valuenum': 304.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, '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': 4.6, 'ref_range_upper': 6.2, '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': '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': '8.2', 'valuenum': 8.2, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.89', 'valuenum': 0.89, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.8', 'valuenum': 1.8, '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': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, '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': '29.0', 'valuenum': 29.0, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, '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': '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': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'PHYSICAL EXAMINATION ON ADMISSION: \n.\nGENERAL: 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 with JVD at 3cm above clavicle at 90 degrees\nCARDIAC: Hyperdynamic precordium, PMI located in ___ intercostal \nspace, midclavicular line. tachycardic but regular rhythm, \nnormal S1, S2. No m/r/g. No thrills, lifts. No S3 or S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. Decreased breath sounds \nat bilateral bases, +egophony at bases, LLB > LLB, ___ sign\nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES: trace ___ pitting edema, No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nNEURO: AAOx3, CNII-XII intact, ___ strength biceps, triceps, \nwrist, knee/hip flexors/extensors, 2+ reflexes biceps, \nbrachioradialis, patellar, ankle. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '41071', 'desc': 'Subendocardial infarction, initial episode of care'}, {'icd_code': '42830', 'desc': 'Diastolic heart failure, unspecified'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '2930', 'desc': 'Delirium due to conditions classified elsewhere'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': 'V5869', 'desc': 'Long-term (current) use of other medications'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': 'V5863', 'desc': 'Long-term (current) use of antiplatelet/antithrombotic'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '60001', 'desc': 'Hypertrophy (benign) of prostate with urinary obstruction and other lower urinary tract symptoms (LUTS)'}, {'icd_code': '29420', 'desc': 'Dementia, unspecified, without behavioral disturbance'}, {'icd_code': '59970', 'desc': 'Hematuria, unspecified'}, {'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': 'E9305', 'desc': 'Cephalosporin group causing adverse effects in therapeutic use'}], 'summary': "LABS ON ADMISSION:\n.\n___ 05:10PM BLOOD WBC-11.4* RBC-4.34 Hgb-13.7 Hct-39.2 \nMCV-90 MCH-31.6 MCHC-35.0 RDW-12.7 Plt ___\n___ 05:10PM BLOOD Neuts-83.2* Lymphs-11.7* Monos-4.5 \nEos-0.1 Baso-0.5\n___ 05:10PM BLOOD ___ PTT-22.7* ___\n___ 05:10PM BLOOD Glucose-131* UreaN-26* Creat-1.3* Na-135 \nK-5.3* Cl-102 HCO3-18* AnGap-20\n___ 09:20PM BLOOD CK(CPK)-45\n___ 09:20PM BLOOD CK-MB-3 cTropnT-0.04*\n___ 09:20PM BLOOD Calcium-8.6 Phos-4.5 Mg-2.4\n.\nREPORTS\n\nCT TORSO ___ 11:29 AM \n1. Extensive mediastinal, supraclavicular and hilar \nlymphadenopathy with mass effect on to the adjacent veins, but \nwithout occlusion. \n2. Interval decrease of pericardial effusion, in keeping with \nthe recent \npericardial drainage. \n3. Interval increase of loculated pleural effusions, left \ngreater than right. New subtotal collapse of the left lower \nlobe. Reticulonodular opacities in the lower lobes raise concern \nfor lymphangitic carcinomatosis. \n4. Heterogeneously enhancing right thyroid nodule, concerning \nfor metastasis. \n5. No definite evidence of intra-abdominal or intra-pelvic \nmetastatic \ndisease. Likely geographic hepatosteatosis. \n\nPERICARDIAL FLUID Procedure Date of ___ \n \n POSITIVE FOR MALIGNANT CELLS, \n consistent with metastatic adenocarcinoma (see note). \n \n Note: The current specimen shows similar findings to the \n prior pericardial fluid specimen (___-___, ___, which \n was reviewed for comparison. \n\n \n___ Tissue: pericardium. ___ ___. \n\nPericardial fluid, cell block:\n\nPositive for Malignant Cells.\n\nConsistent with metastatic poorly differentiated carcinoma.\n\nNote: The tumor cells are immunoreactive for CK7, B72.3, ___, \nand focally positive for mammoglobin. They are negative for \nCK20, CEA, Leu-M1 (background staining of neutrophils and \nmacrophages), GCDFP, ER, PR, Calretinin, and WT-1. Mucicarmine \nstaining is negative. These findings support metastasis from \nbreast origin. See cytology (__).\n\nCXR AP ___\nIMPRESSION: \n1. Placement of a right Pleurx catheter with interval decrease \nin size of a large right pleural effusion. Tiny right basilar \npneumothorax. \n2. Unchanged appearance of left retrocardiac opacity, which may \nrepresent \nsevere atelectasis or consolidation. \n3. Unchanged small left pleural effusion \n\nECHO ___\nThe left atrium is mildly dilated. No atrial septal defect is \nseen by 2D or color Doppler. Overall left ventricular systolic \nfunction is low normal (LVEF 50-55%). Right ventricular chamber \nsize and free wall motion are normal. The ascending, transverse \nand descending thoracic aorta are normal in diameter and free of \natherosclerotic plaque t.. The aortic valve leaflets (3) appear \nstructurally normal with good leaflet excursion. The mitral \nvalve leaflets are mildly thickened. Trivial mitral \nregurgitation is seen. There is a moderate sized pericardial \neffusion. The pericardium may be thickened. No right atrial \ndiastolic collapse is seen. \nNo pericardial effusion after surgical drainage. \n.\n Brain MRI ___:\nPreliminary ReportIMPRESSION: \n1. Small left sphenoid wing meningioma without evidence of \nextension into the optic canal. \n2. No additional intra- or extra-axial lesions. \n3. Acute-on-chronic sinus disease as detailed above.\nHOSPITAL SUMMARY:\n___ year old female PMHx Breast cancer s/p bilateral mastectomy \nwho presented w SOB, found to have pericardial effusion with \ntamponade, s/p pericardial window, also with L pleural effusion \ns/p pleurex placement, both cytology samples returning positive \nfor adenocarcinoma, course complicated by hypoxia thought to be \nsecondary to cancer lymphangitic pulmonary burden, now s/p \ninitiation of taxol.\n\n# Pericardial effusion: On admission, found to have effusion \nwith tamponade physiology; s/p drainage of pericardial effusion \non ___ complicated by RV puncture and transient need for \nlevophed (~3 minutes). Pericardial window performed ___. \nFinal cytology report with malignant cells consistent with \nbreast adenocarcinoma. \n\n# Atrial Fibrillation - First noted following pericardial \nwindow, felt to be secondary to pericardial irritation; no \nevidence of PE on CTA chest (although not protocoled for PE). \nInitiated on amiodarone and metoprolol, converted to normal \nsinus rhythm with occasional episodes of A fib. Pt has been well \ncontrolled on this regimen, although difficult to tolerate due \nto pressures, so metoprolol dose was decreased to 6.25mg. She \nshould continue on this dose, which she tolerates well. \nAmiodarone has just been decreased from 200mg tid after 2 weeks \nto 200mg bid, which shold continue for 4 weeks and then 200mg \ndaily until further recommendations by Cardiology.\n\n# Pleural Effusions - During hospital stay, noted to have \nenlarging R pleural effusion, on ___ underwent tap, with \nconversion to pleurex on ___. Final cytology report with \nmalignant cells consistent with breast adenocarcinoma. Patient \nunderwent daily drainage of pleurex (about 500cc daily) until \n___. She had reaccumulating L sided effusion, and had \npleurex placed on that side on ___, draining 1L of fluid. \nShe should continue to have effusions drained every other day \n(alternating), no more than 1L at a time. Please see attached \ndirections for details. Pt will f/u with Interventional \nPulmonology team on ___ for suture removal of L pleurex \ncathether.\n\n# RUE DVT: In setting of RUE edema, RUE ultrasound demonstrated \nnonocclusive clot around R PICC line; after discussion w primary \noncologist, patient was started on therapeutic lovenox (planned \nduration = lifelong given ongoing onc issues)\n\n# Hypoxia: Patient with hypoxia throughout stay, initially \nrequiring 6LNC and face mask, thought to be multifactorial in \nsetting of pleural effusions, pulmonary edema, and lymphangitic \nspread of tumor to lungs. Of note, patient was never officially \nruled out for pulmonary embolism (had CT chest w contrast that \nwas not protocoled for PE), but as this would not change \nmanagement (already on therapeutic lovenox as above) CT PE was \nnot obtained. TTE did not demonstrate shunt (PFO). With \ndiuresis, drainage of R pleural effusion, patient resp status \nimproved, but not to baseline. Initiated taxol for presumed \ntumor burden component. At transfer to floor, patient satting \n90-93% on 5L nasal canula, occasionally using humidified air via \nshovel mask for comfort. She had increased O2 requirement to \n6LNC on ___ which may have been from small PTX after L \npleruex placement or increased R infiltrate which was possibly \npneumonia, fluid or lymphangitic spread. This most likely \nrepresented a component of lymphangitic spread but since pna \ncouldn't be ruled out, she will complete a 5 day course of \nLevofloxacin.\n\n# Hyponatremia: Sodium ranged from 125-130, initally thought to \nbe hypovolemic in setting of intravascular depletion (had low \nalbumin, lots of third-spaced fluids). It did not however, \nrespond well to hydration. She was then placed on fluid \nrestriction due to concern for SIADH with normalization of her \nsodium. She should continue on a 1200ml fluid restricted diet. \n\n# UTI: Ucx ___ grew pan-sensitive E. coli for which the patient \nwas treated w IV ceftriaxone (d1= ___ treated for 7-day \ncourse. \n\n# Breast Cancer s/p b/l mastectomy (Her 2 negative, ER/PR \npositive) - She was continued on anastrozole, and as discussed \nabove, started taxol chemotherapy while inpatient. HER 2 status \nis pending. She will continue to follow with Dr ___ \nreturn for chemo next week. \n.\n#Hallucinations: Pt developed visual hallucinations during ICU \nstay. At that time she had received Ativan, so it was thought \nthat this was potentially a side effect from ativan. Would \navoid benzos as possible in the future."}}
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{'final_diagnoses': ['Metastatic Breast Cancer', 'Malignant Pericardial Effusion/cardiac tamponade', 'Malignant Pleural Effusion', 'Atrial Fibrillation', 'Deep venous Thrombosis'], 'procedures': ['pericardiocentesis ___'], 'visit_summary': "HOSPITAL SUMMARY:\n___ year old female PMHx Breast cancer s/p bilateral mastectomy \nwho presented w SOB, found to have pericardial effusion with \ntamponade, s/p pericardial window, also with L pleural effusion \ns/p pleurex placement, both cytology samples returning positive \nfor adenocarcinoma, course complicated by hypoxia thought to be \nsecondary to cancer lymphangitic pulmonary burden, now s/p \ninitiation of taxol.\n\n# Pericardial effusion: On admission, found to have effusion \nwith tamponade physiology; s/p drainage of pericardial effusion \non ___ complicated by RV puncture and transient need for \nlevophed (~3 minutes). Pericardial window performed ___. \nFinal cytology report with malignant cells consistent with \nbreast adenocarcinoma. \n\n# Atrial Fibrillation - First noted following pericardial \nwindow, felt to be secondary to pericardial irritation; no \nevidence of PE on CTA chest (although not protocoled for PE). \nInitiated on amiodarone and metoprolol, converted to normal \nsinus rhythm with occasional episodes of A fib. Pt has been well \ncontrolled on this regimen, although difficult to tolerate due \nto pressures, so metoprolol dose was decreased to 6.25mg. She \nshould continue on this dose, which she tolerates well. \nAmiodarone has just been decreased from 200mg tid after 2 weeks \nto 200mg bid, which shold continue for 4 weeks and then 200mg \ndaily until further recommendations by Cardiology.\n\n# Pleural Effusions - During hospital stay, noted to have \nenlarging R pleural effusion, on ___ underwent tap, with \nconversion to pleurex on ___. Final cytology report with \nmalignant cells consistent with breast adenocarcinoma. Patient \nunderwent daily drainage of pleurex (about 500cc daily) until \n___. She had reaccumulating L sided effusion, and had \npleurex placed on that side on ___, draining 1L of fluid. \nShe should continue to have effusions drained every other day \n(alternating), no more than 1L at a time. Please see attached \ndirections for details. Pt will f/u with Interventional \nPulmonology team on ___ for suture removal of L pleurex \ncathether.\n\n# RUE DVT: In setting of RUE edema, RUE ultrasound demonstrated \nnonocclusive clot around R PICC line; after discussion w primary \noncologist, patient was started on therapeutic lovenox (planned \nduration = lifelong given ongoing onc issues)\n\n# Hypoxia: Patient with hypoxia throughout stay, initially \nrequiring 6LNC and face mask, thought to be multifactorial in \nsetting of pleural effusions, pulmonary edema, and lymphangitic \nspread of tumor to lungs. Of note, patient was never officially \nruled out for pulmonary embolism (had CT chest w contrast that \nwas not protocoled for PE), but as this would not change \nmanagement (already on therapeutic lovenox as above) CT PE was \nnot obtained. TTE did not demonstrate shunt (PFO). With \ndiuresis, drainage of R pleural effusion, patient resp status \nimproved, but not to baseline. Initiated taxol for presumed \ntumor burden component. At transfer to floor, patient satting \n90-93% on 5L nasal canula, occasionally using humidified air via \nshovel mask for comfort. She had increased O2 requirement to \n6LNC on ___ which may have been from small PTX after L \npleruex placement or increased R infiltrate which was possibly \npneumonia, fluid or lymphangitic spread. This most likely \nrepresented a component of lymphangitic spread but since pna \ncouldn't be ruled out, she will complete a 5 day course of \nLevofloxacin.\n\n# Hyponatremia: Sodium ranged from 125-130, initally thought to \nbe hypovolemic in setting of intravascular depletion (had low \nalbumin, lots of third-spaced fluids). It did not however, \nrespond well to hydration. She was then placed on fluid \nrestriction due to concern for SIADH with normalization of her \nsodium. She should continue on a 1200ml fluid restricted diet. \n\n# UTI: Ucx ___ grew pan-sensitive E. coli for which the patient \nwas treated w IV ceftriaxone (d1= ___ treated for 7-day \ncourse. \n\n# Breast Cancer s/p b/l mastectomy (Her 2 negative, ER/PR \npositive) - She was continued on anastrozole, and as discussed \nabove, started taxol chemotherapy while inpatient. HER 2 status \nis pending. She will continue to follow with Dr ___ \nreturn for chemo next week. \n.\n#Hallucinations: Pt developed visual hallucinations during ICU \nstay. At that time she had received Ativan, so it was thought \nthat this was potentially a side effect from ativan. Would \navoid benzos as possible in the future.", 'medications_prescribed': ['prochlorperazine maleate 10 mg Tablet Sig: One (1) Tablet PO \nevery six (6) hours as needed for nausea. ', 'senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation. ', 'morphine 30 mg Tablet Extended Release Sig: One (1) Tablet \nExtended Release PO Q12H (every 12 hours). ', 'metoprolol tartrate 25 mg Tablet Sig: 0.25 Tablet PO TID (3 \ntimes a day). ', 'docusate sodium 50 mg/5 mL Liquid Sig: One (1) PO BID (2 \ntimes a day). ', 'amiodarone 200 mg Tablet Sig: One (1) Tablet PO twice a day: \nstart ___ and continue this dose for 4weeks, then change to \nonce daily. ', 'alum-mag hydroxide-simeth 200-200-20 mg/5 mL Suspension Sig: \n___ MLs PO QID (4 times a day) as needed for gerd. ', 'pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours). ', 'bisacodyl 10 mg Suppository Sig: One (1) Suppository Rectal \nHS (at bedtime) as needed for constipation. ', 'multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', 'anastrozole 1 mg Tablet Sig: One (1) Tablet PO daily (). ', 'morphine 15 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for pain. ', 'enoxaparin 60 mg/0.6 mL Syringe Sig: One (1) Subcutaneous \nQ12HR (). ', 'levofloxacin 750 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily) for 3 days. ', 'albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation Q4H (every 4 hours) as \nneeded for shortness of breath or wheezing. ', 'ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation \nQ4H (every 4 hours) as needed for shortness of breath or \nwheezing. ']}
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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': 'found unresponsive on the bathroom', 'medical_history': ['NOne'], 'family_history': 'Unknown', 'present_illness': "___ yo male from the ___ who was found down in the \nbathroom smelling like ETOH with a head laceration. He was \nbrought in to the ED by EMS. \nOn arrival to the emergency room vitals were: HR 98, 109/73, O2 \nsat 100% on arrival. He was responsive to pain with movement. \nPERRLA and sluggish. He was then intubated for airway \nprotection. He was given etomadate, succinate for intubation and \nplaced on propofol drip. He was given 2L of NS. His labs were \nnotable for ETOH level of 396, K of 3.3, no anion gap, neg serum \nketone. He was also found to have a small laceration on his \nposterior scalp for which He had head and cervical CT as per \nwhich showed no acute fracture or IC bleeding. Cxray was WNL \nwith ET tube and OG tube in correct location. His post \nintubation ABG was: pH 7.42/ pCO2 38/ pO2 574/ HCO3 25 on 100% \nFiO2, TV of 500, PEEP 5, RR 20. \nOn arrival to the MICU, patient is intubated, moving in bed, not \nfollowing commands. Smell like alcohol. He has a cell phone that \nis locked. Wallet has Driver's license from ___ and \nInsurance card. I attempted to call the insurance company for \nemergency contact information, but custumer sercise office was \nclosed.", 'medications': [{'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chloraseptic Throat Spray', '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': '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '3X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Mesalamine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS: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': 'Cepacol (Menthol)', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '4X/WEEK', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', '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': 'Q24H', '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': 'NIFEdipine CR', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM:PRN', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Mesalamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'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': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '8.6', 'valuenum': 8.6, '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': '___', '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '272', 'valuenum': 272.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '3.6', 'valuenum': 3.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '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': 491.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.8', 'valuenum': 27.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'General: sedated and intubated, in no acute distress \nHEENT: Sclera anicteric, conjuctiva injected, ___ sluggish. \nNeck: on hard collar, JVP not elevated \nCV: Regular rate and rhythm, normal S1 + S2, no murmurs, rubs, \ngallops \nLungs: Clear to auscultation bilaterally, no wheezes, rales, \nronchi \nAbdomen: soft, non-tender, non-distended, hypoactive bowel \nsounds present, no organomegaly \nGU: foley in place \nExt: warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro: moving extremeties spontaneous, not following commands. \nPERLA sluggish.', 'diagnoses': [{'icd_code': '5609', 'desc': 'Unspecified intestinal obstruction'}, {'icd_code': '5552', 'desc': 'Regional enteritis of small intestine with large intestine'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '4928', 'desc': 'Other emphysema'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': 'V1251', 'desc': 'Personal history of venous thrombosis and embolism'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'V103'}, {'icd_code': 'V1082', 'desc': 'Personal history of malignant melanoma of skin'}], 'summary': 'Admission Labs:\n\n___ 11:57PM BLOOD WBC-9.7 RBC-5.25 Hgb-15.6 Hct-45.2 MCV-86 \nMCH-29.7 MCHC-34.4 RDW-12.0 Plt ___\n___ 11:57PM BLOOD ___ PTT-28.2 ___\n___ 11:57PM BLOOD ___ 11:57PM BLOOD Glucose-133* UreaN-13 Creat-1.0 Na-144 \nK-3.3 Cl-105 HCO3-26 AnGap-16\n___ 11:57PM BLOOD ALT-19 AST-23 AlkPhos-65 TotBili-0.1\n___ 11:57PM BLOOD Albumin-4.8 Calcium-9.4 Phos-4.1 Mg-2.5\n___ 11:57PM BLOOD ASA-NEG ___ Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 12:04AM BLOOD Glucose-125* Lactate-1.9 Na-147* K-3.4 \nCl-103 calHCO3-26\n___ 12:04AM BLOOD freeCa-1.16\n\nImaging:\n\nCT C spine:\nFINDINGS: There is straightening of the normal cervical \nlordosis. \nAdditionally, calcific density is visualized anterior to the \nsuperior endplate of the C6 vertebral body. However, given the \nlack of any associated prevertebral soft tissue swelling, this \nis representative of calcification in the anterior longitudinal \nligament or an old fracture. Otherwise, no acute fractures are \nidentified. There is no prevertebral soft tissue swelling. CT is \nnot able to provide intrathecal detail compared to MRI, but the \nvisualized portion of the thecal sac is normal. \n \nThe visualized lung apices are clear. \n \nIMPRESSION: No acute cervical spine fractures. \n\nCT Head: FINDINGS: \n \nThere is no evidence of acute intracranial hemorrhage, edema, \nlarge vessel \nterritorial infarction, or shift of normally midline structures. \nGray-white matter differentiation is well preserved. Ventricles \nand sulci are normal in size and configuration. There is \nevidence of mid occipital soft tissue swelling with overlying \nstaples. However, no acute fractures are identified. The \nvisualized mastoid air cells are clear. Mucosal thickening is \nnoted in the left maxillary sinus. Otherwise, the remainder of \nthe paranasal sinuses are clear. \n \nIMPRESSION: No acute intracranial injury. \n\nCXR: ET tube tip is in standard position, 5.3 cm above the \ncarina. NG tube is coiled in the stomach, the tip is at the GE \njunction. Cardiomediastinal \ncontours are unchanged. The lungs are clear. There is no \npneumothorax or \npleural effusion\n___ yo male from the ___ who was found down in the \nbathroom smelling like ETOH with a head laceration, who was \nintubated for airway protection. \n \n# AMS: pt was found unresponsive in the bathroom. Noted to have \nan EtOH level of 396. Intubated in the ED for airway protection. \nUpon arrival to the MICU, he was soon extubated without \ndifficulty. He had no memory of the events leading to his \npresentation. He was given thiamine, folate, and a multivitamin. \nHe was strongly advised to limit his EtOH use. He did not \nexhibit signs of withdrawal. \n \n# Head Laceration: Noted to have head laceration in the ED and \nstaples were placed. Advised patient to remove them in ___ days \nwith either the physicians at ___ and also gave \npatient the phone number to ___. \nNotably pt had head trauma with laceration. No acute process on \nimaging of CT head/neck.'}}
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{'final_diagnoses': ['Alcohol Intoxication'], 'procedures': ['Intubation'], 'visit_summary': '___ yo male from the ___ who was found down in the \nbathroom smelling like ETOH with a head laceration, who was \nintubated for airway protection. \n \n# AMS: pt was found unresponsive in the bathroom. Noted to have \nan EtOH level of 396. Intubated in the ED for airway protection. \nUpon arrival to the MICU, he was soon extubated without \ndifficulty. He had no memory of the events leading to his \npresentation. He was given thiamine, folate, and a multivitamin. \nHe was strongly advised to limit his EtOH use. He did not \nexhibit signs of withdrawal. \n \n# Head Laceration: Noted to have head laceration in the ED and \nstaples were placed. Advised patient to remove them in ___ days \nwith either the physicians at ___ and also gave \npatient the phone number to ___. \nNotably pt had head trauma with laceration. No acute process on \nimaging of CT head/neck.', 'medications_prescribed': ['None']}
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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': 'Altered mental status', 'medical_history': ['Sick Sinus Syndrome s/p dual chamber PPM (Dr. ___ Fibrillation (not on A/C due to fall risk)', 'Essential Hypertension', 'Myelodysplasia with chronic Anemia', 'History of falls', 'Dysphagia, oropharyngeal', 'Major Depressive Disorder', 'History of falls', 'Left Femoral Fracture s/p ORIF with intramedullary nail'], 'family_history': 'Unable to obtain', 'present_illness': '___ w/pmh HTN, AFib not on Coumadin, SSS s/p dual chamber PPM, \nand recent L hip fx s/p ORIF in ___ and bilateral heel \nulcers currently at a nursing home for treatment of \nosteomyelitis who presented with altered mental status and \nagitation. In the ED she was grossly aspirating with difficulty \nhandling secretions and was intubated for airway protection. She \nis now admitted to the ICU for further monitoring. \n\nShe has a hx of chronic heel ulcers, debrided by podiatry on \n___ and at ___ on treatment for osteomyelitis. She started \nyelling last night and became increasingly agitated and altered \nthis morning. She had the start of a rash on the abdomen on \ndischarge, but this has significantly spread across her chest \ndespite discontinuation of cefazolin. Recently discontinued on \ncipro and nafcillin, but continued on Flagyl. She has chronic \naspiration and started having diarrhea yesterday. She was \nbriefly on levophed for hypotension following intubation however \nimproved and was able to come off.', 'medications': [{'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen w/Codeine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}, {'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', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', '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', 'route': 'IV', 'frequency': 'Q8H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, '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': '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': '140', 'valuenum': 140.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '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': '42.9', 'valuenum': 42.9, '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': '27.0', 'valuenum': 27.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.18', 'valuenum': 5.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, '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': '43.4', 'valuenum': 43.4, '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': '27.4', 'valuenum': 27.4, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '250', 'valuenum': 250.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '5.11', 'valuenum': 5.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '8.4', 'valuenum': 8.4, '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': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '120', 'valuenum': 120.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, '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}], 'exams': 'ADMISSION PHYSICAL EXAM:\n=======================\nVITALS: 97.3, 84, 155/83, 22, 100% \nGENERAL: elderly, chronically sick appearing woman \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: 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, 2+ pulses, no clubbing, cyanosis or edema \nSKIN: diffuse macular rash with scaling and erythema diffusely \nover entire trunk. bilateral lower extremities with vitalago \nNEURO: pinpoint, but reactive pupils bilaterally, not \nresponding to commands, intubated and sedated\nACCESS: ___\n\nDISCHARGE PHYSICAL EXAM:\n========================\nVITALS: 97.5 162/88 56 18 97 RA \nGEN: elderly thin woman in NAD\nHEENT/Neck: NC/AT, external ear intact, anicteric sclera, MM \ndry,\nOP clear with poor dentition\nCV: irregularly irregular, soft SEM appreciated throughout\nPULM: limited by poo effort otherwise CTAB\nGI: soft NT/ND +BS no rebound or guarding\nEXT: warm well perfused, feet cleanly dressed in waffle boots\nSKIN: erythematous rash on trunk and RUE with areas of\ndesquamation\nNEURO: asleep, awakes to voice. States year is ___, that she is \nin "hospital". Oriented to self. ', 'diagnoses': [{'icd_code': '55090', 'desc': 'Inguinal hernia, without mention of obstruction or gangrene, unilateral or unspecified (not specified as recurrent)'}, {'icd_code': '5521', 'desc': 'Umbilical hernia with obstruction'}, {'icd_code': '9971', 'desc': 'Cardiac complications, not elsewhere classified'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'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': '78052', 'desc': 'Insomnia, unspecified'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': '79029', 'desc': 'Other abnormal glucose'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}], 'summary': "___ 08:56AM BLOOD WBC-7.8 RBC-2.98* Hgb-9.1* Hct-29.1* \nMCV-98 MCH-30.5 MCHC-31.3* RDW-15.9* RDWSD-56.1* Plt ___\n___ 08:56AM BLOOD Neuts-69.9 Lymphs-15.6* Monos-8.7 Eos-4.2 \nBaso-0.4 NRBC-0.3* Im ___ AbsNeut-5.47 AbsLymp-1.22 \nAbsMono-0.68 AbsEos-0.33 AbsBaso-0.03\n___ 08:56AM BLOOD Glucose-97 UreaN-21* Creat-0.7 Na-136 \nK-4.3 Cl-98 HCO3-23 AnGap-15\n___ 08:56AM BLOOD ALT-11 AST-27 AlkPhos-102 TotBili-0.4\n___ 08:56AM BLOOD cTropnT-<0.01\n___ 08:56AM BLOOD Albumin-3.0* Calcium-9.5 Phos-3.9 Mg-2.0\n___ 08:56AM BLOOD TSH-1.7\n___ 05:28PM BLOOD Lactate-1.2\n\n+CT HEAD ___\nIMPRESSION: \nNo acute intracranial abnormality. No acute hemorrhage or large \nterritorial infarction. \n\n+CXR ___\nIMPRESSION: \nSmall left atelectasis is unchanged but there is new opacity in \nthe right \nupper and right lower lobe concerning for aspiration \nET tube tip is 2 cm above the carina. NG tube tip is in the \nstomach. \nPacemaker leads terminate in right atrium and right ventricle. \nCardiomegaly is substantial, unchanged. \n\n___: C diff neg\n\n___ 11:45AM BLOOD WBC-7.5 RBC-2.92* Hgb-8.9* Hct-27.8* \nMCV-95 MCH-30.5 MCHC-32.0 RDW-17.2* RDWSD-57.4* Plt ___\n___ 05:38AM BLOOD Glucose-105* UreaN-15 Creat-0.8 Na-142 \nK-3.7 Cl-105 HCO3-25 AnGap-12\n___ 05:38AM BLOOD Calcium-9.1 Phos-3.4 Mg-1.\n___ w/pmh HTN, AFib not on Coumadin, SSS s/p dual chamber PPM, \nand recent L hip fx s/p ORIF in ___ and bilateral heel \nulcers currently at a nursing home for treatment of \nosteomyelitis who presented with altered mental status and \nagitation. In the ED she was grossly aspirating with difficulty \nhandling secretions and was intubated for airway protection. She \nwas admitted to the ICU for further monitoring. Presentation was \nfelt to be due to aspiration pneumonitis with rapid improvement \nin respiratory status. She was treated initially with broad \nantibiotics and de-escalated to chronic regimen for \nosteomyelitis. Encephalopathy likely delirium, both hyper and \nhypoactive, improving prior to discharge. Pt was started on \nlabetalol for HTN during admission.\n\n===========================\nMICU COURSE (___\n===========================\nThe patient presented from rehab with agitation and altered \nmental status after her recent discharge. She was grossly \naspirating and having difficulty protecting her airway. The most \nlikely etiology is a new aspiration pneumonia given CXR \nconcerning for RUL and RLL consolidation. Other considerations \ninclude infection from known osteomyelitis although her heels \nlook clean and podiatry felt they are uninfected. Finally \nmedication from narcotics and sedation could be playing a role. \nPer the patient's family, the patient lives alone, is AOx3, with \na normal sleep/wake cycle, has attendant in morning and visited \nby son in afternoon; recognizes family members, etc. She has \nbeen in rehab since fall/hip fracture/osteomyelitis. She was \nstarted on IV Vancomycin, Ceftazidime, and Flagyl (___) for \naspiration pneumonia. She was given 2L LR with good response. \nThe patient was extubated on ___ and was weaned to room air. Of \nnote, the patient had a drug rash on last admission which \ndeveloped on ___. Dermatology recommended no further treatment \nat this time. During her ICU stay, she was noted to have \nintermittent agitation and shouting. She was easily redirected. \nShe was continued on mirtazapine at night and ramelteon added to \npreserve sleep wake cycle. \n\n============\nFLOOR COURSE:\n=============\nPatient improved quickly and follow up CXR showed improvement \nwith improved exam. She was felt to have pneumonitis over PNA \nand her antibiotics were de-escalated to Levo/Flagyl (on this \nfor osteomyelitis). She was seen by SLP as well with \nimprovement in her diet. Her encephalopathy also noted \nimprovement. She had no further episodes of agitation but did \nhave episodes of somnolence, easily arousable to voice, felt to \nrepresent hypoactive delirium. She improved with conservative \nmanagement."}}
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{'final_diagnoses': ['Acute aspiration pneumonitis', 'Hypotension', 'Acute metabolic encephalopathy', 'Drug rash', 'Osteomyelitis', 'Afib'], 'procedures': ['Intubation'], 'visit_summary': "___ w/pmh HTN, AFib not on Coumadin, SSS s/p dual chamber PPM, \nand recent L hip fx s/p ORIF in ___ and bilateral heel \nulcers currently at a nursing home for treatment of \nosteomyelitis who presented with altered mental status and \nagitation. In the ED she was grossly aspirating with difficulty \nhandling secretions and was intubated for airway protection. She \nwas admitted to the ICU for further monitoring. Presentation was \nfelt to be due to aspiration pneumonitis with rapid improvement \nin respiratory status. She was treated initially with broad \nantibiotics and de-escalated to chronic regimen for \nosteomyelitis. Encephalopathy likely delirium, both hyper and \nhypoactive, improving prior to discharge. Pt was started on \nlabetalol for HTN during admission.\n\n===========================\nMICU COURSE (___\n===========================\nThe patient presented from rehab with agitation and altered \nmental status after her recent discharge. She was grossly \naspirating and having difficulty protecting her airway. The most \nlikely etiology is a new aspiration pneumonia given CXR \nconcerning for RUL and RLL consolidation. Other considerations \ninclude infection from known osteomyelitis although her heels \nlook clean and podiatry felt they are uninfected. Finally \nmedication from narcotics and sedation could be playing a role. \nPer the patient's family, the patient lives alone, is AOx3, with \na normal sleep/wake cycle, has attendant in morning and visited \nby son in afternoon; recognizes family members, etc. She has \nbeen in rehab since fall/hip fracture/osteomyelitis. She was \nstarted on IV Vancomycin, Ceftazidime, and Flagyl (___) for \naspiration pneumonia. She was given 2L LR with good response. \nThe patient was extubated on ___ and was weaned to room air. Of \nnote, the patient had a drug rash on last admission which \ndeveloped on ___. Dermatology recommended no further treatment \nat this time. During her ICU stay, she was noted to have \nintermittent agitation and shouting. She was easily redirected. \nShe was continued on mirtazapine at night and ramelteon added to \npreserve sleep wake cycle. \n\n============\nFLOOR COURSE:\n=============\nPatient improved quickly and follow up CXR showed improvement \nwith improved exam. She was felt to have pneumonitis over PNA \nand her antibiotics were de-escalated to Levo/Flagyl (on this \nfor osteomyelitis). She was seen by SLP as well with \nimprovement in her diet. Her encephalopathy also noted \nimprovement. She had no further episodes of agitation but did \nhave episodes of somnolence, easily arousable to voice, felt to \nrepresent hypoactive delirium. She improved with conservative \nmanagement.", 'medications_prescribed': ['Betamethasone Dipro 0.05% Cream 1 Appl TP BID to rash \nDuration: 7 Days', 'Labetalol 100 mg PO BID', 'Levofloxacin 750 mg PO Q48H \nthrough ___', 'Ramelteon 8 mg PO QHS:PRN insomnia', 'Acetaminophen 500 mg PO Q6H:PRN Pain - Mild', 'Ascorbic Acid ___ mg PO BID', 'Aspirin 81 mg PO DAILY', 'Bisacodyl 10 mg PR QHS:PRN constipation', 'Citalopram 10 mg PO DAILY', 'Collagenase Ointment 1 Appl TP DAILY', 'Docusate Sodium 200 mg PO DAILY', 'Enema (sodium phosphates) 1 enema rectal DAILY PRN \nConstipation refractory to docusate', 'Ferrous Sulfate 325 mg PO DAILY', 'Hydrochlorothiazide 25 mg PO DAILY', 'Losartan Potassium 100 mg PO DAILY', 'MetroNIDAZOLE 500 mg PO Q8H \nthrough ___', 'Mirtazapine 15 mg PO QHS', 'Multivitamins W/minerals 1 TAB PO DAILY', 'Potassium Chloride 20 mEq PO DAILY \nHold for K >', 'Senna 8.6 mg PO QHS', 'Senna 8.6 mg PO DAILY:PRN Constipation - First Line']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['1. CARDIAC RISK FACTORS \n - Diabetes \n - Hypertension \n + Dyslipidemia \n + Chronic diastolic dysfunction/non-ischemic cardiomyopathy (EF \n \n 40-45%)', '2. CARDIAC HISTORY \n - CABG: None \n - PERCUTANEOUS CORONARY INTERVENTIONS: \n Cardiac cath ___: 40% stenosis proximal LAD \n Pharm stress ___: No evidence of reversible perfusion \ndefect. See discussion above regarding probable attenuation in \nthe anteroseptal wall. \n - PACING/ICD: St. ___ ___ ___ pacing ___, \nlast interrogation ___, Paroxysmal Atrial fibrillation and \nSick sinus syndrome with prior chronotropic incompetence \n - RHYTHM:', '3. OTHER PAST MEDICAL HISTORY \n - Pleural effusion ___ \n - Asthma/Restrictive lung disease \n - Orthostatic hypotension \n - Enlarged thoracic aorta - followed by chest CT \n - Osteoarthritis \n - Hearing loss \n - Glaucoma \n - Memory loss -- ? early dementia \n - Basal cell cancer - back, forehead -- removed \n - Melanoma, squamous cell skin cancer - trunk, back -- removed', '- Low back pain \n - Pituitary gland tumor - benign, excised; secondary male \n hypogonadism \n - Colonic polyp \n - Gout \n - Erectile dysfunction \n - elevated PSA \n - Diverticulosis \n - Depression \n - GERD \n - Hepatitis A \n - Appendectomy \n - Multiple hernia repairs'], 'family_history': 'Mother had ___', 'present_illness': '___ w/ PMHx HFpEF (EF 55% in ___, afib, HLD presenting with \nconstant substernal chest pain concerning for ischemia. \n His chest pain came on suddenly this morning at 930AM while in \nthe waiting room for ___. Describes pain as "pressure" and has \nbeen there constantly. It is similar to prior chest pain. Every \n10 min he has a wave of sharp pain in the ___ his chest \nthat resolves after a few seconds. Pain radiates to jaw \nbilaterally, no pain in arm. Per daughter he is having worsening \nshortness of breath with exertion. Since ___ he has been \nbreathless when walking across room (baseline able to walk 50ft \nbefore needing to rest. Denies fevers, chills, nausea, vomiting, \nabdominal pain. \n His prior cardiac evaluations include cardiac cath ___: 40% \nstenosis proximal LAD. Pharm stress ___: No evidence of \nreversible perfusion defect. Probable attenuation in the \nanteroseptal wall. Last PPM interrogation in ___. Last TTE \n___ LVEF 55% \n In the ED initial vitals were: T: 98.3 HR: 63 BP: 104/65 RR: 20 \nSO2: 97% RA \n Exam notable for: Irregular, no murmurs, No chest wall \ntenderness. No rales. No ___ edema. \n CTA: \n 1. No evidence pulmonary embolism. No aortic dissection seen. \n 2. Small amount of hemopericardium, new since chest CT in ___. \n \n 3. Pleural calcifications of the left lung base, new since \nprior chest CT ___. \n 4. Diffuse idiopathic skeletal hyperostosis \n EKG: 60, atrial paced, no ST or T wave changes. Stable from \n___ EKG. \n CXR: Persistent chronic left base opacity may be due to chronic \npleural effusion \n Cardiology was consulted, stated presentation is consistent \nwith a pericarditis with hemorrhagic conversion in the setting \nof anticoagulation with xarleto. Fellow performed TTE at \nbedside, no aortic root dilation, AI, or other clinical evidence \nof dissection. bp on both arms equal. \n Labs/studies notable for: \n WBC: 11.7 Hgb: 12.8 Plt: 250 \n BUN: 22 Cr: 1.3 \n ___: 16.5 PTT: 34.7 INR: 1.5 \n ___ 12:00 Trop-T: <0.01 \n CRP 38 \n UA negative \n Patient was given: \n ASA 324 mg \n SLN 0.4 mg \n 250 cc NS \n Patient was start on nitro gtt for 30 minutes \n \nVitals on transfer: Temp 98.3 F HR 69 111/68 RR 19 98% RA \n On the floor, patient with shortness of breath in the absence \nof his usual inhalers for COPD. Noted chest heaviness without \nchest pain. \n REVIEW OF SYSTEMS: per HPI', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', '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': 'Hydrocodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '35.8', 'valuenum': 35.8, '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': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.01', 'valuenum': 4.01, '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': '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, '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': '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\n======================\nVS: 98.1 PO 126/76 HR 70 RR 20 97 RA pulus 10 mmHg \nGENERAL: WDWN M 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 xanthelasma. \n\nNECK: Supple with JVP of not elevated. \nCARDIAC: pericardial rub, normal S1/S2, no mumur, rubs, gallops \n\nLUNGS: Velcro lung sounds worst on right base, no crackles, no \nwheezes/rhonic \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: trace pitting edema up through ankles \nSKIN: stasis dermatitis; no ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric \n\nDISCHARGE PHYSICAL EXAM:\n=======================\nVitals: T 97.2, BP 96-118/61-71, HR 64-80, RR 18, SpO2 98/RA\nTele: a-paced with occasional v-pacing, narrow ___\nI/O: (24h) 1260/2625 (-1365), (8h) 200/750 (-550)\nWt: 78.0 kg\nWt on admission: 79.2 kg\nGeneral: well-appearing, NAD. No labored breathing.\nNeck: no JVP\nCardiac: distant and muffled heart sounds; RRR, S1+S2, no M/R/G \nLungs: L basilar crackles with coarse breath sounds throughout\nAbdomen: non-distended, soft, non-tender\nExtremities: trace pitting edema up through ankles \nSkin: stasis dermatitis; no ulcers, scars, or xanthomas.', 'diagnoses': [{'icd_code': '80707', 'desc': 'Closed fracture of seven ribs'}, {'icd_code': '8600', 'desc': 'Traumatic pneumothorax without mention of open wound into thorax'}, {'icd_code': '5569', 'desc': 'Ulcerative colitis, unspecified'}, {'icd_code': 'V1087', 'desc': 'Personal history of malignant neoplasm of thyroid'}, {'icd_code': 'E8261', 'desc': 'Pedal cycle accident injuring pedal cyclist'}], 'summary': "ADMISSION LABS:\n==============\n___ 12:00PM BLOOD WBC-11.7* RBC-3.85* Hgb-12.8* Hct-37.1* \nMCV-96 MCH-33.2* MCHC-34.5 RDW-12.6 RDWSD-44.6 Plt ___\n___ 12:00PM BLOOD Neuts-67.8 Lymphs-16.6* Monos-14.4* \nEos-0.7* Baso-0.2 Im ___ AbsNeut-7.96* AbsLymp-1.94 \nAbsMono-1.69* AbsEos-0.08 AbsBaso-0.02\n___ 12:00PM BLOOD ___ PTT-34.7 ___\n___ 12:00PM BLOOD Glucose-94 UreaN-22* Creat-1.3* Na-140 \nK-3.6 Cl-98 HCO3-29 AnGap-17\n___ 12:00PM BLOOD cTropnT-<0.01\n___ 04:17PM BLOOD CK-MB-<1 cTropnT-<0.01\n___ 12:15AM BLOOD CK-MB-2 cTropnT-<0.01 proBNP-603\n___ 12:00PM BLOOD Calcium-9.0 Phos-3.3 Mg-2.0\n___ 12:15AM BLOOD calTIBC-199* Ferritn-190 TRF-153*\n___ 04:17PM BLOOD CRP-38.4*\n___ 02:00PM URINE Color-Straw Appear-Clear Sp ___\n___ 02:00PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-7.0 Leuks-NEG\n\nMICRO LABS:\n==========\n___ CULTURE-FINALNEGATIVE\n\nIMAGES:\n=======\nCXR (___): Persistent chronic left base opacity may be due to \nchronic pleural effusion and/or pleural thickening.\n\nCTA chest (___): 1. No evidence of pulmonary embolism. No \naortic dissection seen. 2. Small amount of hemopericardium, new \nsince chest CT in ___. 3. Pleural calcifications of the left \nlung base, new since prior chest CT ___. 4. Diffuse idiopathic \nskeletal hyperostosis.\n\nTTE (___): The estimated right atrial pressure is at least 15 \nmmHg. There is mild symmetric left ventricular hypertrophy. The \nleft ventricular cavity size is normal. Due to suboptimal \ntechnical quality, a focal wall motion abnormality cannot be \nfully excluded. Overall left ventricular systolic function is \nnormal (LVEF = 60%). The right ventricular free wall thickness \nis normal. Right ventricular chamber size is normal with \ndepressed free wall contractility. There is a small to moderate \nsized pericardial effusion. No right atrial or right ventricular \ndiastolic collapse is seen. There is significant, accentuated \nrespiratory variation in mitral/tricuspid valve inflows, \nconsistent with impaired ventricular filling. Compared with the \nprior study (images reviewed) of ___, pericardial effusion \nis increased in size, now with evidence of impaired ventricular \nfilling and elevated right heart filling pressure, but not frank \ntamponade. Serial evaluation is recommended. \n\nTTE (___): The estimated right atrial pressure is at least 15 \nmmHg. Regional left ventricular wall motion is normal. Overall \nleft ventricular systolic function is normal (LVEF>55%). The \nright ventricular cavity is mildly dilated with borderline \nnormal free wall function. There is moderate pulmonary artery \nsystolic hypertension. There is a small pericardial effusion \nmeasuring up to 1.0 cm in greatest dimension anterior to the \nright ventricle. The effusion appears circumferential. The \neffusion is echo dense, consistent with blood, inflammation or \nother cellular elements. No right atrial or right ventricular \ndiastolic collapse is seen. IMPRESSION: Small pericardial \neffusion without echocardiographic evidence of tamponade. \nModerate pulmonary artery systolic hypertension. Compared with \nthe prior study (images reviewed) of ___, the size of the \npericardial effusion iappears nominally smaller in some views. \nSignificant respiratory variation of mitral and tricuspid \ninflows is no longer appreciated. The right ventricular systolic \nfunction appears slightly more vigorous. \n\nTTE (___): The left atrium is normal in size. No left atrial \nmass/thrombus seen (best excluded by transesophageal \nechocardiography). The estimated right atrial pressure is ___ \nmmHg. There is mild symmetric left ventricular hypertrophy with \nnormal cavity size and global systolic function (LVEF>55%). \nRight ventricular chamber size and free wall motion are normal. \nThe aortic valve leaflets are mildly thickened (?#). The mitral \nvalve leaflets are structurally normal. Mild (1+) mitral \nregurgitation is seen. There is a small (0.8 cm) circumferential \npericardial effusion without echocardiographic signs of \ntamponade. \nIMPRESSION: Ssmall circumferential pericardial effusion without \nevidence for hemodynamic compromise. Preserved global \nbiventricular systolic function. \nCompared with the prior study (images reviewed) of ___, \nthe pericardial effusion is similar. \n\nDISCHARGE LABS:\n==============\n___ 06:20AM BLOOD WBC-7.9 RBC-3.36* Hgb-11.3* Hct-32.7* \nMCV-97 MCH-33.6* MCHC-34.6 RDW-12.7 RDWSD-45.4 Plt ___\n___ 06:20AM BLOOD Plt ___\n___ 06:20AM BLOOD Glucose-80 UreaN-21* Creat-1.3* Na-138 \nK-3.9 Cl-102 HCO3-23 AnGap-17\n___ 06:20AM BLOOD Calcium-8.5 Phos-3.7 Mg-1.\n___ w/ HFpEF (55%), SSS (PPM/dofet/xerelto), asthma/COPD, HLD, \nh/o CVA ___ p/w acute on chronic substernal CP concerning for \npericarditis.\n\nHe had substernal chest pressure on admission with negative Tn \nx2 and EKG without acute findings. TTE was performed in the ED \nand it showed small pericardial effusion. CT chest was \nconcerning for hemorrhagic conversion so his home xerelto was \nheld. His pulsus was < 10. CRP was 38. He was started on \ncolchicine. Repeat TTE showed slightly larger effusion, but \nanother repeat afterwards showed stabilization/improvement. \nGiven his history of pleural plaques, there was a concern for \nmalignant effusion. His set rates for his PPM were switched from \n60 to 50. Interrogation showed no abnormal rhythm. He was \nrestarted on xarelto, given his history of stroke in ___ and \nrepeat TTE on ___ showed a stable, small pericardial effusion \nwith no evidence of tamponade. He was chest pain free with \nbreathing at baseline for > 24hrs prior to discharge.\n\nTRANSITIONAL ISSUES:\n==================\n-Discharge weight: 78 kg\n-Follow-up: He will follow-up with his PCP, ___, and \ncardiologist upon discharge\n-New medications: Colchicine 0.6 mg BID for 3 months.\n-Pericardial effusion and pleural plaques: He will need to \nfollow-up with both cardiology and pulmonology. He has a new \npericardial effusion that is hemorrhagic and he has evidence of \npleural plaque. Concern for malignant pericardial effusion. \nContinue discussions as an outpatient regarding diagnostic \ntesting and goals of care.\n-Colchicine: He is on atorvastatin and diltiazem, which both \ninteract with colchicine. Please re-evaluate use of this \nmedication, monitor for toxicity, and discontinue when able.\n-Code: full, presumed \n-Contact: HCP: ___ (daughter) ___, ___ \n(daughter) ___\n\n#Chest pain: \n#Pericardial effusion: \n#Pericarditis: \nConstant substernal chest pain, troponin negative, EKG elevated \nJpoint in I, AVR. TTE in the ED performed by cards fellow with \nsmall pericardial effusion. Picture most consistent with \npericarditis with hemorrhagic conversion in the setting of \nanticoagulation with xarelto. Possible relation to his pleural \nplaques concerning for malignant pleural effusion. CRP elevated \nat 38. trops 2X <0.01. Pulus 10 on admission. Symptomatically \nimproved with colchicine. TTE ___ with slightly increased size, \nbut repeat on ___ showed stabilization/improvement - continued \nto be stable effusion on ___ TTE. His xarelto was restarted \nprior to ___ TTE and did not worsen effusion.\n\n#Pleural plaques:\nHas lower left lung plaque on CTA ___ in comparison to CT chest \non ___. He follows a pulmonologist as an outpatient and he has \nhad known limited asbestos exposure. Plaques seen on most recent \natrius CT chest ___. Given history of plaques and CRP \nelevation, concern for malignant pleural effusion.\n\n#Sick sinus syndrome:\n#Atrial fibrillation:\n#History of cerebrovascular accident (___):\nHe had a stroke in ___ thought to be secondary to AF (no MRI as \nhe has a PPM). His LUE deficits are not noticeable on exam. \nSymptomatic bradycardia s/p pacer placement. Tendril STS ___ \nin place. Interrogated in the emergency department two episodes \nof NSVT ___ beats) on ___ @2:30 pm and again ___ with no \nprogramming changes. He is a-paced at ~80%. Anticoagulated with \nxarelto. Started on dofetilide 250 mg Q12hr in ___. Cr at \nbaseline and QTc on admission 453 with heart rate 60's. His low \nset rate was reset to 50. His xerelto was held due to concern \nfor hemorrhagic effusion. Continued fractionated dilt 60 mg q6hr \nfor total 240 mg daily - restarted 240mg XR dose on discharge.\n\n#Heart failure with diastolic dysfunction: \nLEVF on last TTE 55% to 60%, NYHA II, ACC stage D (biventricular \npacing); euvolemic on exam. Admission weight 79 kg (Dry weight \n79 kg). His home torsemide was held on admission, but restarted \nupon discharge.\n\n#Diarrhea:\nLikely secondary to colchicine and bowel regimen. No abdominal \npain. Discontinued laxatives with improvement.\n\n#Asthma:\n#Chronic obstructive pulmonary disease: \nLast PFTs in our system ___ and FEV1/FVC consistent with \nobstructive pattern given I:E ratio however with possible \nrestriction given FEV1/FVC ratio ~106% at home on \numeclidinium-vilanterol 62.5-25 mcg, flucitisone 110 daily and \nalbuterol prn. He was continued on his home medications (advair \nwas switched as umeclifinium is non-formulary).\n\n#Chronic kidney disease: \ncrt 1.4 vs baseline ~1.2-1.5. His medications were renally \ndosed."}}
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{'final_diagnoses': ['Pericardial effusion', 'Pericarditis', 'Pleural plaques', 'Atrial fibrillation', 'Chronic obstructive pulmonary disease', 'History of cerebrovascular disease', 'Heart failure with preserved ejection fraction', 'Sick sinus syndrome', 'Coronary artery disease'], 'procedures': ['none'], 'visit_summary': "___ w/ HFpEF (55%), SSS (PPM/dofet/xerelto), asthma/COPD, HLD, \nh/o CVA ___ p/w acute on chronic substernal CP concerning for \npericarditis.\n\nHe had substernal chest pressure on admission with negative Tn \nx2 and EKG without acute findings. TTE was performed in the ED \nand it showed small pericardial effusion. CT chest was \nconcerning for hemorrhagic conversion so his home xerelto was \nheld. His pulsus was < 10. CRP was 38. He was started on \ncolchicine. Repeat TTE showed slightly larger effusion, but \nanother repeat afterwards showed stabilization/improvement. \nGiven his history of pleural plaques, there was a concern for \nmalignant effusion. His set rates for his PPM were switched from \n60 to 50. Interrogation showed no abnormal rhythm. He was \nrestarted on xarelto, given his history of stroke in ___ and \nrepeat TTE on ___ showed a stable, small pericardial effusion \nwith no evidence of tamponade. He was chest pain free with \nbreathing at baseline for > 24hrs prior to discharge.\n\nTRANSITIONAL ISSUES:\n==================\n-Discharge weight: 78 kg\n-Follow-up: He will follow-up with his PCP, ___, and \ncardiologist upon discharge\n-New medications: Colchicine 0.6 mg BID for 3 months.\n-Pericardial effusion and pleural plaques: He will need to \nfollow-up with both cardiology and pulmonology. He has a new \npericardial effusion that is hemorrhagic and he has evidence of \npleural plaque. Concern for malignant pericardial effusion. \nContinue discussions as an outpatient regarding diagnostic \ntesting and goals of care.\n-Colchicine: He is on atorvastatin and diltiazem, which both \ninteract with colchicine. Please re-evaluate use of this \nmedication, monitor for toxicity, and discontinue when able.\n-Code: full, presumed \n-Contact: HCP: ___ (daughter) ___, ___ \n(daughter) ___\n\n#Chest pain: \n#Pericardial effusion: \n#Pericarditis: \nConstant substernal chest pain, troponin negative, EKG elevated \nJpoint in I, AVR. TTE in the ED performed by cards fellow with \nsmall pericardial effusion. Picture most consistent with \npericarditis with hemorrhagic conversion in the setting of \nanticoagulation with xarelto. Possible relation to his pleural \nplaques concerning for malignant pleural effusion. CRP elevated \nat 38. trops 2X <0.01. Pulus 10 on admission. Symptomatically \nimproved with colchicine. TTE ___ with slightly increased size, \nbut repeat on ___ showed stabilization/improvement - continued \nto be stable effusion on ___ TTE. His xarelto was restarted \nprior to ___ TTE and did not worsen effusion.\n\n#Pleural plaques:\nHas lower left lung plaque on CTA ___ in comparison to CT chest \non ___. He follows a pulmonologist as an outpatient and he has \nhad known limited asbestos exposure. Plaques seen on most recent \natrius CT chest ___. Given history of plaques and CRP \nelevation, concern for malignant pleural effusion.\n\n#Sick sinus syndrome:\n#Atrial fibrillation:\n#History of cerebrovascular accident (___):\nHe had a stroke in ___ thought to be secondary to AF (no MRI as \nhe has a PPM). His LUE deficits are not noticeable on exam. \nSymptomatic bradycardia s/p pacer placement. Tendril STS ___ \nin place. Interrogated in the emergency department two episodes \nof NSVT ___ beats) on ___ @2:30 pm and again ___ with no \nprogramming changes. He is a-paced at ~80%. Anticoagulated with \nxarelto. Started on dofetilide 250 mg Q12hr in ___. Cr at \nbaseline and QTc on admission 453 with heart rate 60's. His low \nset rate was reset to 50. His xerelto was held due to concern \nfor hemorrhagic effusion. Continued fractionated dilt 60 mg q6hr \nfor total 240 mg daily - restarted 240mg XR dose on discharge.\n\n#Heart failure with diastolic dysfunction: \nLEVF on last TTE 55% to 60%, NYHA II, ACC stage D (biventricular \npacing); euvolemic on exam. Admission weight 79 kg (Dry weight \n79 kg). His home torsemide was held on admission, but restarted \nupon discharge.\n\n#Diarrhea:\nLikely secondary to colchicine and bowel regimen. No abdominal \npain. Discontinued laxatives with improvement.\n\n#Asthma:\n#Chronic obstructive pulmonary disease: \nLast PFTs in our system ___ and FEV1/FVC consistent with \nobstructive pattern given I:E ratio however with possible \nrestriction given FEV1/FVC ratio ~106% at home on \numeclidinium-vilanterol 62.5-25 mcg, flucitisone 110 daily and \nalbuterol prn. He was continued on his home medications (advair \nwas switched as umeclifinium is non-formulary).\n\n#Chronic kidney disease: \ncrt 1.4 vs baseline ~1.2-1.5. His medications were renally \ndosed.", 'medications_prescribed': ['Colchicine 0.6 mg PO DAILY \nRX *colchicine 0.6 mg One tablet(s) by mouth Once a day Disp \n#*30 Tablet Refills:*0', 'Albuterol Inhaler 2 PUFF IH Q4H:PRN wheezing', 'Atorvastatin 40 mg PO QPM', 'Diltiazem Extended-Release 240 mg PO DAILY', 'Dofetilide 250 mcg PO Q12H', 'Dorzolamide 2%/Timolol 0.5% Ophth. 1 DROP LEFT EYE BID', 'FLUoxetine 20 mg PO DAILY', 'Fluticasone Propionate 110mcg 2 PUFF IH DAILY', 'Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS', 'Midodrine 2.5 mg PO BID', 'Omeprazole 20 mg PO DAILY', 'Potassium Chloride 40 mEq PO DAILY', 'Rivaroxaban 15 mg PO DAILY', 'Selenium Sulfide 5 mL TP DAILY', 'Torsemide 20 mg PO DAILY', 'umeclidinium-vilanterol 62.5-25 mcg/actuation inhalation \nDAILY']}
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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': 'Abdominal pain', 'medical_history': ['Allergic rhinitis', 'Cystoscopy as a child'], 'family_history': 'NC', 'present_illness': 'This ___ male awoke up from sleep 30 hours preop with \nright lower quadrant abdominal pain, which gradually worsened. \nHe had consumed a pizza for dinner. He denied nausea, vomiting, \nand abnormal bowel movements.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H: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': '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Methylene Blue 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Gentamicin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [], 'exams': 'On admission: the abdomen was soft, nondistended and with focal \ntenderness to palpation and guarding in the right lower quadrant \nwith a positive Rovsing sign. \n-\nOn discharge: \nVS: 98, 96, 110/62, 20, 98% RA\nGen - NAD\nHeart - RRR\nLungs - CTAB\nAbd - soft, mildly distended, dressings intact with some \nserosanguinous drainage at umbilical site\nExtrem - no edema', 'diagnoses': [{'icd_code': '8911', 'desc': 'Open wound of knee, leg [except thigh], and ankle, complicated'}, {'icd_code': 'E8192', 'desc': 'Motor vehicle traffic accident of unspecified nature injuring motorcyclist'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}], 'summary': '___ 12:20AM WBC-10.2 RBC-4.75 HGB-15.1 HCT-42.1 MCV-89 \nMCH-31.9 MCHC-35.9* RDW-13.0\n___ 12:20AM NEUTS-54.1 ___ MONOS-5.3 EOS-5.4* \nBASOS-0.7\n___ 12:20AM PLT COUNT-213\n___ 12:20AM ALT(SGPT)-21 AST(SGOT)-23 ALK PHOS-61 TOT \nBILI-0.3\n___ 12:20AM LIPASE-40\n___ 12:20AM GLUCOSE-129* UREA N-15 CREAT-0.9 SODIUM-141 \nPOTASSIUM-3.6 CHLORIDE-103 TOTAL CO2-28 ANION GAP-14\n___ 01:40AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-5.5 \nLEUK-NEG\n\n---\n___ CT A/P: The appendix is seen in the right lower quadrant, \ndilated to a 9 mm with hyper enhancement and minimal adjacent \nstranding. Although fluid cannot be seen within it, there is no \nair within it, and the findings suggest early acute \nappendicitis. There is no adjacent fluid collection and no free \nintraperitoneal air.\n___ was admitted on ___ under the acute care surgery \nservice for management of his acute appendicitis. He was taken \nto the operating room and underwent a laparoscopic appendectomy. \nPlease see operative report for details of this procedure. He \ntolerated the procedure well and was extubated upon completion. \nHe was subsequently taken to the PACU for recovery.\n\nHe was transferred to the surgical floor hemodynamically stable. \nHis vital signs were routinely monitored and he remained \nafebrile and hemodynamically stable. He was initially given IV \nfluids postoperatively, which were discontinued when he was \ntolerating PO. Post-operatively, his diet was advanced as \ntolerated to regular, which he tolerated without abdominal pain, \nnausea, or vomiting. He was voiding adequate amounts of urine \nwithout difficulty. He was encouraged to mobilize out of bed and \nambulate as tolerated, which he was able to do independently. \nHis pain level was routinely assessed and well controlled at \ndischarge with an oral regimen as needed. On ___, he was \ndischarged home with follow up in ___ clinic.'}}
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{'final_diagnoses': ['Acute appendicitis'], 'procedures': ['___ - laparoscopic appendectomy'], 'visit_summary': '___ was admitted on ___ under the acute care surgery \nservice for management of his acute appendicitis. He was taken \nto the operating room and underwent a laparoscopic appendectomy. \nPlease see operative report for details of this procedure. He \ntolerated the procedure well and was extubated upon completion. \nHe was subsequently taken to the PACU for recovery.\n\nHe was transferred to the surgical floor hemodynamically stable. \nHis vital signs were routinely monitored and he remained \nafebrile and hemodynamically stable. He was initially given IV \nfluids postoperatively, which were discontinued when he was \ntolerating PO. Post-operatively, his diet was advanced as \ntolerated to regular, which he tolerated without abdominal pain, \nnausea, or vomiting. He was voiding adequate amounts of urine \nwithout difficulty. He was encouraged to mobilize out of bed and \nambulate as tolerated, which he was able to do independently. \nHis pain level was routinely assessed and well controlled at \ndischarge with an oral regimen as needed. On ___, he was \ndischarged home with follow up in ___ clinic.', 'medications_prescribed': ['1. Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain \nRX *oxycodone-acetaminophen 5 mg-325 mg ___ tablet(s) by mouth \nevery 4 hours Disp #*25 Tablet Refills:*0']}
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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': 'headache', 'medical_history': ['Severe scoliosis during childhood, corrected at ___. Has cervical\nthrough thoracic fusion, ___.', 'Eczema', '+Car sickness as a child'], 'family_history': 'Mother with migraines. Maternal grandfather with strokes. No\nbleeding or clotting disorders. Aunt with fibromyalgia. Sister\nwith thyroid disease.', 'present_illness': 'The patient is a ___ woman\nwho presents with headaches for 1 month. History is obtained \nfrom\nthe patient as well as from documentation from Drs. ___. \n\nShe has never had headaches before ___. Symptoms began\nwith right ear infection in ___ treated with amoxicillin for\n10 days. She subsequently developed pain in the left ear which\nwas sharp (unlike right ear which was pressure-like pain), and\n___ intensity. ENT evaluated left ear and found it was normal.\nShe initially treated her headaches with ibuprofen 600mg Q6H\nalong with Tylenol ___ Q6H. \n\nSince then she continues to have bitemportal and supra-auricular\nheadache, pressure sensation, mild and barely noticeable. \nHowever\nin ___ her head pressure gradually became more intense and\nis now painful as of the 2 weeks. The pain is pulsating along\nwith heartbeat, and worsens when she goes up stairs or does any\nactivity. The pulsing is also worse when lying flat or with\nValsalva maneuver, eg laughing, or when bending over. It is also\nworse after sex. It\'s making her significantly anxious as well.\nNo fevers (she measures). No night sweats. \n\nShe feels like her field of vision is pulsating as well, which\nshe describes as "narrows with the pulsation". No double vision,\nbut does feel it\'s slightly blurry and takes more time to focus.\nHas had flashes in her vision "like confetti" since she was ___. \n\nShe had full eye exam in late ___ which was normal, but she\ndid not have eye symptoms at the time. She had an evaluation at\n___ Eye and Ear, and no evidence of sinus disease \ncould\nbe found. Evaluation included a CT scan of her head and negative\nEBV\ntesting. \n\nWhen seen by Drs. ___, she had a normal exam,\nincluding fundoscopy and visual fields. An MRI was obtained,\nincluding with MPRAGE sequences, and was normal.\n\nHowever, due to ongoing symptoms and concern for vascular\npathology, IIH, etc. she is referred to the ED for further\nevaluation. \n\nOn my interview, she confirms the history as above. She \ncontinues\nto complain of a mild holocephalic "pressure" sensation, which \nis\nworse when lying flat. Headache is essentially constant. It\nimproves when standing but does not completely go away. She\nstates she is sleeping poorly recently, but it does not seem \nthat\nthe headaches wake her from sleep, per se. She usually wakes up\nwith a headache, and it worsens throughout the day. Regarding \nher\ndyspnea, she reports feeling "winded" after climbing stairs or\notherwise exerting herself. There is no limitation in how far \nshe\ncan walk, or how many stairs she can climb. She occasionally\nfeels lightheaded after climbing stairs but this is very brief.\nShe has not lost consciousness. She has had very brief\npalpitations though again these are brief.', 'medications': [{'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': '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 IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY: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': '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': '30.5', 'valuenum': 30.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 24.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '4.5', 'valuenum': 4.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75.9', 'valuenum': 75.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '417', 'valuenum': 417.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.77', 'valuenum': 2.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '10', 'valuenum': 10.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 0.4, '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 20-29 is 116 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, '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': 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': 'LG.'}, {'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': 'MOD.'}, {'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': '4', 'valuenum': 4.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.008', 'valuenum': 1.008, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 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': '5', 'valuenum': 5.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, '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': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70.1', 'valuenum': 70.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '401', 'valuenum': 401.0, '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': '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': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '523', 'valuenum': 523.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'MOD.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, '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': 'SM .'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/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': 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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Physical Examination:\nVitals: T: 98.7 P: 85 R: 18 BP: 125/73 SaO2: 98% room air\n*when ambulated around ED, no tachycardia or change in O2 sat\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx\nNeck: Supple. Mild tenderness of cervical spine and paraspinal\nmuscles, no spasm. \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 ___ edema.\nSkin: no rashes or lesions noted.\n\nNeurologic:\n-Mental Status: Alert, oriented x 3. Able to relate history\nwithout difficulty. Attentive to interview and exam. Language is\nfluent with intact repetition and comprehension. Normal prosody.\nThere were no paraphasic errors. Speech was not dysarthric. Able\nto follow both midline and appendicular commands. There was no\nevidence of apraxia or neglect.\n-Cranial Nerves:\nII, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without\nnystagmus. Normal saccades. VFF to confrontation. Visual acuity\n___ bilaterally. Fundoscopic exam revealed very slight \nblurring\nof the nasal margins of the optic discs bilaterally\nV: Facial sensation intact to light touch.\nVII: No facial droop, facial musculature symmetric.\nVIII: Hearing intact to finger-rub bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii and SCM bilaterally.\nXII: Tongue protrudes in midline.\n-Motor: Normal bulk, tone throughout. No pronator drift\nbilaterally.\nNo adventitious movements, such as tremor, noted. No asterixis\nnoted.\n Delt Bic Tri WrE FFl FE IO IP Quad Ham TA ___\nL 5 ___ ___ 5 5 5 5 5 5 \nR 5 ___ ___ 5 5 5 5 5 5 \n-Sensory: No deficits to light touch, pinprick, cold sensation,\nvibratory sense, proprioception throughout. No extinction to \nDSS.\n-DTRs:\n Bi Tri ___ Pat Ach\nL 2 2 2 2 1\nR 2 2 2 2 1\nPlantar response was flexor bilaterally.\n-Coordination: No intention tremor, no dysdiadochokinesia noted.\nNo dysmetria on FNF or HKS bilaterally.\n-Gait: Good initiation. Narrow-based, normal stride and arm\nswing. Able to walk in tandem without difficulty. Romberg\nabsent.\n\n========================================================\n\nDischarge Physical Exam:\n24 HR Data (last updated ___ @ 007)\n Temp: 97.9 (Tm 98.3), BP: 116/78 (100-116/58-78), HR: 83\n(72-98), RR: 16 (___), O2 sat: 94% (94-97), O2 delivery: Ra \n\nGeneral: young woman sitting up comfortably in bed, NAD\nHEENT: NC/AT\nCardiac: warm, well-perfused\nPulmonary: no increased work of breathing\nAbdomen: soft, ND\nExtremities: wwp, no C/C/E bilaterally\nSkin: no rashes or lesions noted. \nNeurologic: \n-MS - awake, alert, oriented to self, hospital, date, situation.\nSpeech is fluent. Able to give history without difficulty. \n-CN- PERRL 3-2 mm, visual acuity ___ OS, ___ OD. Slightly\nblurry nasal margins on L optic disk, +venous pulsations. EOMI,\nno nystagmus. Pain when moving L eye to L or up. No facial\nasymmetry. V1, V2, V3 intact, equal to light touch b/l. \nSymmetric\npalate elevation. tongue midline. \n-Motor- normal bulk and tone. No tremor. No pronator drift. \n [Delt] [Bic] [Tri] [ECR] [FEx] [IP] [Quad] [Ham] [TA] [Gas]\n L 5 5 5 5 5 5 5 5 5 5\n R 5 5 5 5 5 5 5 5 5 5\n-Sensory: intact to soft touch. \n-Reflexes: deferred\n-Coordination: intact FNF b/l. \n-Gait: deferred', 'diagnoses': [{'icd_code': '67434', 'desc': 'Other complications of obstetrical surgical wounds, postpartum condition or complication'}, {'icd_code': 'E8788', 'desc': 'Other specified surgical operations and procedures causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}], 'summary': 'MRI brain with and wo cont ___: IMPRESSION: \n \nNormal brain MRI. No evidence of dural venous sinus thrombosis.\n\nMRA neck w/wo cont ___: IMPRESSION:\n \n \n1. Normal neck MRA.\n2. Patent internal jugular veins of the neck. Apparent areas of \nnarrowing of bilateral upper internal jugular veins at the level \nof C2 and C3 (the level of the lower parotid glands) may be \nartifactual, but could be further assessed by ultrasound if \nclinically warranted.\n\nT-SPINE; LUMBO-SACRAL SPINE (AP & LAT) \nIMPRESSION: \n \nThoracic and lumbar spine AP and lateral views demonstrate \nposterior spinal hardware extending from T4 to L3 on the right \nside and T5-L3 on the left side. No hardware related \ncomplications are seen. There is mild thoracolumbar scoliosis. \nHeart size is within normal limits. Visualized lung fields are \ngrossly clear. There are degenerative changes of the upper \nthoracic spine with anterior spurring. There are no definite \ncompression deformities. \nT-shaped IUD device is seen within the lower pelvis.\n\n___ 08:52AM BLOOD WBC-18.3* RBC-4.21 Hgb-12.0 Hct-36.1 \nMCV-86 MCH-28.5 MCHC-33.2 RDW-13.1 RDWSD-40.3 Plt ___\n___ 11:40AM BLOOD WBC-13.1* RBC-4.66 Hgb-13.2 Hct-40.4 \nMCV-87 MCH-28.3 MCHC-32.7 RDW-13.2 RDWSD-41.2 Plt ___\n___ 08:52AM BLOOD Neuts-85.3* Lymphs-9.6* Monos-4.2* \nEos-0.0* Baso-0.2 Im ___ AbsNeut-15.58* AbsLymp-1.76 \nAbsMono-0.76 AbsEos-0.00* AbsBaso-0.03\n___ 08:52AM BLOOD ___ PTT-27.7 ___\n___ 11:40AM BLOOD Glucose-80 UreaN-11 Creat-0.6 Na-140 \nK-4.6 Cl-104 HCO3-25 AnGap-11\n___ 08:52AM BLOOD ALT-16 AST-18\n___ 11:40AM BLOOD cTropnT-<0.01\n___ 11:40AM BLOOD proBNP-21\n___ 11:40AM BLOOD Calcium-9.7 Phos-3.4 Mg-1\n___ year old woman with a history of relatively new onset \nheadaches since ___ of this year, which initially\nbegan with an ear infection, but has since progressed to a \nnearly constant pressure-like pain, with pulsatile tinnitus and \ntransient visual obscurations. Headaches seem to be worse when \nrecumbent and with Valsalva. \nHer neurologic exam is non focal and her discs look good. \nConcern is for pseudotumor phenomenon/IIH. MRI/MRV was\nunremarkable, except for possible bilateral jugular vein \ncompression vs artifact. US of jugular veins was obtained and \nshowed patent flow. LP showed OP of 16 and was overall bland. At \nthis time will treat headache with course of steroids. Of note, \npatients was noted to have tonsillar hypertrophy which can cause \nOSA, she should follow up with ENT for this.'}}
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{'final_diagnoses': ['Headache', 'Leukocytosis'], 'procedures': ['___ guided Lumbar puncture'], 'visit_summary': '___ year old woman with a history of relatively new onset \nheadaches since ___ of this year, which initially\nbegan with an ear infection, but has since progressed to a \nnearly constant pressure-like pain, with pulsatile tinnitus and \ntransient visual obscurations. Headaches seem to be worse when \nrecumbent and with Valsalva. \nHer neurologic exam is non focal and her discs look good. \nConcern is for pseudotumor phenomenon/IIH. MRI/MRV was\nunremarkable, except for possible bilateral jugular vein \ncompression vs artifact. US of jugular veins was obtained and \nshowed patent flow. LP showed OP of 16 and was overall bland. At \nthis time will treat headache with course of steroids. Of note, \npatients was noted to have tonsillar hypertrophy which can cause \nOSA, she should follow up with ENT for this.', 'medications_prescribed': ['Omeprazole 40 mg PO DAILY Duration: 7 Days \nRX *omeprazole 40 mg 1 capsule(s) by mouth once a day Disp #*7 \nCapsule Refills:*0', 'PredniSONE 60 mg PO DAILY Duration: 7 Days \nThis is dose # of tapered doses\nRX *prednisone 20 mg 3 tablet(s) by mouth once a day Disp #*21 \nTablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 30, 'gender': 'M', 'symptoms': 'Bradycardia, Asystole', 'medical_history': ['Atrial fibrillation', 'CHF', 'CAD s/p CABG ___ (2VD, SVG -> OM1/PDA)', 's/p mitral valve repair', 's/p cholecystectomy', 's/p ERCP for CBD stone removal'], 'family_history': 'Mother- colon CA\nBrother- liver CA\nFather- COPD', 'present_illness': "___ F ___ only with h/o afib on Coumadin, CAD s/p \n\n___, and diastolic CHF LVEF >55% presents with abdominal \npain in ED. While in ED, patient became bradycardic to the ___ \nand continued to the ___ when she then went into asystole. \nPatient coded by ED team intermittently for 20 minutes. \nIntubated. Cardiology fellow and EP fellow called- placed \ntemporary pacing line. Patient's rhythm and pulse returned- \nthen transferred to the CCU for further monitoring/evaluation.\n.\nUpon transfer to floor, patient was intubated on mechanical \nventilation. HR in ___ and SBP of 109/53. Non-responsive. \nAgain seen and evaluated by EP fellow and cardiology fellow as \nwell as by CCU team. \n. \nUnable to obtain review of systems given patient is sedated.", 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Penicillin G Potassium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', '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': '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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Q8H: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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Clindamycin', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Penicillin G Potassium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', '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': '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', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, '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': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, '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 1.3, . estimated GFR (eGFR) is likely between 65 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': 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': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '268', 'valuenum': 268.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, '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': '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '0.27', 'valuenum': 0.27, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': 'NEG', '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, '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': '40.6', 'valuenum': 40.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '35.7', 'valuenum': 35.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 73.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': 'LOW*.'}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.64', 'valuenum': 4.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.55', 'valuenum': 0.55, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.19', 'valuenum': 8.19, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.6', 'valuenum': 38.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', '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': None, 'valuenum': None, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '>1.050*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'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': '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': 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': '-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': '43', 'valuenum': 43.0, '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': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 26.0, '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': '1.12', 'valuenum': 1.12, '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': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, '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': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 68.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'SL TOXIC GRANULATIONS. DOHLE BODIES PRESENT.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LOW*.'}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.19', 'valuenum': 4.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, '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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'OCCASIONAL*.'}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '0.37', 'valuenum': 0.37, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.63', 'valuenum': 7.63, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '18.3', 'valuenum': 18.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', '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}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '31', 'valuenum': 31.0, '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': '2.2', 'valuenum': 2.2, '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '381', 'valuenum': 381.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, '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': '22', 'valuenum': 22.0, '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': 'NEG.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '192', 'valuenum': 192.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', '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': '0.439', 'valuenum': 0.439, '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': '1.60', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.044', 'valuenum': 0.044, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 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'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', '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': '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': '35.6', 'valuenum': 35.6, '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': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, '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': '436', 'valuenum': 436.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.90', 'valuenum': 3.9, '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': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '___', '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': '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': '14.0', 'valuenum': 14.0, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', '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': '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': 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': 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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.9, '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, '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': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '452', 'valuenum': 452.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.93', 'valuenum': 3.93, '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': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 69.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37', 'valuenum': 37.0, '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.64', 'valuenum': 2.64, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.1', 'valuenum': 37.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '33.4', 'valuenum': 33.4, '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': '9.0', 'valuenum': 9.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '487', 'valuenum': 487.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.16', 'valuenum': 0.16, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.60', 'valuenum': 0.6, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.08', 'valuenum': 3.08, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '41.2', 'valuenum': 41.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Physical ___:\nVS: T= 96.3 BP= 140/70 HR= 90s RR= 12 O2 sat= 100% RA \nGENERAL: lying in bed, NAD, A and O x 3 \nHEENT: NCAT. PERRL. Conjunctiva were pink, no pallor or cyanosis \nof the oral mucosa. No xanthalesma. \nNECK: Supple with no elevated JVD \nCARDIAC: irregularly irregular S1, S2. No m/r/g. No thrills, \nlifts. No S3 or S4. \nLUNGS: CTA bilat \nABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not \nenlarged by palpation. No abdominial bruits. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: ___ 2+/1+ \nLeft: ___ 2+/1+', 'diagnoses': [{'icd_code': 'A400', 'desc': 'Sepsis due to streptococcus, group A'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'R6520', 'desc': 'Severe sepsis without septic shock'}, {'icd_code': 'T360X5A', 'desc': 'Adverse effect of penicillins, initial encounter'}, {'icd_code': 'Y92230', 'desc': 'Patient room in hospital as the place of occurrence of the external cause'}, {'icd_code': 'D6959', 'desc': 'Other secondary thrombocytopenia'}, {'icd_code': 'M25551', 'desc': 'Pain in right hip'}, {'icd_code': 'D638', 'desc': 'Anemia in other chronic diseases classified elsewhere'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}, {'icd_code': 'M79642', 'desc': 'Pain in left hand'}, {'icd_code': 'S0081XA', 'desc': 'Abrasion of other part of head, initial encounter'}, {'icd_code': 'W1839XA', 'desc': 'Other fall on same level, initial encounter'}, {'icd_code': 'Y92098', 'desc': 'Other place in other non-institutional residence as the place of occurrence of the external cause'}, {'icd_code': 'D72810', 'desc': 'Lymphocytopenia'}, {'icd_code': 'J029', 'desc': 'Acute pharyngitis, unspecified'}, {'icd_code': 'R791', 'desc': 'Abnormal coagulation profile'}, {'icd_code': 'R1032', 'desc': 'Left lower quadrant pain'}], 'summary': "CXR ___:\nFINDINGS: In comparison with the study of ___, the right IJ \ncatheter has \nbeen removed. Little change in the appearance of the heart and \nlungs with \nenlargement of the cardiac silhouette and blunting of the \ncostophrenic angles bilaterally. No definite pulmonary vascular \ncongestion at this time. \n.\nTTE ___:\nThe left atrium is moderately dilated. The right atrium is \nmoderately dilated. Left ventricular wall thickness, cavity size \nand regional/global systolic function are normal (LVEF 60-70%). \nRight ventricular chamber size and free wall motion are normal. \nThe ascending aorta is moderately dilated. The aortic valve \nleaflets (3) are mildly thickened but aortic stenosis is not \npresent. Moderate (2+) aortic regurgitation is seen. The mitral \nvalve leaflets are mildly thickened. The tricuspid valve \nleaflets are mildly thickened. Moderate [2+] tricuspid \nregurgitation is seen. There is mild pulmonary artery systolic \nhypertension. There is no pericardial effusion. Compared with \nthe findings of the prior report (images unavailable for review) \nof 25 vNov ember v2008, probably no major change.\n.\nCT chest/abd/pelvis ___:\nIMPRESSION:\n1. No pulmonary embolism.\n2. Mild aneurysmal dilatation of the ascending aorta without \nevidence of \ndissection or intramural hematoma.\n3. Diffuse ground-glass opacities and septal thickening within \nthe lungs with bilateral pleural effusions, likely on the basis \nof pulmonary edema/fluid overload. There is also cardiomegaly.\n4. Stable intrahepatic biliary ductal dilatation and air as well \nas common \nbile duct dilatation.\n5. Mesenteric stranding and fluid in a peripancreatic region \naround the \npancreatic head extending into the porta hepatis and anterior \nperirenal \nfascia. These findings may relate to pancreatitis, please \nclinically \ncorrelate with patient's laboratory values.\n6. Poor renal cortical enhancement identified on arterial phase \nimaging, \nwhich is symmetric. Given patient's history of recent PEA \narrest, ATN is \nhighly considered.\n7. Featureless appearance of the entire large bowel with \nintramural fat \ndeposition and absence of skip lesions. No pericolonic \ninflammatory changes are noted. These findings may be related to \nburnt out/chronic ulcerative colitis, as opposed to a more acute \nprocess.\n8. Ascites.\n\nLabs at discharge\nWBC RBC Hgb Hct MCV MCH MCHC RDW Plt Ct \n6.9 4.25 11.9* 36.2 85 28.1 33.0 15.0 140\n\nINR 3.1\n\nGlucose UreaN Creat Na K Cl HCO3 AnGap \n189* 22* 1.0 138 4.0 ___ \n\n \n___ y/o F with CAD presenting with abdominal pain, bradycardia \nprogressing to PEA arrest, s/p resuscitation, intubated and on \npressors.\n.\n# RHYTHM/PEA: Has chronic history of a-fib (on \nanticoagulation). Patient became asystolic while in ED in the \nsetting of bradycardia. Suspect vagal episode. Was coded by ED \nteam, intubated, and had temporary pacer wire placed by \ncardiology fellow. Interestingly, unsure if the event was true \nasystole, as patient seems to recall the entire event. \nPulse/pressure returned and patient immediately trasferred to \nCCU. Patient extubated on hospital day 2. In paced rhythm with \nHR of 90. Telemetry without other events, and temporary pacer \nwire was removed soon thereafter. Of note, etiology likely \nbradycardia/vagal reaction, as CT chest, abdomen, and pelvis not \nconsistent with other etiologies of PEA/asystole including \ntrauma, pneumothorax, aortic dissection, PE, AAA, MI, mesenteric \nischemia, etc. Patient's HR ranged from ___, while on \nmetoprolol 75 mg tid. Patient was discharged on the following \nregimen for rate control: coreg 25 mg BID, dilt ER 120 mg daily.\n.\n#Hypotension: unclear etiology, but in the setting of her \nPEA/asystolic/bradycardia event. Patient was weaned of pressors \nfairly rapidly while in the CCU, did well, was soon transferred \nto floor. Pt continued to be normotensive upon discharge.\n.\n# Abdominal pain - CT abdomen/pelvis without clear etiology for \nabdominal pain. Pain resolved fairly rapidly and may have been \nrelated to incomplete obstruction/constipation.\n.\n# Hypoxia: CXR with ?LLL infiltrate, cardiomegaly, coin lesion \nin RLL. In setting of her leukocytosis, empiric flagyl and \nlevofloxacin were started. Abx were continued for total of 5 \ndays.\n.\n#Acute renal failure: Baseline Creatinine 1.0, was 2.0 on \npresentation, suspect etiology to be pre-renal insult in setting \nof her bradycardia/asystolic event. On discharge, Cr was 1, at \nbaseline. \n.\n#Leukocytosis: WBC 20.0. Suspected from stress of cardiac \narrest, epinephrine administration. Unlikely from abdominal \ncatastophy as CT abdomen and pelvis negative for acute process. \nPatient to complete 5 day course of flagyl and levofloxacin.\n. \n# CORONARIES: History of CAD s/p CABG in ___. Continued on \naspirin, atorvastatin. Cardiac enzymes not c/w ACS.\n. \n# PUMP: History of HTN- patient on carvedilol 25mg PO BID and \nlasix 40mg daily. Echo from ___ showing moderately dilated LA. \nThe right atrium is moderately dilated. Left ventricular wall \nthickness, cavity size and regional/global systolic function are \nnormal (LVEF 60-70%). Right ventricular chamber size and free \nwall motion are normal. The ascending aorta is moderately \ndilated. The aortic valve leaflets (3) are mildly thickened but \naortic stenosis is not present. Moderate (2+) aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. The tricuspid valve leaflets are mildly thickened. \nModerate [2+] tricuspid regurgitation is seen. There is mild \npulmonary artery systolic hypertension. There is no pericardial \neffusion. Compared with the findings of the prior report (images \nunavailable for review) of 25 vNov ember v___, probably no \nmajor change. \n. \n# Anticoagulation- on coumadin 2mg daily for chronic a-fib. On \ndischarge INR was 3.1, likely elevated in setting of short \ncourse of antibiotics. Pt will have close follow up to monitor \nINR. Dose will be held on day of discharge, and 1 mg will be \ngiven day after discharge. Home regimen prior to admission was \nwarfarin 2 mg daily."}}
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{'final_diagnoses': ['vagal episode, asystole', 'LLL pneumonia', 'CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension', 'CARDIAC HISTORY:', '-CABG: ___, SVG-->OM1/PDA', '-PERCUTANEOUS CORONARY INTERVENTIONS: None', '-PACING/ICD: Temporary pacer placed in ED', 'Atrial fibrillation', 'CHF', 's/p mitral valve repair', 'OTHER PAST MEDICAL HISTORY:', 's/p cholecystectomy', 's/p ERCP for CBD stone removal'], 'procedures': ['Cardiopulmonary resucitation', 'Intubation', 'Temporary pacing wire'], 'visit_summary': "___ y/o F with CAD presenting with abdominal pain, bradycardia \nprogressing to PEA arrest, s/p resuscitation, intubated and on \npressors.\n.\n# RHYTHM/PEA: Has chronic history of a-fib (on \nanticoagulation). Patient became asystolic while in ED in the \nsetting of bradycardia. Suspect vagal episode. Was coded by ED \nteam, intubated, and had temporary pacer wire placed by \ncardiology fellow. Interestingly, unsure if the event was true \nasystole, as patient seems to recall the entire event. \nPulse/pressure returned and patient immediately trasferred to \nCCU. Patient extubated on hospital day 2. In paced rhythm with \nHR of 90. Telemetry without other events, and temporary pacer \nwire was removed soon thereafter. Of note, etiology likely \nbradycardia/vagal reaction, as CT chest, abdomen, and pelvis not \nconsistent with other etiologies of PEA/asystole including \ntrauma, pneumothorax, aortic dissection, PE, AAA, MI, mesenteric \nischemia, etc. Patient's HR ranged from ___, while on \nmetoprolol 75 mg tid. Patient was discharged on the following \nregimen for rate control: coreg 25 mg BID, dilt ER 120 mg daily.\n.\n#Hypotension: unclear etiology, but in the setting of her \nPEA/asystolic/bradycardia event. Patient was weaned of pressors \nfairly rapidly while in the CCU, did well, was soon transferred \nto floor. Pt continued to be normotensive upon discharge.\n.\n# Abdominal pain - CT abdomen/pelvis without clear etiology for \nabdominal pain. Pain resolved fairly rapidly and may have been \nrelated to incomplete obstruction/constipation.\n.\n# Hypoxia: CXR with ?LLL infiltrate, cardiomegaly, coin lesion \nin RLL. In setting of her leukocytosis, empiric flagyl and \nlevofloxacin were started. Abx were continued for total of 5 \ndays.\n.\n#Acute renal failure: Baseline Creatinine 1.0, was 2.0 on \npresentation, suspect etiology to be pre-renal insult in setting \nof her bradycardia/asystolic event. On discharge, Cr was 1, at \nbaseline. \n.\n#Leukocytosis: WBC 20.0. Suspected from stress of cardiac \narrest, epinephrine administration. Unlikely from abdominal \ncatastophy as CT abdomen and pelvis negative for acute process. \nPatient to complete 5 day course of flagyl and levofloxacin.\n. \n# CORONARIES: History of CAD s/p CABG in ___. Continued on \naspirin, atorvastatin. Cardiac enzymes not c/w ACS.\n. \n# PUMP: History of HTN- patient on carvedilol 25mg PO BID and \nlasix 40mg daily. Echo from ___ showing moderately dilated LA. \nThe right atrium is moderately dilated. Left ventricular wall \nthickness, cavity size and regional/global systolic function are \nnormal (LVEF 60-70%). Right ventricular chamber size and free \nwall motion are normal. The ascending aorta is moderately \ndilated. The aortic valve leaflets (3) are mildly thickened but \naortic stenosis is not present. Moderate (2+) aortic \nregurgitation is seen. The mitral valve leaflets are mildly \nthickened. The tricuspid valve leaflets are mildly thickened. \nModerate [2+] tricuspid regurgitation is seen. There is mild \npulmonary artery systolic hypertension. There is no pericardial \neffusion. Compared with the findings of the prior report (images \nunavailable for review) of 25 vNov ember v___, probably no \nmajor change. \n. \n# Anticoagulation- on coumadin 2mg daily for chronic a-fib. On \ndischarge INR was 3.1, likely elevated in setting of short \ncourse of antibiotics. Pt will have close follow up to monitor \nINR. Dose will be held on day of discharge, and 1 mg will be \ngiven day after discharge. Home regimen prior to admission was \nwarfarin 2 mg daily.", 'medications_prescribed': ['Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Warfarin 2 mg Tablet Sig: One (1) Tablet PO Once Daily at 4 \n___: Take ___ tab on ___ then start taking full tablet on \n___.', 'Carvedilol 12.5 mg Tablet Sig: Two (2) Tablet PO BID (2 times \na day).', 'Diltiazem HCl 120 mg Capsule, Sustained Release Sig: One (1) \nCapsule, Sustained Release PO DAILY (Daily).', 'Lasix 40 mg Tablet Sig: One (1) Tablet PO once a day.', 'Outpatient Lab Work\nplease check INR in next ___ days\ncall results to Dr. ___ at ___', 'Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO once a day.', 'Lidoderm 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: One \n(1) Topical once a day for 3 days.\nDisp:*1 0* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 63, 'gender': 'F', 'symptoms': 's/p DES, chest pain', 'medical_history': ['CARDIAC RISK FACTORS \n- Hypertension \n- Dyslipidemia', 'CARDIAC HISTORY \n- Coronaries: CABG ___. LIMA to LAD, occluded VG to Ramus, 50% \nstenosis distal RCA, 30% proximal/distal LCX, 50% tubular \nstenosis distal LAD after anastamosis\n- Pumping function: 60%\n- Rhythm: NSR', 'OTHER PAST MEDICAL HISTORY \n- GERD', 'PAST SURGICAL HISTORY\n- Hysterectomy ___\n- L breast lumpectomy\n- Cholecystectomy\n- C section x2'], 'family_history': 'Mother died of MI at ___. Father had angina, died at ___. Brother \nhad rheumatic fever, s/p renal transplant, diet at 72.', 'present_illness': '___ year old female with history of CABG in ___ with LIMA to the\nLAD; SVG to ramus, had recurrent chest pain, recent\nhospitalization ___, with cardiac catheterization c/b \nLAD\ndissection and CCU stay with IABP placement, now presented for\nelective cardiac catheterization, today s/p DES to LCx, admitted\nfor monitoring given catheter-thrombosis with distal\nembolization. \n\nShe developed recurrent chest pain in ___, had cardiac\ncatheterization ___ which showed patent LIMA to LAD,\noccluded VG to Ramus and 50% stenosis in the distal RCA\nbranch(PLA), 30% proximal and distal LCX. She was maintained on\nmedical mainagment. She had a cardiac perfusion study in \n___ after significant episode of chest pain. This was notable\nfor small area of moderate ischemia in the posterolateral area\nc/w occluded VG to Ramus and small zoned of mild ischemia in the\n___ LAD territory c/w trapped myocardium. Imdur was increased. \nShe presented to ___ for outpatient cardiac catheterization on\n___. During that admission for cath, there was unsuccessful\nballoon angioplasty c/b dissection of LAD. IABP was placed,\ndiscontinued 1 day after admission. Decision was made not to\nrevascularize during that hospitalization. She was continued on\nASA 81mg, Atorvastatin 80mg, and her imdur, labetalol and\nvalsartan were uptitrated. \n\nShe was discharged and continued having frequent episodes of\nchest pain, both at rest and exertion, relieved by SL\nnitroglycerin. She came in today for elective cardiac\ncatheterization. She has had ___ chest pain since after\nprocedure, does feel anxiety is contributing. She also has been\nnauseaous as above.', 'medications': [{'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin Flush (100 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', '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': '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', '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': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atenolol', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Nitrate Vag Cream 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'VG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'PB', 'frequency': '1X', 'doses_per_24_hrs': 0.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Enalapril Maleate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': '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': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'BID: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': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': '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': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', '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}]}, 'clinical_findings': {'labs': [{'value': '0.20', 'valuenum': 0.2, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.0', 'valuenum': 0.0, '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': '26.7', 'valuenum': 26.7, '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': '2.3', 'valuenum': 2.3, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87.6', 'valuenum': 87.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '182', 'valuenum': 182.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.0', 'valuenum': 19.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.63', 'valuenum': 2.63, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '0.00', 'valuenum': 0.0, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.83', 'valuenum': 0.83, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.66', 'valuenum': 7.66, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70.0', 'valuenum': 70.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '471', 'valuenum': 471.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '2.8', 'valuenum': 2.8, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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 0.9, . 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 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 168.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '3.6', 'valuenum': 3.6, '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': '15', 'valuenum': 15.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, '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': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.52', 'valuenum': 2.52, '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': '67.1', 'valuenum': 67.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '480', 'valuenum': 480.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '131', 'valuenum': 131.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 170.0, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '260', 'valuenum': 260.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, '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': '1.4', 'valuenum': 1.4, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.7', 'valuenum': 67.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '489', 'valuenum': 489.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '74', 'valuenum': 74.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '112', 'valuenum': 112.0, '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1139', 'valuenum': 1139.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49', 'valuenum': 49.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '176', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '462', 'valuenum': 462.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '450', 'valuenum': 450.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '66', 'valuenum': 66.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 152.0, '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': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', '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': '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '37.5', 'valuenum': 37.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, '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': '33.3', 'valuenum': 33.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.8', 'valuenum': 18.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.61', 'valuenum': 2.61, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '68.3', 'valuenum': 68.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.42', 'valuenum': 2.42, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.1', 'valuenum': 69.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '393', 'valuenum': 393.0, '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': '47', 'valuenum': 47.0, '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 193.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '394', 'valuenum': 394.0, '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': '57', 'valuenum': 57.0, '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 153.0, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, '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': '33', 'valuenum': 33.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '433', 'valuenum': 433.0, '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': '59', 'valuenum': 59.0, '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 160.0, 'valueuom': 'mg/dL', 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'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '484', 'valuenum': 484.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '3', 'valuenum': 3.0, '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}], 'exams': 'ADMISSION EXAM:\n===============\nGENERAL: Well-developed, well-nourished, anxious affect, \nspeaking\nin full sentences\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no\npallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with no JVD \nCARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. No \nthrills,\nlifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp\nwere unlabored, no accessory muscle use. No crackles, wheezes or\nrhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. \nPULSES: Distal pulses palpable and symmetric.\nNEURO: No focal deficits. CNs intact. Strength and sensation\nintact in ___ upper and lower extremities. \n\nDISCHARGE EXAM:\n===============\nGENERAL: Well-developed, well-nourished, anxious affect, \nspeaking\nin full sentences\nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no\npallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with no JVD \nCARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. No \nthrills,\nlifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp\nwere unlabored, no accessory muscle use. No crackles, wheezes or\nrhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. \nPULSES: Distal pulses palpable and symmetric.\nNEURO: No focal deficits. CNs intact. Strength and sensation\nintact in ___ upper and lower extremities.', 'diagnoses': [{'icd_code': 'A4189', 'desc': 'Other specified sepsis'}, {'icd_code': 'K831', 'desc': 'Obstruction of bile duct'}, {'icd_code': 'G9349', 'desc': 'Other encephalopathy'}, {'icd_code': 'K830', 'desc': 'Cholangitis'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'C7951', 'desc': 'Secondary malignant neoplasm of bone'}, {'icd_code': 'E1140', 'desc': 'Type 2 diabetes mellitus with diabetic neuropathy, unspecified'}, {'icd_code': 'D630', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': 'Z853', 'desc': 'Personal history of malignant neoplasm of breast'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'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': 'Z794', 'desc': 'Long term (current) use of insulin'}], 'summary': "ADMISSION LABS:\n===============\n___ 07:25PM BLOOD WBC-8.6 RBC-3.26* Hgb-10.3* Hct-30.6* \nMCV-94 MCH-31.6 MCHC-33.7 RDW-13.2 RDWSD-45.1 Plt ___\n___ 07:25PM BLOOD Glucose-112* UreaN-12 Creat-0.6 Na-138 \nK-3.6 Cl-98 HCO3-27 AnGap-13\n___ 07:25PM BLOOD cTropnT-0.34*\n___ 07:25PM BLOOD Calcium-9.2 Phos-3.5 Mg-1.6\n\nPERTINENT STUDIES:\n==================\nCath Physician ___ ___\nRight dominant\nLM: Distal 90% calcified stenosis.\nLCx: Ostial 90% disease.\n\nPCI of the LM into LCx (IVUS guided), placement of single DES.\nComplicated by catheter-thrombosis with distal embolization\n\nDISCHARGE LABS:\n===============\n___ 06:13AM BLOOD WBC-8.1 RBC-3.16* Hgb-9.9* Hct-30.4* \nMCV-96 MCH-31.3 MCHC-32.6 RDW-13.1 RDWSD-46.2 Plt ___\n___ 06:13AM BLOOD Glucose-134* UreaN-12 Creat-0.7 Na-143 \nK-4.1 Cl-100 HCO3-29 AnGap-14\n___ 05:28PM BLOOD CK-MB-28* cTropnT-0.86*\n___ 06:13AM BLOOD Calcium-9.1 Phos-4.4 Mg-1.9\nMs. ___ is a ___ y.o. lady with h/o CAD s/p CABG ___ (LIMA to \n LAD, SVG to ramus), GERD, HTN who presented with recurrent \nchest pain, s/p DES to LM, c/b thrombus s/p thrombectomy, \nadmitted for pain control.\n\n# CAD s/p DES to Cx\n# In procedure thrombus s/p aspiration thromectomy\n# Recent LAD dissection: The patient has a long history of CAD \nwith a CABG in ___. The patient developed unstable angina in \nthe ___ which was medically managed. She had \ncontinued Angina over the past month and is s/p cath on ___ \ncomplicated by unsuccessful balloon angioplasty with dissection \nof LAD. On this hospitalization, she presented for elective \ncardiac catheterization s/p DES to left main into the \nCircumflex, c/b distal embolization. She had continued pain and \nnausea post procedurally which was treated with a Nitro drip, \nmorphine and Zofran. She was medically optimized with ASA, \nPlavix, Atorvastatin, as well as an antianginal regimen of \nLabetolol 150, Imdur 120, Valsartan 80, and Amlodipine 5. When \nthe patient's chest pain and nausea had resolved, and her blood \npressure was stable on this regimen, she was discharged home \nwith close follow up with PCP and with cardiology. \n\nCHRONIC ISSUES\n==============\n#Hx of recent urinary retention: The patient has a history of \nurinary retention, however she did not have any symptoms or \ncomplications of this during this admission. \n\n# HTN: The patient was treated with the medical regimen as \noutlined above with good blood pressure control. She had some \nmild hypotension with SBPs in the ___ and 100s prior to \ndischarge, but was asymptomatic. \n\n# GERD: Continued on Omeprazole\n\nTRANSITIONAL ISSUES:\n======================\n-Please monitor blood pressures on amlodipine 5 and dose reduced \nValsartan. Amlodipine added for help with anginal symptoms, with \nsome slightly low BPs on this regimen (90s to 100s systolic, \nassymptomatic) \n-Outpatient ECHO for follow up of EF (last ECHO ___- normal \nleft ventricular cavity size and global systolic function)\n-Outpatient Cardiac Rehab"}}
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{'final_diagnoses': ['-Unstable Angina, Coronary Artery Disease s/p DES to circumflex', '-Hypertension', '-GERD', '-Anxiety'], 'procedures': ['___ Cardiac Catheterization', 'PCI of the LM into LCx (IVUS guided), placement of single DES. Complicated by catheter-thrombosis with distal embolization.'], 'visit_summary': "Ms. ___ is a ___ y.o. lady with h/o CAD s/p CABG ___ (LIMA to \n LAD, SVG to ramus), GERD, HTN who presented with recurrent \nchest pain, s/p DES to LM, c/b thrombus s/p thrombectomy, \nadmitted for pain control.\n\n# CAD s/p DES to Cx\n# In procedure thrombus s/p aspiration thromectomy\n# Recent LAD dissection: The patient has a long history of CAD \nwith a CABG in ___. The patient developed unstable angina in \nthe ___ which was medically managed. She had \ncontinued Angina over the past month and is s/p cath on ___ \ncomplicated by unsuccessful balloon angioplasty with dissection \nof LAD. On this hospitalization, she presented for elective \ncardiac catheterization s/p DES to left main into the \nCircumflex, c/b distal embolization. She had continued pain and \nnausea post procedurally which was treated with a Nitro drip, \nmorphine and Zofran. She was medically optimized with ASA, \nPlavix, Atorvastatin, as well as an antianginal regimen of \nLabetolol 150, Imdur 120, Valsartan 80, and Amlodipine 5. When \nthe patient's chest pain and nausea had resolved, and her blood \npressure was stable on this regimen, she was discharged home \nwith close follow up with PCP and with cardiology. \n\nCHRONIC ISSUES\n==============\n#Hx of recent urinary retention: The patient has a history of \nurinary retention, however she did not have any symptoms or \ncomplications of this during this admission. \n\n# HTN: The patient was treated with the medical regimen as \noutlined above with good blood pressure control. She had some \nmild hypotension with SBPs in the ___ and 100s prior to \ndischarge, but was asymptomatic. \n\n# GERD: Continued on Omeprazole\n\nTRANSITIONAL ISSUES:\n======================\n-Please monitor blood pressures on amlodipine 5 and dose reduced \nValsartan. Amlodipine added for help with anginal symptoms, with \nsome slightly low BPs on this regimen (90s to 100s systolic, \nassymptomatic) \n-Outpatient ECHO for follow up of EF (last ECHO ___- normal \nleft ventricular cavity size and global systolic function)\n-Outpatient Cardiac Rehab", 'medications_prescribed': ['amLODIPine 5 mg PO DAILY \nRX *amlodipine 5 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet \nRefills:*0', 'Clopidogrel 75 mg PO DAILY to prevent stent thrombosis \nRX *clopidogrel 75 mg 1 tablet(s) by mouth Daily Disp #*30 \nTablet Refills:*0', 'Valsartan 80 mg PO DAILY \nRX *valsartan 80 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet \nRefills:*0', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 80 mg PO QPM', 'Isosorbide Mononitrate (Extended Release) 120 mg PO DAILY', 'Labetalol 150 mg PO BID', 'Nitroglycerin SL 0.4 mg SL Q5MIN:PRN chest pain', 'Omeprazole 20 mg PO BID', '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': 56, 'gender': 'M', 'symptoms': 'sob, wheezing', 'medical_history': ['1) Asthma; has history of 4 prior intubations', '2) Bipolar disorder', '3) Seizure disorder, thought to be related to drug withdrawal', '4) Depression/PTSD', '5) Polysubstance abuse, has history of heroin abuse/dependence, \ncocaine, and other substances', '6) Hep C diagnosed in ___', '7) antisocial personality disorder', '8) History of malingering with multiple admissions determined to \n\nbe faking symptoms to avoid incarceration', '9) Sexually assaulted a woman at the hospital while admitted to \nthe hospital in ___'], 'family_history': 'Father overdosed on cocaine in ___, was incarcerated for ___ \nyears. Died 6 months after being release from prison.', 'present_illness': "Mr. ___ is a ___ man with severe asthma since childhood \nrequiring multiple prior admissions and intubations, most \nrecently admitted twice in the last two months for asthma \nexacerbations presenting with dyspnea, cough and chest tightness \nin setting of completing recent steroid taper.\n\nMr. ___ was admitted this past ___ to ICU with asthma \nexacerbation in setting of new exposures at construction site \nwhich quickly resolved without intubation and was discharged on \nsteroid taper. He was readmitted from ___ to the medical \nfloor for recurrent asthma exacerbation thought to be secondary \nto URI. He was discharged on 10 day steroid taper and per \npatient was restarted on steroid taper by PCP following initial \ntaper due to recurrent symptoms. He was also discharged on \nalbuterol, tiotropium, fluticasone-salmeterol and loratidine \nwhich he reports he has taken as prescribed since discharge as \nhe lives in a half-way house where medications are monitored. \n\nPatient reports that he completed his steroid taper yesterday, \n___ with 10mg prednisone. However, yesterday he noticed after \nreturning from work (same ___ job as previously \nmentioned) that he began to develop shortness of breath and \ndifficulty breathing. He tried to relief his symptoms through \nhis inhalers at home and overnight was becoming increasingly \ndifficult to breath with worsening dyspnea. He repeated his peak \nflow at home which was 100. Given worsening symptoms, patient \npresented to ED. Of note, patient notes sick contacts with \nrespiratory symptoms at home but denies fevers, chills or mucous \nproduction. He reports starting ritalin recently as well. Also \nnotably, patient has some anxiety related to steroids in past. \n\nIn the ED, initial vitals: 97.6 72 108/63 20 95% ra. Patient \nreceived solumedrol 125mg IV, 3 duonebs and 2g magnesium. He was \nnoted to have normal labs, worsening respiratory status \nrequiring 4L NC. CXR was done which did not show hyperinflation \nor acute pulmonary process. Given patient's history of acute \ndecompensation, admitted to MICU for monitoring. On transfer, \nvitals were: 98.8 82 111/56 22 95% Nasal Cannula 4L.\n\nOn arrival to the MICU, vitals: 98.3 BP:172/69 P:64 R: 18 O2: \n94% on 4L. Patient reports feeling very tight in his chest and \nSOB but otherwise doing well.", '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': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', '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': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Alteplase 1mg/2mL ( Clearance ie. PICC, midline, tunneled access line, PA )', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE PER LUMEN (2 LUMEN)', 'doses_per_24_hrs': None}, {'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': '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': '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': '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', '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': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', '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': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': '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': 'HS', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': '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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Cisatracurium Besylate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': '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': 'HS', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', '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': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears GEL 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lidocaine Jelly 2% (Glydo)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Prochlorperazine', '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': 'HS', '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': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fentanyl Citrate', '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': 'Q6H', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoclopramide', '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 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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Fentanyl Citrate', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Chlorothiazide', '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': 'Discontinued via patient discharge', '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': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, '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': '14.5', 'valuenum': 14.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.66', 'valuenum': 1.66, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, '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': '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': 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': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NORMAL.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': '76', 'valuenum': 76.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, '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': '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': 'abnormal', 'priority': 'ROUTINE', 'comments': '1+*.'}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.85', 'valuenum': 3.85, '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': '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': '0.24', 'valuenum': 0.24, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.00', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, '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': '___'}, {'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': '___', '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': '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': '118', 'valuenum': 118.0, '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': 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/1.73 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': 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': '35', 'valuenum': 35.0, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.1, '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': 152.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '269', 'valuenum': 269.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '38', 'valuenum': 38.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 32.0, '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': '471', 'valuenum': 471.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '80', 'valuenum': 80.0, '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': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '61', 'valuenum': 61.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '340', 'valuenum': 340.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24/.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '283', 'valuenum': 283.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE RANGE AS OF ___.'}, {'value': '262', 'valuenum': 262.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, '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': 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': '8', 'valuenum': 8.0, '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': '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': 4.0, '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': 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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '46.7', 'valuenum': 46.7, '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': 'STAT', 'comments': '___'}, {'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': '40', 'valuenum': 40.0, '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': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '340', 'valuenum': 340.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28/.', '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': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, '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': '28/.', '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': '___', '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': '115', 'valuenum': 115.0, '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': 160.0, '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': '30', 'valuenum': 30.0, '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': 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': 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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': 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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '169', 'valuenum': 169.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '24', 'valuenum': 24.0, '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': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, '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': '37.6', 'valuenum': 37.6, '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': '___'}, {'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': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 195.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'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': '183', 'valuenum': 183.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '___', 'valuenum': 165.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'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': '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': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 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'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': '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': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '742', 'valuenum': 742.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 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'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '16.6', 'valuenum': 16.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, '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': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, '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': '-3', 'valuenum': -3.0, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, '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': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.6', 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'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', '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': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 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'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 385.0, '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': 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': '32', 'valuenum': 32.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, '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': '24.9', 'valuenum': 24.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '271', 'valuenum': 271.0, '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': '3.01', 'valuenum': 3.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.3', 'valuenum': 45.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '205', 'valuenum': 205.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '71', 'valuenum': 71.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 442.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', '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': 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': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, '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': '9', 'valuenum': 9.0, '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': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LG*.'}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'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': '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': 'abnormal', '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': '___', '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 397.0, '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': '32', 'valuenum': 32.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '37', 'valuenum': 37.0, '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': '23.5', 'valuenum': 23.5, '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': '24.7', 'valuenum': 24.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '336', 'valuenum': 336.0, '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': '3.04', 'valuenum': 3.04, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '1.4', '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': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '191', 'valuenum': 191.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '63', 'valuenum': 63.0, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, '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 1.6, . estimated GFR (eGFR) is likely between 45 and 54 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': 388.0, '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': '799', 'valuenum': 799.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.1, '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': 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': '35', 'valuenum': 35.0, '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': '24.2', 'valuenum': 24.2, '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': '25.1', 'valuenum': 25.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '382', 'valuenum': 382.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.11', 'valuenum': 3.11, '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': '46.6', 'valuenum': 46.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '204', 'valuenum': 204.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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 ___.'}, 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None}, {'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': '22.7', 'valuenum': 22.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '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': '118', 'valuenum': 118.0, 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'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': '22.1', 'valuenum': 22.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 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'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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 45.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, 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'priority': 'STAT', 'comments': None}, {'value': '2.67', 'valuenum': 2.67, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': 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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', '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': '219', 'valuenum': 219.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '85', 'valuenum': 85.0, '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': '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, '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': 411.0, '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': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '601', 'valuenum': 601.0, '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': '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': 4.1, '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': 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': '36', 'valuenum': 36.0, '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': '24.8', 'valuenum': 24.8, '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': '25.7', 'valuenum': 25.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '81', 'valuenum': 81.0, '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': '16.8', 'valuenum': 16.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.8', 'valuenum': 48.8, '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': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE RANGE AS OF ___.'}, {'value': '151', 'valuenum': 151.0, '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': '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': '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': 336.0, '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': '643', 'valuenum': 643.0, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 153.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '36', 'valuenum': 36.0, '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': '25.1', 'valuenum': 25.1, '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': '25.8', 'valuenum': 25.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '455', 'valuenum': 455.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.2', 'valuenum': 48.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '___', 'valuenum': 40.0, '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': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '284', 'valuenum': 284.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely >75 mL/min/1.73 m2, . provided the serum creatinine value is stable. . (Patients with more muscle mass and better nutritional status are more . likely to be at the higher end of this range.) . An eGFR < 60 suggests kidney disease in those below the age of 65 . and there may be kidney disease in those over 65.."}, {'value': '___', 'valuenum': 274.0, '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': '60', 'valuenum': 60.0, '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': '641', 'valuenum': 641.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '447', 'valuenum': 447.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '52.2', 'valuenum': 52.2, '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': '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': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, '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': 266.0, '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': '36', 'valuenum': 36.0, '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}, 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'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 199.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission Physical Exam\nPHYSICAL EXAM:\nVitals- T:98.3 BP:172/69 P:64 R: 18 O2: 94% on 4L\nGENERAL: Alert, oriented, no acute distress\nHEENT: Sclera anicteric, MMM, oropharynx clear\nNECK: supple, JVP not elevated, no LAD\nLUNGS: Wheezes throughout all lung fields, poor air movement \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: multiple tattoos\nNEURO: grossly intact \n\nDischarge Physical Exam\nVS - 97.7 98/48 74 16 98% RA \nGENERAL: Alert, oriented, no acute distress. \nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: CTAB, good air movement \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: multiple tattoos \nNEURO: grossly intact', 'diagnoses': [{'icd_code': 'J690', 'desc': 'Pneumonitis due to inhalation of food and vomit'}, {'icd_code': 'J80', 'desc': 'Acute respiratory distress syndrome'}, {'icd_code': 'G931', 'desc': 'Anoxic brain damage, not elsewhere classified'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'E870', 'desc': 'Hyperosmolality and hypernatremia'}, {'icd_code': 'J95851', 'desc': 'Ventilator associated pneumonia'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}, {'icd_code': 'R569', 'desc': 'Unspecified convulsions'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'Z931', 'desc': 'Gastrostomy status'}, {'icd_code': 'R402440', 'desc': 'Other coma, without documented Glasgow coma scale score, or with partial score reported, unspecified time'}, {'icd_code': 'E8770', 'desc': 'Fluid overload, unspecified'}, {'icd_code': 'Y848', 'desc': 'Other medical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}], 'summary': "Admission Labs:\n\n___ 08:57PM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 04:30PM WBC-9.4 RBC-4.51* HGB-14.3 HCT-41.6 MCV-92 \nMCH-31.7 MCHC-34.4 RDW-13.7\n___ 04:30PM NEUTS-59.8 ___ MONOS-6.9 EOS-1.5 \nBASOS-0.6\n___ 08:01PM ALT(SGPT)-76* AST(SGOT)-70* ALK PHOS-70 TOT \nBILI-0.3\n___ 08:01PM CALCIUM-9.6 PHOSPHATE-2.6* MAGNESIUM-2.1\n___ 08:01PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 08:01PM WBC-10.3 RBC-4.54* HGB-14.7 HCT-41.8 MCV-92 \nMCH-32.5* MCHC-35.2* RDW-13.7\n___ 08:01PM PLT COUNT-332\n___ 08:01PM ___ PTT-29.7 ___\n___ 04:44PM COMMENTS-GREEN\n___ 04:44PM LACTATE-1.4\n___ 04:42PM ___ PO2-48* PCO2-41 PH-7.43 TOTAL CO2-28 \nBASE XS-2\n___ 04:42PM O2 SAT-82\n___ 04:30PM GLUCOSE-113* UREA N-18 CREAT-1.0 SODIUM-140 \nPOTASSIUM-3.6 CHLORIDE-103 TOTAL CO2-26 ANION GAP-15\n___ 04:30PM estGFR-Using this\n___ 04:30PM CALCIUM-9.7 PHOSPHATE-3.9 MAGNESIUM-2.1\n___ 04:30PM WBC-9.4 RBC-4.51* HGB-14.3 HCT-41.6 MCV-92 \nMCH-31.7 MCHC-34.4 RDW-13.7\n___ 04:30PM NEUTS-59.8 ___ MONOS-6.9 EOS-1.5 \nBASOS-0.6\n___ 04:30PM PLT COUNT-369\n\nImaging:\nNo acute cardiopulmonary process with low lung volumes.\n\nDischarge Labs:\n___ 05:46AM BLOOD WBC-13.1* RBC-4.70 Hgb-14.8 Hct-42.6 \nMCV-91 MCH-31.6 MCHC-34.8 RDW-13.3 Plt ___\n___ 05:46AM BLOOD Plt ___\n___ 05:46AM BLOOD Glucose-142* UreaN-12 Creat-0.8 Na-139 \nK-4.0 Cl-104 HCO3-25 AnGap-14\n___ 08:34AM BLOOD ALT-77* AST-39 LD(LDH)-174 AlkPhos-64 \nTotBili-0.2\n___ 05:46AM BLOOD Calcium-9.3 Phos-4.0 Mg-2.___ year old man PMHx severe asthma exacerbation p/w shortness of \nbreath and increasing difficulty breathing likely secondary to \nasthma exacerbation.\n# Asthma Exacerbation: Patient remained hemodynamically stable \nand required maximum oxygen saturations of 4L NC. His exam was \nnotable for a hoarse voice, diffuse expiratory wheezes and poor \nair movement. He was given IV methylprednisolone in the ED and \ncontinued on Prednisone 60mg while inpatient. He was initially \nadmitted to the MICU given his tenuous nature but was quickly \nstepped down to medicine after initiation of steroids and \naggressive albuterol and duonebs treatments. The patient has a \nhistory of severe asthma exacerbations requiring 4 intubations \nin the past as well as several recent hospitalizations. This \ncurrent episode is most likely secondary to an environmental \nexposure from his workplace. Given his lack of infectious \nsymptoms, fever, or leukocytosis, an infectious workup was not \npursued although he did have some features of a viral URI \nincluding dry cough, pleuritic chest pain and hoarse voice. His \npeak flows were monitored and his symptoms gradually improved. \nHe was discharged on a Prednisone taper. He was set up with an \noutpatient pulmonologist and allergist for follow up. \n\nChronic Issues:\n# Social/Case Management: Patient with multiple issues, \nincluding PTSD, polysubstance abuse, incarceration. Social work \nwas consulted during this admission. \n\n# Chronic Hepatitis C Virus: The patient's liver enzymes were \nmonitored during hospitalization. He should follow-up with his \nPCP for chronic management. \n\n# Chronic Pain: The patient was continued on home gabapentin and \ntramadol. \n\n# Anxiety: The patient was continued on home klonopin."}}
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{'final_diagnoses': ['Asthma exacerbation'], 'procedures': ['none'], 'visit_summary': "# Asthma Exacerbation: Patient remained hemodynamically stable \nand required maximum oxygen saturations of 4L NC. His exam was \nnotable for a hoarse voice, diffuse expiratory wheezes and poor \nair movement. He was given IV methylprednisolone in the ED and \ncontinued on Prednisone 60mg while inpatient. He was initially \nadmitted to the MICU given his tenuous nature but was quickly \nstepped down to medicine after initiation of steroids and \naggressive albuterol and duonebs treatments. The patient has a \nhistory of severe asthma exacerbations requiring 4 intubations \nin the past as well as several recent hospitalizations. This \ncurrent episode is most likely secondary to an environmental \nexposure from his workplace. Given his lack of infectious \nsymptoms, fever, or leukocytosis, an infectious workup was not \npursued although he did have some features of a viral URI \nincluding dry cough, pleuritic chest pain and hoarse voice. His \npeak flows were monitored and his symptoms gradually improved. \nHe was discharged on a Prednisone taper. He was set up with an \noutpatient pulmonologist and allergist for follow up. \n\nChronic Issues:\n# Social/Case Management: Patient with multiple issues, \nincluding PTSD, polysubstance abuse, incarceration. Social work \nwas consulted during this admission. \n\n# Chronic Hepatitis C Virus: The patient's liver enzymes were \nmonitored during hospitalization. He should follow-up with his \nPCP for chronic management. \n\n# Chronic Pain: The patient was continued on home gabapentin and \ntramadol. \n\n# Anxiety: The patient was continued on home klonopin.", 'medications_prescribed': ['1. Aripiprazole 20 mg PO DAILY', '2. ClonazePAM 1 mg PO TID', '3. Gabapentin 800 mg PO TID', '4. Loratadine 10 mg PO DAILY', '5. MethylPHENIDATE (Ritalin) 20 mg PO QAM', '6. TraMADOL (Ultram) 50 mg PO BID', '7. Tiotropium Bromide 1 CAP IH DAILY \nRX *tiotropium bromide [Spiriva with HandiHaler] 18 mcg 1 cap \ninhaled daily Disp #*1 Capsule Refills:*0', '8. Fluticasone-Salmeterol Diskus (250/50) 1 INH IH BID \nRX *fluticasone-salmeterol [Advair Diskus] 250 mcg-50 mcg/Dose 1 \npuff inhaled twice a day Disp #*1 Disk Refills:*0', '9. Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath \nRX *albuterol sulfate 90 mcg ___ puffs inhaled every 4 hours \nDisp #*1 Inhaler Refills:*0', '10. Naproxen 500 mg PO Q12H:PRN pain', '11. Albuterol 0.083% Neb Soln 1 NEB IH Q2H:PRN wheezing \nRX *albuterol sulfate 2.5 mg/3 mL (0.083 %) 1 neb inhaled every \n2 hours Disp #*1 Vial Refills:*0', '12. PredniSONE 10 mg PO DAILY \nPLEASE FOLLOW TAPERED DOSING AS WRITTEN \nTapered dose - DOWN \nRX *prednisone 10 mg 6 tablet(s) by mouth daily Disp #*12 Tablet \nRefills:*0\nRX *prednisone 10 mg 5 tablet(s) by mouth daily Disp #*10 Tablet \nRefills:*0\nRX *prednisone 10 mg 4 tablet(s) by mouth daily Disp #*8 Tablet \nRefills:*0\nRX *prednisone 10 mg 3 tablet(s) by mouth daily Disp #*6 Tablet \nRefills:*0\nRX *prednisone 10 mg 2 tablet(s) by mouth daily Disp #*4 Tablet \nRefills:*0\nRX *prednisone 10 mg 1 tablet(s) by mouth daily Disp #*2 Tablet \nRefills:*0\nRX *prednisone 10 mg 0.5 (One half) tablet(s) by mouth daily \nDisp #*1 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'M', 'symptoms': 'Dyslexia', 'medical_history': ['PAST ONCOLOGIC HISTORY: \n-___ Diagnosed\n-___, Cycle 1 Rituxan/CHOP, Cycle 1. Complicated by \nadmission for febrile neutropenia despite receiving Neulasta; \nthen ulcerative colitis flare.\n-___, Cycle 2 Rituxan/CHOP\n-___, Cycle 3 Rituxan-CHOP. \n-___, PET imaging showed decreased uptake in the left \nparotid gland with resolution of multiple focal FDG avid osseous \nlesions as well as resolution of FDG avidity within the left \nadrenal gland, gastric fundus, right breast and subcutaneous \ntissues.\n-___, Admitted with diplopia, right sided ptosis, \nheadache, and RLE weakness. MRI of the orbit revealed \nthickening and enhancement of the left ocular motor nerve from \nthe interpeduncular cistern to the cavernous sinus, as well as \nmild enhancement of the right ocular motor nerve near the \ncavernous sinus. Lumbar puncture was performed which showed \ninvolvement by CNS lymphoma. \n-___, Rituxan and high-dose methotrexate at 8 gm/m2. \nDischarged to home on ___\n-___, Rituxan. \n-___, Rituxan. Double vision better but not gone with\ndevelopment of some thigh numbness and leg weakness and back \npain\n-___, Admitted for treatment with high dose Methotrexate, \nIfosfamide and IT Ara-C(Depocyt). \n-___, Rituxan Neurological symptoms had markedly improved \nwith this treatment.\n-___, 2nd dose of IT Ara-C(Depocyt). \n-___, admitted for planned ___ cycle of treatment but \ndeveloped new headache with vomiting. MRI of the head showed\nsignificant progression of her CNS disease. \n-___, HD Methotrexate @ 4 gm/m2, then 12 gm/m2 on \n___. Discharged on ___. \n-___, Rituxan. Started on Ibrutinib at 140 mg daily. \nIncreased slowly to 420 mg per day as of ___. \n-___, Admitted with increasing fever, somnolence, \nheadache, nausea with concern for CNS progression vs. infection. \nNo progression noted on imaging.\n-___, C1D1 of TEDDI-R (Temozolomide, Etoposide, Doxil,\nDexamethasone, Ibrutinib, Rituximab). \n-___, C2D1 of TEDDI-R (Temozolomide, Etoposide, Doxil,\nDexamethasone, Ibrutinib, Rituximab) with IT Cytarabine.\n-___, C3D1 of TEDDI-R (Temozolomide, Etoposide, Doxil,\nDexamethasone, Ibrutinib, Rituximab) with IT Cytarabine', "PAST MEDICAL/SURGICAL HISTORY: \n1. Diffuse large B-cell lymphoma(Primary bone marrow lymphoma) \nas noted above with CNS involvement.\n2. Ulcerative colitis, last flare in ___ with fever and \nneutropenia admission. Previously treated with ___ for about \none and a half years as well as prednisone during flares.\n3. Sjogren's with dry eyes, uses Restasis. \n4. Osteoarthritis.\n5. Eczema.\n6. Hypercholesterolemia.\n7. Fatty liver.\n8. Diabetes. \n9. Pancreatic cyst\n10. Allergic rhinitis."], 'family_history': 'A paternal aunt with breast cancer. Sister with breast cancer in \nher ___ but died from other medical issues.', 'present_illness': 'Ms. ___ is a ___ year-old woman with history of DLBCL with \nknown CNS involvement on C3D2 of TEDDI-R, had intrathecal \ncytarabine yesterday, awoke this morning with word finding \ndifficulties, which had mostly resolved by the time she arrived \nto the ER. States she continues to have occasional difficulty \nfinding words. No headaches, diplopia, blurry vision, \nfevers/chills, dysarthria, numbness/weakness/tingling in her \nface, arms, or legs, bowel/bladder difficulty, or difficulty \nwalking, dyspnea, chest pain, n/v, abdominal pain.\n\nCT head showed no acute bleed or large infarct, but did show \nleft periventricular hyperdense lesions that appeared to have \nprogressed from MRI ___, MRI performed in ED with read \npending.', 'medications': [{'medication': 'Efavirenz', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'ATRIPLA', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QHS', 'doses_per_24_hrs': None}, {'medication': 'ATRIPLA', 'proc_type': 'Non-Formulary', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', 'frequency': 'QHS', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Citalopram Hydrobromide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Emtricitabine-Tenofovir (Truvada)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PHYSICAL EXAM:\n========================\nVitals: T 98.1, HR 87, BP 128/77, RR 18, O2 96% RA\nGen: Pleasant, calm \nHEENT: No conjunctival pallor. No icterus. MMM. OP clear. PERRL, \nEOMI\nLYMPH: No cervical or supraclav LAD\nCV: Normocardic, regular. Normal S1,S2. II/VI systolic murmur at \nbase \nLUNGS: No incr WOB. CTAB. No wheezes, rales, or rhonchi. \nABD: NABS. Soft, NT, ND. \nEXT: WWP. Trace ___ edema\nSKIN: No rashes/lesions, petechiae/purpura ecchymoses. \nNEURO: PERRL, EOMI, CN II-XII intact, no dysarthria or word \nfinding difficulty during interview, strength ___ in ___ \nbilaterally, sensation intact to light touch in ___ \nbilaterally\n\nDISCHARGE PHYSICAL EXAM:\n========================\nVS T 97.8, HR 53, BP 159/67, RR 18, O2 100% RA\nGen: Pleasant, calm \nHEENT: No conjunctival pallor. No icterus. MMM. OP clear. PERRL, \nEOMI\nCV: Normocardic, regular. Normal S1,S2. II/VI systolic murmur at \nbase \nLUNGS: No incr WOB. CTAB. No wheezes, rales, or rhonchi. \nABD: NABS. Soft, NT, ND. \nEXT: WWP. Trace ___ edema\nSKIN: No rashes/lesions, petechiae/purpura ecchymoses. \nNEURO: PERRL, EOMI, CN II-XII intact, no dysarthria or word \nfinding difficulty during interview, strength ___ in ___ \nbilaterally, sensation intact to light touch in ___ \nbilaterally. FNF intact', 'diagnoses': [{'icd_code': '29630', 'desc': 'Major depressive affective disorder, recurrent episode, unspecified'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': 'V08', 'desc': 'Asymptomatic human immunodeficiency virus [HIV] infection status'}], 'summary': 'ADMISSION LABS:\n===============\n___ 09:58AM BLOOD WBC-6.0 RBC-3.11* Hgb-9.4* Hct-30.4* \nMCV-98 MCH-30.2 MCHC-30.9* RDW-18.6* RDWSD-66.6* Plt ___\n___ 09:58AM BLOOD Neuts-63 Bands-1 Lymphs-9* Monos-19* \nEos-0 Baso-1 Atyps-1* Metas-5* Myelos-1* AbsNeut-3.84 \nAbsLymp-0.60* AbsMono-1.14* AbsEos-0.00* AbsBaso-0.06\n___ 09:58AM BLOOD ___ PTT-36.1 ___\n___ 09:58AM BLOOD UreaN-8 Creat-0.4 Na-141 K-4.1 Cl-105 \nHCO3-25 AnGap-15\n___ 09:58AM BLOOD ALT-29 AST-35 LD(LDH)-478* AlkPhos-300* \nTotBili-<0.2\n\nDISCHARGE LABS:\n===============\n___ 12:00AM BLOOD WBC-16.9*# RBC-3.06* Hgb-9.4* Hct-29.0* \nMCV-95 MCH-30.7 MCHC-32.4 RDW-17.2* RDWSD-59.2* Plt ___\n___ 12:00AM BLOOD Neuts-91* Bands-1 Lymphs-2* Monos-3* \nEos-0 Baso-0 ___ Metas-3* Myelos-0 AbsNeut-15.55* \nAbsLymp-0.34* AbsMono-0.51 AbsEos-0.00* AbsBaso-0.00*\n___ 12:00AM BLOOD Glucose-262* UreaN-27* Creat-0.4 Na-137 \nK-3.7 Cl-100 HCO3-24 AnGap-17\n___ 12:00AM BLOOD ALT-17 AST-14 LD(LDH)-321* AlkPhos-146* \nTotBili-0.3\n___ 12:00AM BLOOD Calcium-8.3* Phos-4.7* Mg-2.2\n\nIMAGING/STUDIES:\n================\nCT HEAD ___:\n1. No evidence of intracranial hemorrhage or acute large \nterritorial \ninfarction. \n2. Hyperdense lesions in the left periventricular area and \ncorpus callosum \nwith surrounding hypodensity that may represent vasogenic edema. \n The \nsurrounding hypodensity appears to have increased in size from \nprior MR study from ___. Please refer to nearly \nconcurrent MRI brain study for more detailed characterization. \n\nMRI HEAD ___:\n1. Interval increase in size and enhancement of several \nperiventricular \nlymphoma lesions, compared to most recent prior exam. \n2. Increase in associated edema around the largest lesion near \nthe left \noccipital horn and left periventricular atrium. \n\nCT HEAD ___:\n1. No evidence of hemorrhage or infarction. \n2. The changes of parenchymal lymphoma are far better seen on \nthe MR exam of ___. However, allowing for the difference \nin technique, there appears to be no progression. Surrounding \nedema is stable to slightly improved. \n\nEEG READ (continuous):\nIMPRESSION: This telemetry captured no pushbutton activations. \nIt showed a \nmildly slow background throughout, indicative of a mild to \nmoderate \nencephalopathy. Medications, metabolic disturbances, and \ninfection are among the most common causes. There was some \nadmixed slowing on either side but no major lateralized finding. \nThere were no epileptiform features or electrographic seizures. \nA bradycardia was noted. \n\nIMPRESSION: This telemetry captured no pushbutton activations. \nIt showed a \nnormal background in wakefulness and sleep. There were no focal \nabnormalities, epileptiform features, or electrographic \nseizures.\nMs. ___ is a ___ year-old woman with history of DLBCL with \nknown CNS involvement on C3D3 of TEDDI-R, presented with word \nfinding difficulties felt most likely due to seizures started on \nlevetiracetam.\n\n#APHASIA: Initial concern for stroke, MRI w/o acute ischemia, \nread stating progression of several periventricular lesions, but \non review with Dr. ___ felt may have been due to \ndifferences in contrast timing and that overall imaging \nconsistent with mixed response to treatment. LP ___ only \nremarkable for protein 119 with negative gram stain and no \ngrowth on preliminary culture. Per discussion with Dr. ___ \n___ seizure most likely etiology, started on levetiracetam \n500mg BID empirically. EEG w/o seizure activity. Difficulty \nprimarily seen in saying months backwards when questioned, and \ntexts to husband with missing or improper words.\n\n#DLBCL W/ KNOWN CNS LESIONS: Primary bone marrow lymphoma, C3D1 \nof TEDDI-R ___. On review of imaging and discussion with \nprimary oncologist and Dr. ___ MRI showing mixed \nresponse to treatment. TTE with normal EF, mild aortic \nregurgitation. Completed cycle 3 of TEDDI-R inpatient. Of note, \nmissed day two of ibrutinib due to hospitalization, resumed same \nschedule on day 3 to complete full prior course. Continued \nacyclovir, atovaquone, voriconazole prophylaxis\n\n#URINARY TRACT INFECTION, COMPLICATED: Urine culture on \nadmission growing >100,000 klebsiella pneumonia. Asymptomatic \nwith unremarkable UA. Repeat UA with >100 WBCs. Given current \nchemotherapy and steroid use decided to treat for 7 days for \ncomplicated UTI. IV ceftriaxone inpatient transitioned to \ncefpodoxime outpatient, last day ___. \n\n#BRADYCARDIA/HYPERTENSION: Several days of asymptomatic \nbradycardia to high ___ BP in 150s, above her past baseline. \nConcerning for possible ___ reflex, no headaches or visual \nchanges, and neuro exam nonfocal. CT head w/o worsening edema or \nsigns of increased ICP. Improved off of dexamethasone prior to \ndischarge and may have been related to dexamethasone and \npossibly keppra.'}}
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{'final_diagnoses': ['Aphasia'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ year-old woman with history of DLBCL with \nknown CNS involvement on C3D3 of TEDDI-R, presented with word \nfinding difficulties felt most likely due to seizures started on \nlevetiracetam.\n\n#APHASIA: Initial concern for stroke, MRI w/o acute ischemia, \nread stating progression of several periventricular lesions, but \non review with Dr. ___ felt may have been due to \ndifferences in contrast timing and that overall imaging \nconsistent with mixed response to treatment. LP ___ only \nremarkable for protein 119 with negative gram stain and no \ngrowth on preliminary culture. Per discussion with Dr. ___ \n___ seizure most likely etiology, started on levetiracetam \n500mg BID empirically. EEG w/o seizure activity. Difficulty \nprimarily seen in saying months backwards when questioned, and \ntexts to husband with missing or improper words.\n\n#DLBCL W/ KNOWN CNS LESIONS: Primary bone marrow lymphoma, C3D1 \nof TEDDI-R ___. On review of imaging and discussion with \nprimary oncologist and Dr. ___ MRI showing mixed \nresponse to treatment. TTE with normal EF, mild aortic \nregurgitation. Completed cycle 3 of TEDDI-R inpatient. Of note, \nmissed day two of ibrutinib due to hospitalization, resumed same \nschedule on day 3 to complete full prior course. Continued \nacyclovir, atovaquone, voriconazole prophylaxis\n\n#URINARY TRACT INFECTION, COMPLICATED: Urine culture on \nadmission growing >100,000 klebsiella pneumonia. Asymptomatic \nwith unremarkable UA. Repeat UA with >100 WBCs. Given current \nchemotherapy and steroid use decided to treat for 7 days for \ncomplicated UTI. IV ceftriaxone inpatient transitioned to \ncefpodoxime outpatient, last day ___. \n\n#BRADYCARDIA/HYPERTENSION: Several days of asymptomatic \nbradycardia to high ___ BP in 150s, above her past baseline. \nConcerning for possible ___ reflex, no headaches or visual \nchanges, and neuro exam nonfocal. CT head w/o worsening edema or \nsigns of increased ICP. Improved off of dexamethasone prior to \ndischarge and may have been related to dexamethasone and \npossibly keppra.', 'medications_prescribed': ['1. Cefpodoxime Proxetil 200 mg PO Q12H Duration: 4 Days \nRX *cefpodoxime 200 mg 1 tablet(s) by mouth twice a day Disp #*8 \nTablet Refills:*0', '2. LevETIRAcetam 500 mg PO Q12H \nRX *levetiracetam [Keppra] 500 mg 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*0', '3. Acyclovir 400 mg PO Q8H', '4. Atovaquone Suspension 1500 mg PO DAILY', '5. butalbital-acetaminophen-caff 50-300-40 mg oral Q8H:PRN \nheadache', '6. Cyclosporine 0.05% Ophth Emulsion 0.05 % ophthalmic BID', '7. Fluticasone Propionate NASAL 2 SPRY NU DAILY', '8. Ibrutinib 420 mg PO EVERY OTHER DAY', '9. Ibrutinib 560 mg PO EVERY OTHER DAY', '10. Insulin SC \n Sliding Scale\nInsulin SC Sliding Scale using HUM Insulin', '11. LORazepam 0.5 mg PO Q6H:PRN \nnausea/vomiting/insomnia/anxiety', '12. MetFORMIN XR (Glucophage XR) 500 mg PO BID type 2 diabetes', '13. Omeprazole 20 mg PO DAILY:PRN heartburn', '14. Ondansetron 8 mg PO Q8H:PRN nausea/vomiting', '15. Prochlorperazine 10 mg PO Q6H:PRN nausea/vomiting', '16. Pyridoxine 100 mg PO DAILY', '17. Voriconazole 200 mg PO Q12H']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 39, 'gender': 'M', 'symptoms': 'Dyspnea\nShortness of breath\nCough\nAmbulatory hypoxemia', 'medical_history': ['PE, thought due to OCP use and ?immobility', 'Tachy-brady syndrome - s/p pacemaker implantation in ___ \nsecondary to bradycardia and syncope', 'CLOTTING DISORDER - mild platelet dysfunction', 'Asthma', 'GASTROESOPHAGEAL REFLUX', 'DUODENAL ULCER', 'COLITIS', 'MIGRAINE HEADACHES', 'PSEUDOTUMOR CEREBRI', 'ANXIETY', 'POBHx: SAB, preeclampsia, dysmenorrhea'], 'family_history': 'Paternal aunt and cousin with history of thrombosis - exact \netiology of clotting disorder is unclear.', 'present_illness': 'Ms. ___ is a ___ female with past medical history \nsignificant for pseudotumor cerebri, asthma, tachybrady syndrome \nwith a pacemaker, who presents with dyspnea and SOB. \n\nShe was recently hospitalized ___ at ___ and was \nbriefly on BiPAP in the ICU. She was treated with doxycycline \nfor LLL PNA for 7d days and was put on a pred taper for asthma \nexacerbation. \n\nSince discharge on ___ she has felt fatigue, SOB, air hunger, \nDOE, and a feeling of "heavy lungs." She also reports dyspnea \nwith both inspiration and expiration for ~the past week, \nstarting localized at the sternum, spreading over several days \nto the upper chest midline and bilaterally. She describes the \ndyspnea as "the way it feels when you go running in the cold." \nThe pain makes it difficult to fall asleep. For the past few \nnights, it has also woken her from sleep, gasping for air. Since \ndischarge from ___ she has also had drenching night sweats, \nwhich are new for her. She has been limited in her ADLs; most \nrecently, she had to call a relative to bathe her toddler son \ndue to DOE.\n\nShe had temperatures elevated to 99 since ___. On ___, she \nalso had a sore throat and rhinorrhea. On ___, she was seen in \nclinic and was noted to have with good O2Sat without tachypnea \nor respiratory distress, and good air movement without wheezing \non lung exam. EKG and CXR were normal.\n\nOf note, she does have a history of PE in ___ after pacemaker\nwas placed and is not on lifelong anticoagulation. CT angiogram \ndone at OSH was negative for PE. Her asthma triggers are URI and \nhumidity. She has had two intubations in the past for asthma, \nas well as several ___ visits and hospitalizations for pulmonary \nissues during her pregnancy. She has had no sick contacts. She \nlives at home with her ___ son and her husband, but no \none has been ill. She works as a visiting ___, but has not \nbeen back to work since her most recent hospitalization.\n\nShe was sent from her PCP to ___ for evaluation, investigate \npulmonary vs cardiac \n\nIn the ___, initial vitals: T 98.8, HR 79, BP 129/82, RR 20, O2S \n98% 3L \nOn exam, she was A&Ox3, unable to speak in complete sentences. \nTachypnic, RR ___. SpO2>95% on 3L O2. Lungs coarse \nbilaterally. EKG showed NSR in the ___. CXR and d-dimer were \nnegative, but her symptoms continued.\nShe was treated with albuterol and ipratropium nebs, 125mg \nmethylprednisolone, 15mg ketorolac, 2mg Mg sulfate, lorazepam, \nand two doses of 5mg morphine. Her O2 sats dropped while \nambulating to 93% and on repeat ambulation to 90%. She was \nadmitted to the Medicine service for further evaluation and \ntreatment. \nVitals prior to transfer: T 98.5, HR 85, BP 109/70, RR 19, O2S \n94% RA \n\nCurrently, she presents with dry bronchitic cough, anterior \nchest pain with inspiration and expiration, and anxiety. \n \nShe has not had any nausea or vomiting. No diarrhea or \nconstipation. No dysuria or hematuria. No hematochezia, no \nmelena. No numbness or weakness, no focal deficits.', 'medications': [{'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q6H:PRN', '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': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', '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': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Daptomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Daptomycin', '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', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'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': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.08', 'valuenum': 2.08, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.1', 'valuenum': 21.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '65.1', 'valuenum': 65.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.29', 'valuenum': 4.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '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': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.21', 'valuenum': 1.21, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.40', 'valuenum': 6.4, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '44.5', 'valuenum': 44.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '78', 'valuenum': 78.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 187.2, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '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': 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 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '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': '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': 'VEN.', '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': '___', 'valuenum': 245.6, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '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': 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': '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': '4.1', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.1', 'valuenum': 40.1, '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': '30.0', 'valuenum': 30.0, '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': '92', 'valuenum': 92.0, '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': 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': '4.36', 'valuenum': 4.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, 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'comments': None}, {'value': '142', 'valuenum': 142.0, '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': '76', 'valuenum': 76.0, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 45.0, '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': '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': 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': '12', 'valuenum': 12.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 19.5, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Low risk <1.0, Average risk 1.0-3.0, High risk >3.0 (but <10).'}, {'value': '8', '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': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.0', 'valuenum': 43.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '325', 'valuenum': 325.0, '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': '4.74', 'valuenum': 4.74, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '42.3', 'valuenum': 42.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'EXAM ON ADMISSION\nVS: T 97.9, HR 73, BP 115/73, RR 16, O2S 96 RA\nGENERAL: Alert, oriented, appears fatigued, no acute distress \nexcept when coughing \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nRESP: Decreased breath sounds at L base. No dullness to \npercussion. CTAB no wheezes, rales, rhonchi \nCV: RRR, Nl S1, S2, No MRG \nABD: Soft, NT/ND bowel sounds present, no rebound tenderness or \nguarding, no organomegaly \nGU: no foley \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNEURO: CNs2-12 intact, motor function grossly normal\nSKIN: No excoriations or rash.\n\nEXAM ON DISCHARGE\nVS: T 98, HR 50 (50-81), BP 116/61 (99-116/47/73), RR 16, O2S 97 \n1L (96 RA, ___ 2L)\nGENERAL: Alert, oriented, appears fatigued, no acute distress \nexcept when coughing \nHEENT: Sclerae anicteric, MMM, oropharynx clear \nRESP: CTAB, no wheezes, rales, rhonchi. Good air movement \nthroughout.\nCV: RRR, Nl S1, S2, No MRG \nABD: Soft, NT/ND bowel sounds present, no rebound tenderness or \nguarding, no organomegaly \nGU: no foley \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNEURO: CNs2-12 intact, motor function grossly normal\nSKIN: No excoriations or rash.', 'diagnoses': [{'icd_code': 'M4642', 'desc': 'Discitis, unspecified, cervical region'}, {'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}], 'summary': 'LABS ON ADMISSION:\n___ 01:44PM LACTATE-1.8\n___ 01:15PM GLUCOSE-84 UREA N-14 CREAT-0.6 SODIUM-138 \nPOTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-27 ANION GAP-16\n___ 01:15PM cTropnT-<0.01\n___ 01:15PM proBNP-10\n___ 01:15PM D-DIMER-345\n___ 01:44PM PO2-226* PCO2-42 PH-7.42 TOTAL CO2-28 BASE \nXS-3 COMMENTS-GREEN TOP\n___ 01:15PM WBC-15.1*# RBC-4.40 HGB-12.5 HCT-38.7 MCV-88 \nMCH-28.4 MCHC-32.3 RDW-13.5 RDWSD-43.3\n___ 01:15PM NEUTS-58 BANDS-0 ___ MONOS-5 EOS-1 \nBASOS-0 ___ MYELOS-0 AbsNeut-8.76* AbsLymp-5.44* \nAbsMono-0.76 AbsEos-0.15 AbsBaso-0.00*\n___ 01:15PM HYPOCHROM-NORMAL ANISOCYT-NORMAL \nPOIKILOCY-NORMAL MACROCYT-NORMAL MICROCYT-NORMAL \nPOLYCHROM-NORMAL\n___ 01:15PM PLT SMR-NORMAL PLT COUNT-280\n___ 05:20PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 05:20PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-TR \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-SM \n___ 05:20PM URINE RBC-5* WBC-1 BACTERIA-FEW YEAST-NONE \nEPI-4\n___ 05:20PM URINE MUCOUS-RARE\n\nLABS ON DISCHARGE:\nsame\nMs. ___ is a ___ year old female with history of asthma, PE \n(while immobilized), pre-eclampsia, platelet dysfunction, \ntachybrady syndrome s/p pacemaker placement, anxiety, and \ndepression, with recent admission to ___ for asthma \nexacerbation and PNA requiring BiPAP (s/p 7d course of \ndoxycycline, on prednisone taper), who presented with chief \ncomplaint of dyspnea and shortness of breath on exertion. \n\n# Dyspnea: No clear single etiology. Main signs and symptoms are \ndyspnea on inspiration and expiration, waking with gasping for \nair, air hunger, bronchitic cough, and ambulatory O2 desats to \n90. Consider heart failure given orthopnea and paroxysmal \nnocturnal dyspnea. Ddx also includes post-infectious \ninflammatory, autoimmune, or infectious process. Possible \nsomatoform component to the pain. Waking with gasping for air \ncould be c/w panic attacks or pulmonary/cardiopulmonary process. \nThis is not likely to be asthma/RAD because she does not have \nwheezes, does not have prolonged expiratory phase, and does not \nhave significant improvement with aggressive asthma treatment. A \nsmall L pleural effusion would not be large enough to cause SOB \nor desats.\nRecent chest CTA was negative for PE. Since her symptoms had not \nchanged significantly since that time, repeat CTA was not \npursued during this admission.\n Since PE, asthma, and inflammatory bronchitis/pneumonitis \nwere felt to be unlikely given the workup performed, it was \ndetermined that there was no acute reversible etiology for her \ndyspnea, so she will follow up pulmonary evaluation on an \noutpatient basis to investigate possible pulmonary hypertension \nor other disease processes that contribute to her symptoms. She \nwould benefit from ___ as well as CBT to modulate the \ncontribution of possible somatosensory amplification processes \non pain experienced due to her organic disease burden.\n\nCHRONIC ISSUES:\n# Oral Thrush: continued clotrimazole troches, magic mouthwash\n# Anxiety: no SI. Continue lorazepam\n# Tachy/Brady syndrome: PPM in place w/ recent interrogation. \nContinued sotalol.\n\nTransitional Issues:\n-consider TTE to look for evidence of pulmonary hypertension. \nShe may be at risk for chronic thromboembolic PH'}}
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{'final_diagnoses': ['Dyspnea of unknown etiology', 'Hypoxia', 'Anxiety'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ year old female with history of asthma, PE \n(while immobilized), pre-eclampsia, platelet dysfunction, \ntachybrady syndrome s/p pacemaker placement, anxiety, and \ndepression, with recent admission to ___ for asthma \nexacerbation and PNA requiring BiPAP (s/p 7d course of \ndoxycycline, on prednisone taper), who presented with chief \ncomplaint of dyspnea and shortness of breath on exertion. \n\n# Dyspnea: No clear single etiology. Main signs and symptoms are \ndyspnea on inspiration and expiration, waking with gasping for \nair, air hunger, bronchitic cough, and ambulatory O2 desats to \n90. Consider heart failure given orthopnea and paroxysmal \nnocturnal dyspnea. Ddx also includes post-infectious \ninflammatory, autoimmune, or infectious process. Possible \nsomatoform component to the pain. Waking with gasping for air \ncould be c/w panic attacks or pulmonary/cardiopulmonary process. \nThis is not likely to be asthma/RAD because she does not have \nwheezes, does not have prolonged expiratory phase, and does not \nhave significant improvement with aggressive asthma treatment. A \nsmall L pleural effusion would not be large enough to cause SOB \nor desats.\nRecent chest CTA was negative for PE. Since her symptoms had not \nchanged significantly since that time, repeat CTA was not \npursued during this admission.\n Since PE, asthma, and inflammatory bronchitis/pneumonitis \nwere felt to be unlikely given the workup performed, it was \ndetermined that there was no acute reversible etiology for her \ndyspnea, so she will follow up pulmonary evaluation on an \noutpatient basis to investigate possible pulmonary hypertension \nor other disease processes that contribute to her symptoms. She \nwould benefit from ___ as well as CBT to modulate the \ncontribution of possible somatosensory amplification processes \non pain experienced due to her organic disease burden.\n\nCHRONIC ISSUES:\n# Oral Thrush: continued clotrimazole troches, magic mouthwash\n# Anxiety: no SI. Continue lorazepam\n# Tachy/Brady syndrome: PPM in place w/ recent interrogation. \nContinued sotalol.\n\nTransitional Issues:\n-consider TTE to look for evidence of pulmonary hypertension. \nShe may be at risk for chronic thromboembolic PH', 'medications_prescribed': ['1. Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN dyspnea', '2. ClonazePAM 0.5 mg PO TID:PRN anxiety', '3. guaiFENesin 400 mg oral BID:PRN cough', '4. Mirtazapine 15 mg PO QHS', '5. Montelukast 10 mg PO DAILY', '6. Pantoprazole 40 mg PO Q24H', '7. PredniSONE 20 mg PO DAILY asthma exacerbation \nTapered dose - DOWN', '8. Prenatal Vitamins 1 TAB PO DAILY', '9. Sotalol 120 mg PO BID', '10. Sucralfate 1 gm PO BID', '11. Benzonatate 100 mg PO TID \nRX *benzonatate [Tessalon Perles] 100 mg 1 capsule(s) by mouth \nTID PRN Disp #*30 Capsule Refills:*0', '12. beclomethasone dipropionate 80 mcg/actuation inhalation BID', '13. Clotrimazole 1 TROC PO TID', '14. Clotrimazole 1% Vaginal Cream 1 Appl VG QHS', '15. Maalox/Diphenhydramine/Lidocaine 30 mL PO Q3H', '16. butalbital-acetaminophen-caff 50 mg ORAL TID:PRN migraine']}
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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': 'hypotension.', 'medical_history': ['1)ESLD from schistosomiasis; currently on the transplant list. \nShe is s/p single treatment with Praziquantel and no evidence of \norganisms on ERCP evaluations; she has known about her liver \ndisease for about ___ years. She also had episodes of jaundice \nand pruritis 10 to ___ years ago in ___, both times when she \nwas pregnant. Once in her sixth month of pregnancy and once in \nher eight month of pregnancy. She was told that she had \nhepatitis C. She has hepatitis C antibody, but negative PCR. She \nlost her baby both times. Her jaundice and pruritis resolved \nafter delivery, both episodes. She is immune to hepatitis A. She \nis vaccinated for hepatitis B. No prior history of culture \npositive SBP, but has received empiric treatment in the past.', '2)Grade ___ varicies and portal gastropathy without bleeding on \nendoscopy in ___ but PCR repeatedly negative', '4)s/p CCY ___ ago in ___ for which she received blood txf', '5)s/p tubal ligation', '6)GERD, previously admitted for associated epigastric pain', '7)Strongyloides Ab positive in ___ - treated w/5 days\nIvermectin', '8) SBP on cefpodoxime'], 'family_history': 'Non-contributory', 'present_illness': "___ yo F w cirrhosis ___ schistosomaisis, on liver transplant \nlist, w/ slightly low BPs at home today, albiet asymtomatic. Her \n___ came to take her BPs and she ranged from ___ throughtout \nthe day. She reported that she had lightheadedness when upright \nand that resolved when she was supine. She denies chest pain, \nsob, abdominal pain, abdominal swelling, leg swelling, fevers \nchills, medication noncompliance, diarrhea, vomiting, dysuria, \nhematuria, hematochezia, melena. She was also recently dischargd \non Lasix 20mg daily, which is a new medication. \n\nShe was given 750 CC IVF in the ED with resolution of her SBP \nfrom 70's to 80's which is her baseline. She is being admitted \nfor observation. \n\nOf note, the patient was recently admitted from ___ - ___ \nand had SBP which progressed to HRS requiring midodrine, \noctreotide and albumin culminating in ICU stay for presumed \nsepsis as a result of SBP. Paracentesis revealed Zosyn sensitive \ne.coli. Patient also had hepatic encephalopathy responsive to \nlactulose. She was discharged on Cefopodoxime prophylaxis give \nthe E. coli resistance pattern.", 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': '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}]}, 'clinical_findings': {'labs': [], 'exams': 'Vitals - T:98.2 BP:85/38 HR:86 RR:18 02 sat: 100RA \nGENERAL: NAD, laying in ___\nSKIN: diffusely jaundiced, warm and well perfused, no \nexcoriations or lesions, no rashes\nHEENT: AT/NC, EOMI, PERRLA, icteric sclera, pink conjunctiva, \npatent nares, MMM, good dentition, nontender supple neck, no \nLAD, no JVD\nCARDIAC: RRR, S1/S2, ___ SEM at base\nLUNG: CTAB\nABDOMEN: distended, +BS, nontender in all quadrants, no \nrebound/guarding, + fluid wave\nM/S: moving all extremities well, no cyanosis, clubbing or \nedema, no obvious deformities\nPULSES: 2+ DP pulses bilaterally\nNEURO: CN II-XII intact', 'diagnoses': [{'icd_code': '340', 'desc': 'Multiple sclerosis'}], 'summary': "Admission labs:\n131 104 44\n------------<68\n6.3 22 0.6 \nComments: Na: Verified By Alternate Methodology\nNa: Lipemic\nK: Hemolyzed, Moderately\nK: Hemolysis Falsely Elevates K\nK: ___ @ 1721 \n\nMg: 3.1 P: 5.5 D\nALT: 127 AP: 166 Tbili: 51.0 Alb: 3.4 \nAST: 288 Lip: 85 \n\n 9.3\n3.9>--<61 \n 26.4 \nN:56.6 L:30.3 M:10.3 E:2.3 Bas:0.6 \n\n___: 33.5 PTT: 57.9 INR: 3.5\nThis is a ___ year old woman with cirrhosis admitted for \nhypotension to the ______. This was thought due to the recent \naddition of lasix and spironolactone in addition to nadolol for \nascites. Her blood pressure was stable and improved to the 80's \novernight and she was asymptomatic with this blood pressure. Her \nmedications were adjusted to decrease her furosemide to 10mg \ndaily from 20mg daily and she was discharged to continue on the \nnadolol and spironolactone as previously prescribed."}}
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{'final_diagnoses': ['Primary: Asymptomatic hypotension.', 'Secondary: Cirrhosis secondary to schistosomiasis.'], 'procedures': ['None.'], 'visit_summary': "This is a ___ year old woman with cirrhosis admitted for \nhypotension to the ______. This was thought due to the recent \naddition of lasix and spironolactone in addition to nadolol for \nascites. Her blood pressure was stable and improved to the 80's \novernight and she was asymptomatic with this blood pressure. Her \nmedications were adjusted to decrease her furosemide to 10mg \ndaily from 20mg daily and she was discharged to continue on the \nnadolol and spironolactone as previously prescribed.", 'medications_prescribed': ['1. Cefpodoxime 100 mg Tablet Sig: Two (2) Tablet PO Q12H (every \n12 hours).', '2. Lactulose 10 gram/15 mL Syrup Sig: Thirty (30) ML PO TID (3 \ntimes a day).', '3. Citalopram 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. Clotrimazole 10 mg Troche Sig: One (1) Troche Mucous membrane \n5X A DAY ().', '5. Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).', '6. Rifaximin 200 mg Tablet Sig: Two (2) Tablet PO TID (3 times a \nday).', '7. Spironolactone 50 mg Tablet Sig: One (1) Tablet PO once a \nday.', '8. Lasix 20 mg Tablet Sig: ___ Tablet PO once a day. Tablet(s)', '9. Nadolol 20 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': 72, 'gender': 'M', 'symptoms': 'Altered Mental Status\nTime of encounter: 5AM on ___', 'medical_history': ['-CAD s/p CABG ___ ', '-Chronic Diastolic CHF', '-Atrial fibrillation on Coumadin: 3mg ___, 6mg ___ for low inr \n(nl 3mg) ', '-Type 2 DM, diet controlled ', '-Hypertension ', '-Anemia, undetermined etiology ', '-OA ', '-Colon Ca s/p resection ___ ', '-Cervical spondylosis ', '-Subclavian venous thrombosis ', '-Hx vertebral TIA ___, on coumadin ', '-R CN VI palsy thought secondary to a carotid cavernous aneurysm ', '-R hip fracture s/p surgery at ___ ___ ', '-CKD 1.3-1.5 '], 'family_history': 'Negative for stroke. Positive for DM and MIs.', 'present_illness': '___ yo F came from home with altered mental status. She was found \nto have AMS last ___ which kept waxing/waning. ___ today \nnoted that patient had a temp of 102.7. Of note she also had \nbeen having diarrhea for 2 days but denied any abdominal pain, \nnausea, vomiting, dysuria. Her baseline MS is around AOx2 and is \nessentially wheel chair bound due to her sever ___ OA.\n.\nIn the ED, her vitals were 99.7, 60, 140/54, 14, 98%/RA. She was \nAOx1. She had white count of 19.3, creatinine of 2.1 and INR of \n3.5. A CT Head, Abd was negative for any acute pathology. CXR \ndid not reveal any PNA. She got 3L NS, IV Vanc, Ceftriaxone. A \nLP was tried but procedure was aborted ___ to traumatic tap. She \nwas admitted for further monitoring and workup.', 'medications': [{'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', '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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Argatroban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', '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': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 3% Inhalation Soln', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', 'frequency': 'ONCE MR1', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': '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': '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', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': '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', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': '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': 'Azithromycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q2H: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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Milrinone', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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 3% Inhalation Soln', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NEB', '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': 'Cepastat (Phenol) Lozenge', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Amiodarone', '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Dextrose 50%', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Bicarbonate', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', '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': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Argatroban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY: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': 'Doxycycline Hyclate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'moxifloxacin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'OS', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Nystatin Oral Suspension', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Argatroban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Sodium Chloride 0.9% Flush', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Guaifenesin', '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': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Argatroban', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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: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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': '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', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'Discontinued', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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', 'route': 'IV', 'frequency': 'Q8H', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Doxycycline Hyclate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin (Regular) for Hyperkalemia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Amiodarone', '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': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY: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}, {'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': 'PHENYLEPHrine', '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': '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 199.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES ALT.'}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 337.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST..'}, {'value': 'NEG', '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': 'BENZODIAZEPINE IMMUNOASSAY SCREEN DOES NOT RELIABLY DETECT SOME DRUGS,;INCLUDING LORAZEPAM, CLONAZEPAM, AND FLUNITRAZEPAM.'}, {'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': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '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': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, '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': '35.0', 'valuenum': 35.0, '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': '6.6', 'valuenum': 6.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82.9', 'valuenum': 82.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '478', 'valuenum': 478.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '___', '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': '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': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'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': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. HEMOLYZED SPECIMEN.'}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED. POINT OF CARE. Hydroxyurea may cause falsely elevated values with this method.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '___', 'valuenum': 6.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '-12', 'valuenum': -12.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': '29', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', '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': '314', 'valuenum': 314.0, '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': 'HOLD.'}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.4', 'valuenum': 38.4, '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': '5.1', 'valuenum': 5.1, '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': '34.1', 'valuenum': 34.1, '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': '3.4', 'valuenum': 3.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91.3', 'valuenum': 91.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '443', 'valuenum': 443.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.6', 'valuenum': 17.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '466', 'valuenum': 466.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 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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': '19', 'valuenum': 19.0, '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': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': '30', 'valuenum': 30.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 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THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '33.2', 'valuenum': 33.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '131', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 629.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.2', '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': '5.9', 'valuenum': 5.9, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '4.3', 'valuenum': 4.3, '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': 116.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '29', 'valuenum': 29.0, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.0', 'valuenum': 45.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 166.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '18.7', 'valuenum': 18.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.1', 'valuenum': 49.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.4', 'valuenum': 35.4, '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': '31.8', 'valuenum': 31.8, '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': '129', 'valuenum': 129.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.72', 'valuenum': 3.72, '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': '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 187.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, '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': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.9', 'valuenum': 59.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56.9', 'valuenum': 56.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '65.6', 'valuenum': 65.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 200.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '471', 'valuenum': 471.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '622', 'valuenum': 622.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, '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 1.9,. Estimated GFR = 35 if non African-American (mL/min/1.73 m2). Estimated GFR = 42 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': 198.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', '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': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.4', 'valuenum': 67.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 184.0, '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': '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': '4.3', 'valuenum': 4.3, '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': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, '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': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.78', 'valuenum': 3.78, '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': '3.4', 'valuenum': 3.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86.3', 'valuenum': 86.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70.4', 'valuenum': 70.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '27.2', 'valuenum': 27.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61.1', 'valuenum': 61.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, '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': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', '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': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61.2', 'valuenum': 61.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '253', 'valuenum': 253.0, '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': '43', 'valuenum': 43.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 204.0, '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 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{'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '57.0', 'valuenum': 57.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'ROUTINE', '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, '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': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '60.7', 'valuenum': 60.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.2', 'valuenum': 67.2, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 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'valuenum': 4.4, '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': '49', 'valuenum': 49.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '65.7', 'valuenum': 65.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 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'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '98.9', 'valuenum': 98.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '2.5', 'valuenum': 2.5, '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 2.5,. Estimated GFR = 26 if non African-American (mL/min/1.73 m2). Estimated GFR = 31 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': 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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '33.7', 'valuenum': 33.7, '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': '218', 'valuenum': 218.0, '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': '2.88', 'valuenum': 2.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '74.8', 'valuenum': 74.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83.8', 'valuenum': 83.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '209', 'valuenum': 209.0, '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': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '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': '___', 'valuenum': 190.0, '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': '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': '4.1', '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': '49', 'valuenum': 49.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61.1', 'valuenum': 61.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '86.5', 'valuenum': 86.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 187.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, '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': '47', 'valuenum': 47.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63.2', 'valuenum': 63.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '8.3', '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': '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': 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': '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': '4.5', 'valuenum': 4.5, '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': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '16.3', 'valuenum': 16.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61.0', 'valuenum': 61.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '219', 'valuenum': 219.0, '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': '2.85', 'valuenum': 2.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '8.5', 'valuenum': 8.5, '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': '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': 170.0, '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': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '44', 'valuenum': 44.0, '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': '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': '51', 'valuenum': 51.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '165', 'valuenum': 165.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 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'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, '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': '31.7', 'valuenum': 31.7, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.78', 'valuenum': 2.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '16', 'valuenum': 16.0, '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': '8.4', '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': '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': 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': '2.2', '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': '___', 'valuenum': 5.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '8.7', 'valuenum': 8.7, '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': '32.8', 'valuenum': 32.8, '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': '199', 'valuenum': 199.0, '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': '2.79', 'valuenum': 2.79, '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': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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 2.0,. Estimated GFR = 33 if non African-American (mL/min/1.73 m2). Estimated GFR = 40 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, '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': '26.6', 'valuenum': 26.6, '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': '31.2', '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': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '94', 'valuenum': 94.0, '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': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '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': '___', 'valuenum': 2686.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 229.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'REFERENCE VALUES VARY WITH AGE, SEX, AND RENAL FUNCTION;AT 35% PREVALENCE, NTPROBNP VALUES; < 450 HAVE 99% NEG PRED VALUE; >1000 HAVE 78% POS PRED VALUE;SEE ONLINE LAB MANUAL FOR MORE DETAILED INFORMATION.'}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: Tmax: T:97 BP:120/60 HR:78 RR:18 O2:10%/RA\nGen: AOx1 (to person), follows commands, highly un-cooperative \nwith my examination\nEyes: L ptosis, EOMI, PERRL, conjunctiva clear, noninjected, \nanicteric, no exudate\nENT: Moist\nNeck: No JVD, no LAD, no thyromegaly, no carotid bruits \nCardiovascular: RRR, nl S1/S2, no m/r/g\nRespiratory: CTA bilaterally, comfortable, no wheezing, no \nronchi, no rales\nGastrointestinal: soft, non-tender, non-distended, no \nhepatosplenomegaly, normal bowel sounds\nMusculoskeletal/Extremities: no clubbing, no cyanosis, no joint \nswelling, no edema in the bilateral extremities\nNeurological: Alert and oriented x1, minimal movement of \nbilateral ___ with increased tonicity, chronic flexure \ncontractures of bilateral ___, wiggles toes on commands\nIntegument: warm, no rash, no ulcer\nPsychiatric: appropriate, pleasant\nHematological/Lymphatic: No cervical, supraclavicular, axillary, \nor inguinal lymphadenopathy\nGU: normal genitalia, catheter present\n.', 'diagnoses': [{'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '4275', 'desc': 'Cardiac arrest'}, {'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '5070', 'desc': 'Pneumonitis due to inhalation of food or vomitus'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '78551', 'desc': 'Cardiogenic shock'}, {'icd_code': '37854', 'desc': 'Sixth or abducens nerve palsy'}, {'icd_code': '42823', 'desc': 'Acute on chronic systolic heart failure'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '42732', 'desc': 'Atrial flutter'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '2639', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '7843', 'desc': 'Aphasia'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4263', 'desc': 'Other left bundle branch block'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '53290', 'desc': 'Duodenal ulcer, unspecified as acute or chronic, without hemorrhage or perforation, without mention of obstruction'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '37749', 'desc': 'Other disorders of optic nerve'}, {'icd_code': '43320', 'desc': 'Occlusion and stenosis of vertebral artery without mention of cerebral infarction'}, {'icd_code': '43310', 'desc': 'Occlusion and stenosis of carotid artery without mention of cerebral infarction'}], 'summary': "___ 02:40PM BLOOD WBC-19.3*# RBC-3.48* Hgb-9.4* Hct-29.0* \nMCV-83 MCH-27.0# MCHC-32.5 RDW-13.6 Plt ___\n___ 02:40PM BLOOD ___ PTT-40.0* ___\n___ 02:40PM BLOOD Glucose-154* UreaN-69* Creat-2.1* Na-135 \nK-4.4 Cl-106 HCO3-16* AnGap-17\n___ 02:46PM BLOOD Lactate-1.9\n.\nCXR\nNo evidence of pneumonia.\n.\nCT HEAD\nChronic small vessel ischemic disease, with chronic lacunar \ninfarcts and old infarcts in the left occipital lobe and left \ncerebellum, which are new from ___. No definite evidence of \nan acute process. \n.\nCT Abd/Pelvis\nNo acute process. Fecal impaction rectum.\n.\nPMIBI ___\nSevere fixed inferior wall defect with akinesis and EF 37%. \n.\nECHO ___\nThe left atrium is mildly dilated. The right atrium is \nmoderately dilated. There is mild symmetric left ventricular \nhypertrophy. The left ventricular cavity size is normal. Overall \nleft ventricular systolic function is mildly-to-moderately \ndepressed (LVEF= 40 %) secondary to hypokinesis of the inferior \nseptum and inferior free wall; the posterior wall is also mildly \nhypokinetic; the midventricular portion of the inferior free \nwall is dyskinetic. Tissue Doppler imaging suggests an increased \nleft ventricular filling pressure (PCWP>18mmHg). There is no \nventricular septal defect. Right ventricular chamber size and \nfree wall motion are normal. The ascending aorta is mildly \ndilated. The aortic valve leaflets (3) are mildly thickened but \naortic stenosis is not present. The mitral valve leaflets are \nmildly thickened. There is no mitral valve prolapse. The \ntricuspid valve leaflets are mildly thickened. There is moderate \npulmonary artery systolic hypertension. There is no pericardial \neffusion. \n.\nCompared with the findings of the prior study (images reviewed) \nof ___, left ventricular contractile function is \nsignificantly reduced secondary to intercurrent inferior \nposterior myocardial infarction. \n.\nEKG: Vpaced rhythm\n.\n___ yo WF w PMHx of CAD s/p CABG, T2DM, chronic diastolic heart \nfailure, afib on coumadin, w altered ms, leukocytosis\n1. Altered MS, leukocytosis - infectious workup neg initially \nbut later stool was pos for Cdiff and pt' ms improved ___/ fluids, \npo flagyl and stopping of oxycodone. she was placed on scheduled \ntylenol here and that appeared to help. pt ms returned to \nbaseline. Even though urine Cx shows ___ organisms, UA was \nneg (2 wbc, small leuk but no nit) and pt did not have sx of \nUTI. Pt has chronic foley and ucx thought to represent \ncolonization. \n2. Cdiff infection- hx of diarrhea on HPI and pt denied it and \nnot noted here, CT w/ feces in rectum. Manual disimpaction was \nunsuccessful, pt was placed on bowel regimen and had 2 large BMs \nbefore discharge. Even though unusual to see constipation w \nCdiff, still possible and pt's leukocytosis improved with \nempiric flagyl and stool was pos for Cdiff, so decision made to \ntreat pt w Flagyl for total ___. Acute on chronic renal failure - improving w/ fluids, likely \n___ dehydration. Lasix held in hospital but Cr down to baseline \nand pt told to restart lasix at half dose at home at discharge \nfor hx of diastolic heart failure. \n4. Mixed gap, non-gap acidosis - combination of renal failure \nand ?diarrhea. improved with bicarb. Pt was off bicarb for >36 \nhrs and bicarb remained stable.\n5. HTN - continue coreg, norvasc. lisinopril held on admission \n___ arf, pt told to restart it at home\n6. Afib - rate controlled. Pt's INR was 4.6 on admission ___ \nsigns of bleeding. Coumadin held for several days (correction \nfrom prior notes) and INR drifted down to therapeutic level. Pt \ntold to restart coumadin at lower dose \n7. Anemia - longstanding, h/h stable, pcp to ___\n8. DM - pt only on Glipizide 5mg three times per week. Held \nhere, BS were fine. Pt told to restart half dose glipizide at \nhome and have ___ monitor blood sugars. PCP to ___\n. FEN - reg diet\n. Code status - DNr/DNI\n. Dispo - home w ___ services today"}}
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{'final_diagnoses': ['Cdiff infection', 'Constipation', 'Non healed surgical wound.', '-CAD s/p CABG ___ ', '-Chronic Diastolic CHF ', '-Atrial fibrillation on Coumadin ', '-Type 2 DM, diet controlled ', '-Hypertension ', '-Anemia, undetermined etiology ', '-OA ', '-Colon Ca s/p resection ___ ', '-Cervical spondylosis ', '-Subclavian venous thrombosis ', '-Hx vertebral TIA ___, on coumadin ', '-R CN VI palsy thought secondary to a carotid cavernous aneurysm ', '-R hip fracture s/p surgery at ___ ___ ', '-CKD 1.3-1.5 '], 'procedures': ['CT head ___', 'CT abd/pelvis ___'], 'visit_summary': "___ yo WF w PMHx of CAD s/p CABG, T2DM, chronic diastolic heart \nfailure, afib on coumadin, w altered ms, leukocytosis\n1. Altered MS, leukocytosis - infectious workup neg initially \nbut later stool was pos for Cdiff and pt' ms improved ___/ fluids, \npo flagyl and stopping of oxycodone. she was placed on scheduled \ntylenol here and that appeared to help. pt ms returned to \nbaseline. Even though urine Cx shows ___ organisms, UA was \nneg (2 wbc, small leuk but no nit) and pt did not have sx of \nUTI. Pt has chronic foley and ucx thought to represent \ncolonization. \n2. Cdiff infection- hx of diarrhea on HPI and pt denied it and \nnot noted here, CT w/ feces in rectum. Manual disimpaction was \nunsuccessful, pt was placed on bowel regimen and had 2 large BMs \nbefore discharge. Even though unusual to see constipation w \nCdiff, still possible and pt's leukocytosis improved with \nempiric flagyl and stool was pos for Cdiff, so decision made to \ntreat pt w Flagyl for total ___. Acute on chronic renal failure - improving w/ fluids, likely \n___ dehydration. Lasix held in hospital but Cr down to baseline \nand pt told to restart lasix at half dose at home at discharge \nfor hx of diastolic heart failure. \n4. Mixed gap, non-gap acidosis - combination of renal failure \nand ?diarrhea. improved with bicarb. Pt was off bicarb for >36 \nhrs and bicarb remained stable.\n5. HTN - continue coreg, norvasc. lisinopril held on admission \n___ arf, pt told to restart it at home\n6. Afib - rate controlled. Pt's INR was 4.6 on admission ___ \nsigns of bleeding. Coumadin held for several days (correction \nfrom prior notes) and INR drifted down to therapeutic level. Pt \ntold to restart coumadin at lower dose \n7. Anemia - longstanding, h/h stable, pcp to ___\n8. DM - pt only on Glipizide 5mg three times per week. Held \nhere, BS were fine. Pt told to restart half dose glipizide at \nhome and have ___ monitor blood sugars. PCP to ___\n. FEN - reg diet\n. Code status - DNr/DNI\n. Dispo - home w ___ services today", 'medications_prescribed': ['1. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '2. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '3. Lidocaine 5 %(700 mg/patch) Adhesive Patch, Medicated Sig: \nOne (1) Adhesive Patch, Medicated Topical DAILY (Daily). ', '4. Acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO QID (4 \ntimes a day). ', '5. Senna 8.6 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime) as \nneeded for constipation.\nDisp:*60 Tablet(s)* Refills:*2*', '6. Carvedilol 3.125 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day). ', '7. Metronidazole 500 mg Tablet Sig: One (1) Tablet PO TID (3 \ntimes a day) for 10 days.\nDisp:*30 Tablet(s)* Refills:*0*', '8. Gabapentin 100 mg Capsule Sig: Two (2) Capsule PO BID (2 \ntimes a day). ', '9. Miconazole Nitrate 2 % Powder Sig: One (1) Appl Topical BID \n(2 times a day) for 13 days.\nDisp:*1 1* Refills:*0*', '10. Lasix 40 mg Tablet Sig: 0.5 Tablet PO once a day. ', '11. Glipizide 5 mg Tablet Sig: 0.5 Tablet PO three times per \nweek. ', '12. Warfarin 2 mg Tablet Sig: One (1) Tablet PO once a day. ', '13. Lisinopril 20 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': 73, 'gender': 'F', 'symptoms': 'Abdominal pain, alcohol withdrawal symptoms', 'medical_history': ['Hep C (untreated)', 'Chronic back pain', 'Migraine headaches', '___ treated for a variety of injuries from mountain biking \nand motor boating incidents.', 'ETOH abuse, with prior withdrawal c/b seizures and intubation', 'opioid use disorder on methadone CSAC on ___. ___', 'HTN', 'Anti-Social Personality Disorder', 'Pancreatitis c/b necrosis ___'], 'family_history': 'Possible depression in his mother.', 'present_illness': 'HPI: Mr ___ is a ___ yo homeless man with history of ETOH abuse\nc/b prior withdrawal seizures and intubation, opioid use \ndisorder\non methadone, HCV (untreated), personality disorder with\nanti-social traits, who presented to the ED with c/o alcohol\nwithdrawal and abdominal pain. \n\nPatient states he has been drinking > ___ a gallon of vodka each\nnight. He reported symptoms of ___ in the ED. Pain is constant,\nnonradiating and worse in epigastrium. He reports copious clear\nvomit as well. \nDenies chills, N/V/Diarrhea. Last drink was day prior to\nadmission. Denies CP or SOB. \n\nROS: Pertinent positives and negatives as noted in the HPI. All\nother systems were reviewed and are negative.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sumatriptan Succinate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'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': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nortriptyline', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PrednisoLONE Acetate 1% Ophth. Susp.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'RIGHT EYE', 'frequency': 'BID', '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': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', '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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': 'Clotrimazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 19.8, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'New Reference Range as of ___. Normal Diurnal Pattern: 7-10AM 6.0-18.4 ug/dL / 4-8PM 2.7-10.5 ug/dL.'}, {'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': 301.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, 'flag': None, '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': '262', 'valuenum': 262.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 126.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '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': 'RANDOM.'}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', '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': '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': '6.0', 'valuenum': 6.0, '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': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1.007', 'valuenum': 1.007, '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', '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': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', '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': '6', 'valuenum': 6.0, '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': 123.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '5', 'valuenum': 5.0, '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': 'RANDOM.'}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'mg/dL', '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': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '289', 'valuenum': 289.0, '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': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, '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': 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', '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': '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': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 130.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, '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': '34', 'valuenum': 34.0, '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': 127.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '6', 'valuenum': 6.0, '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': 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': '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': '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': 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'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.2', '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '29', 'valuenum': 29.0, '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': '32.6', 'valuenum': 32.6, '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': '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': '300', 'valuenum': 300.0, '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': '3.74', 'valuenum': 3.74, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '41.3', 'valuenum': 41.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '263', 'valuenum': 263.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'FEW*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'MOD*.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'LG*.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.011', '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': 'abnormal', 'priority': 'ROUTINE', 'comments': 'Hazy*.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '179', 'valuenum': 179.0, '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': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '324', 'valuenum': 324.0, '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': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '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': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, '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': '___', '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': '27', 'valuenum': 27.0, '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': 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': '1.6', 'valuenum': 1.6, '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 1.6, . estimated GFR (eGFR) is likely between 32 and 38 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': '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': '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': '3.7', 'valuenum': 3.7, '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': '___', 'valuenum': 131.0, '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': '4', 'valuenum': 4.0, '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': '/hpf', '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': 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': 'LG*.'}, {'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': '9', 'valuenum': 9.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.017', 'valuenum': 1.017, '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': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'RARE*.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '>182*.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', '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': '11.4', 'valuenum': 11.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, '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': '28.0', 'valuenum': 28.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '335', 'valuenum': 335.0, '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': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.1', 'valuenum': 43.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.7', '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New 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': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, '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': 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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '45', 'valuenum': 45.0, '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': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '335', 'valuenum': 335.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.79', 'valuenum': 3.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43.4', 'valuenum': 43.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\nVITALS: Afebrile and vital signs stable (see eFlowsheet)\n___ 1525 Temp: 98.8 PO BP: 156/85 HR: 106 RR: 18 O2 sat: \n96%\nO2 delivery: RA \nGENERAL: Alert and in no apparent distress, but with tremors at\nbaseline\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 and tachycardic, no murmur, no S3, no S4. No\nJVD.\nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, tender to palpation in\nepigastric region. Bowel sounds present. No HSM\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent, moves all limbs, sensation to light touch grossly\nintact throughout\n\nDISCHARGE PHYSICAL EXAM:\nEXAM\nVITALS: \n___ 1136 Temp: 98.3 PO BP: 142/82 L Sitting HR: 96 RR: 18 \nO2 sat: 96% O2 delivery: Ra \nGENERAL: Alert and in no apparent distress, but with tremors at\nbaseline\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 and tachycardic, no murmur, no S3, no S4. No\nJVD.\nRESP: Lungs clear to auscultation with good air movement\nbilaterally. Breathing is non-labored\nGI: Abdomen soft, non-distended, mildly tender to palpation in\nepigastric region and LUQ without rebound or guarding (appears \nto be chronic). Bowel sounds present. No HSM\nMSK: Neck supple, moves all extremities, strength grossly full\nand symmetric bilaterally in all limbs\nNEURO: Alert, oriented, face symmetric, gaze conjugate with \nEOMI,\nspeech fluent, moves all limbs, sensation to light touch grossly\nintact throughout. Mild bilateral tremors noted.', 'diagnoses': [{'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'I129', 'desc': 'Hypertensive chronic kidney disease with stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'R51', 'desc': 'Headache'}, {'icd_code': 'R112', 'desc': 'Nausea with vomiting, unspecified'}, {'icd_code': 'R8271', 'desc': 'Bacteriuria'}, {'icd_code': 'R319', 'desc': 'Hematuria, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'H409', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'Z8673', 'desc': 'Personal history of transient ischemic attack (TIA), and cerebral infarction without residual deficits'}], 'summary': '___ 10:22PM BLOOD WBC-5.3 RBC-4.01* Hgb-12.6* Hct-37.7* \nMCV-94 MCH-31.4 MCHC-33.4 RDW-14.8 RDWSD-51.8* Plt ___\n___ 06:40AM BLOOD WBC-2.8* RBC-3.63* Hgb-11.1* Hct-35.0* \nMCV-96 MCH-30.6 MCHC-31.7* RDW-14.8 RDWSD-53.1* Plt ___\n___ 04:45AM BLOOD WBC-3.1* RBC-3.58* Hgb-11.2* Hct-34.6* \nMCV-97 MCH-31.3 MCHC-32.4 RDW-14.6 RDWSD-52.8* Plt ___\n\n___ 04:45AM BLOOD Glucose-119* UreaN-3* Creat-0.7 Na-145 \nK-3.2* Cl-102 HCO3-29 AnGap-14\n___ 04:45AM BLOOD Glucose-126* Na-141 K-3.0* Cl-100 HCO3-28 \nAnGap-13\n___ 04:45AM BLOOD Glucose-110* UreaN-2* Creat-0.7 Na-143 \nK-3.4* Cl-104 HCO3-26 AnGap-13\n\n___ 06:40AM BLOOD ALT-101* AST-143* AlkPhos-87 TotBili-1.0\n___ 04:45AM BLOOD ALT-122* AST-170* AlkPhos-92 TotBili-0.6\n___ 04:45AM BLOOD ALT-162* AST-220* TotBili-0.5\n___ 04:45AM BLOOD ALT-179* AST-191* AlkPhos-86 TotBili-0.4\n\n___ 04:45AM BLOOD Calcium-8.7 Phos-3.2 Mg-1.7\n___ 04:45AM BLOOD Albumin-3.9 Mg-2.0\n___ 04:45AM BLOOD Calcium-8.9 Mg-1.8\n\nCXR ___:\nINDICATION: History: ___ with hx of alcohol use with nausea and \nvomiting, \nchest discomfort.// Aspiration? Pneumonia? \n \nTECHNIQUE: Chest PA and lateral \n \nCOMPARISON: Chest radiograph from ___ \n \nFINDINGS: \n \nThe lungs appear clear without focal consolidation. There is no \npulmonary \nedema, pneumothorax, or pleural effusion. Normal \ncardiomediastinal and hilar \nsilhouettes. \n \nIMPRESSION: \n \nNo acute cardiopulmonary process \n \n\nCT ABD PELVIS WITH CONTRAST\nFINDINGS: \n \nLOWER CHEST: Visualized lung fields are within normal limits. \nThere is no \nevidence of pleural or pericardial effusion. \n \nABDOMEN: \n \nHEPATOBILIARY: Hepatic steatosis. Within the right hepatic lobe \nis an \napproximately 1.5 cm lesion demonstrating peripheral nodular \nenhancement, \npreviously characterized on MRI as a hemangioma. There is no \nevidence of \nintrahepatic or extrahepatic biliary dilatation. The \ngallbladder is within \nnormal limits. \n \nPANCREAS: The pancreas has normal attenuation throughout. A \ncyst within the \npancreatic head measures 7 mm (02:38), better assessed on prior \nMRI. There is \nfluid and stranding of the fat in the pancreaticoduodenal groove \nsuspicious \nfor groove pancreatitis. Alternatively this could reflect \nduodenitis. \nProminent peripancreatic lymph nodes are likely reactive \n(601:31). \n \nSPLEEN: The spleen shows normal size and attenuation throughout, \nwithout \nevidence of focal lesions. \n \nADRENALS: The right and left adrenal glands are normal in size \nand shape. \n \nURINARY: The kidneys are of normal and symmetric size with \nnormal nephrogram. \nThere is no evidence of focal renal lesions or hydronephrosis. \nThere is no \nperinephric abnormality. \n \nGASTROINTESTINAL: The stomach is unremarkable. Small bowel \nloops demonstrate \nnormal caliber, wall thickness, and enhancement throughout. A \n1.6 cm lipoma \nwithin the descending colon (02:55) is again seen. Otherwise, \nthe colon and \nrectum are within normal limits. Trace ascites within the right \npericolic \ngutter. The appendix is normal. \n \nPELVIS: The bladder wall appears thickened, likely secondary to \nunderdistention. There is no free fluid in the pelvis. \n \nREPRODUCTIVE ORGANS: The prostate is unremarkable. \n \nLYMPH NODES: Prominent periportal and porta hepatis nodes \nmeasures up to 0.9 \ncm (02:32). There is no mesenteric lymphadenopathy. There is \nno pelvic or \ninguinal lymphadenopathy. \n \nVASCULAR: There is no abdominal aortic aneurysm. No \natherosclerotic disease \nis noted. \n \nBONES: There is no evidence of worrisome osseous lesions or \nacute fracture. \n \nSOFT TISSUES: The abdominal and pelvic wall is within normal \nlimits. \n \nIMPRESSION: \n \n \n1. Findings suggestive of groove pancreatitis, as described \nabove. Recommend \ncorrelation with lab testing. Alternatively this appearance \ncould reflect \nduodenitis. \n2. Trace ascites. \n3. Hepatic steatosis. \n4. Other findings, as described above. \n \nNOTIFICATION: The findings were discussed with ___, M.D. by \n___, M.D. on the telephone on ___ at 1:14 pm, 30 \nminutes after discovery of the findings.\nSUMMARY/ASSESSMENT:\nMr ___ is a ___ yo homeless man with history of ETOH abuse c/b\nprior withdrawal seizures and intubation, opioid use disorder on\nmethadone, HCV (untreated), personality disorder with \nanti-social\ntraits, who presented to the ED with c/o alcohol withdrawal and\nabdominal pain.\n\n# Abdominal pain\n# Pancreatitis vs duodenitis \nPatient presented with epigastric pain and associated tenderness \non \nexam. However lipase was flat on admission compared to lipase \n700s in ___ and ___ during his prior admission for\npancreatitis in ___ in the setting of ETOH abuse. CT scan\nhowever concerning for groove pancreatitis vs duodenitis and \ncorrelated with\nclinical symptoms, likely has acute on chronic pancreatitis. \nBISAP score 0.\n\nWe had initially kept the patient NPO and provided aggressive \nfluids. For pain control, non-opioids were used with caution \ndue to his being on methadone; His LFTs were monitored closely \nfor worsening in his LFTs; and his renal function was monitored \nwhile giving NSAIDs. Possible duodenitis was also noted on CT \nA/P. \nThe patient was non-compliant with being NPO. He strongly urged \nto be allowed to eat even though he had vomited while being NPO. \nHe was initially given a low fat diet which provoked his \nabdominal pain, however he continued to ask to eat and did not \nvomit subsequently. On the day of discharge, he was asking to \near regular food. He did continue to have abdominal pain, \nhowever no IV pain medicines were given. The pt was extensively \neducated about pancreatitis however he appeared to have poor \ninsight about his disease. \n\nAlcohol cessation counseling was provided. \n\n#ETOH abuse \nActive heavy ETOH use with ___ gallon vodka daily with last \ndrink midday ___. Pt reports he has had complicated\nwithdrawal in the past with seizures and intubation at ___ years\nago. \n\nHe was started on CIWA scale with Ativan. This was gradually \ntapered and transitioned to his home clonazepam 0.5 mg BID. He \nwas seen by our social worker. He was given Folic acid, thiamine \nand multivitamins. He will discharge to ___ home. \n\n# Elevated AST/ALT: Elevated LFTs on admission. Most likely \nrelated to ETOH use and steatosis on top of untreated HCV \ninfection (Viral Load was 7.1 in ___. Hep B immune in \n___. Encouraged ETOH cessation as above. Pt should f/u with\nGI for consideration of hep C treatment. He has been made an \nappointment with liver/pancreas team for ___ at 5 ___ with \nDr. ___. \n\n#Acute encephalopathy:\nThe pt was lethargic and somnolent during this admission. This \nwas thought to be secondary to medications. Psychiatry was \nconsulted - initially we attempted to wean off medicines, \nhowever pt stated that he was sleep deprived from watching the \n___ game until late, and requested not changing his \noutpatient psychiatric medicines. He does have slow speech at \nbaseline. At the time of discharge, he appeared to be alert and \nat baseline. \n\n#Hypokalemia\n#Hypomagnesemia \nRepleted as needed\n\n# HTN: \n- continued home clonidine\n- Patient was not on ace or ccb per review\n\n# Opiate use disorder: Confirmed 75mg methadone dosing with \noutpatient ___ clinic ___ on ___. ___. \nContinue the same. Last dose this hospitalization was on ___ \nat 07:57 AM. \n\n# Antisocial personality disorder: \n- cont home Depakote \n- cont home bupropion \n- cont home clonidine \n- continue home gabapentin\n- cont home Adderall'}}
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{'final_diagnoses': ['Alcohol withdrawal', 'Pancreatitis', 'Elevated Transaminases'], 'procedures': ['None'], 'visit_summary': 'SUMMARY/ASSESSMENT:\nMr ___ is a ___ yo homeless man with history of ETOH abuse c/b\nprior withdrawal seizures and intubation, opioid use disorder on\nmethadone, HCV (untreated), personality disorder with \nanti-social\ntraits, who presented to the ED with c/o alcohol withdrawal and\nabdominal pain.\n\n# Abdominal pain\n# Pancreatitis vs duodenitis \nPatient presented with epigastric pain and associated tenderness \non \nexam. However lipase was flat on admission compared to lipase \n700s in ___ and ___ during his prior admission for\npancreatitis in ___ in the setting of ETOH abuse. CT scan\nhowever concerning for groove pancreatitis vs duodenitis and \ncorrelated with\nclinical symptoms, likely has acute on chronic pancreatitis. \nBISAP score 0.\n\nWe had initially kept the patient NPO and provided aggressive \nfluids. For pain control, non-opioids were used with caution \ndue to his being on methadone; His LFTs were monitored closely \nfor worsening in his LFTs; and his renal function was monitored \nwhile giving NSAIDs. Possible duodenitis was also noted on CT \nA/P. \nThe patient was non-compliant with being NPO. He strongly urged \nto be allowed to eat even though he had vomited while being NPO. \nHe was initially given a low fat diet which provoked his \nabdominal pain, however he continued to ask to eat and did not \nvomit subsequently. On the day of discharge, he was asking to \near regular food. He did continue to have abdominal pain, \nhowever no IV pain medicines were given. The pt was extensively \neducated about pancreatitis however he appeared to have poor \ninsight about his disease. \n\nAlcohol cessation counseling was provided. \n\n#ETOH abuse \nActive heavy ETOH use with ___ gallon vodka daily with last \ndrink midday ___. Pt reports he has had complicated\nwithdrawal in the past with seizures and intubation at ___ years\nago. \n\nHe was started on CIWA scale with Ativan. This was gradually \ntapered and transitioned to his home clonazepam 0.5 mg BID. He \nwas seen by our social worker. He was given Folic acid, thiamine \nand multivitamins. He will discharge to ___ home. \n\n# Elevated AST/ALT: Elevated LFTs on admission. Most likely \nrelated to ETOH use and steatosis on top of untreated HCV \ninfection (Viral Load was 7.1 in ___. Hep B immune in \n___. Encouraged ETOH cessation as above. Pt should f/u with\nGI for consideration of hep C treatment. He has been made an \nappointment with liver/pancreas team for ___ at 5 ___ with \nDr. ___. \n\n#Acute encephalopathy:\nThe pt was lethargic and somnolent during this admission. This \nwas thought to be secondary to medications. Psychiatry was \nconsulted - initially we attempted to wean off medicines, \nhowever pt stated that he was sleep deprived from watching the \n___ game until late, and requested not changing his \noutpatient psychiatric medicines. He does have slow speech at \nbaseline. At the time of discharge, he appeared to be alert and \nat baseline. \n\n#Hypokalemia\n#Hypomagnesemia \nRepleted as needed\n\n# HTN: \n- continued home clonidine\n- Patient was not on ace or ccb per review\n\n# Opiate use disorder: Confirmed 75mg methadone dosing with \noutpatient ___ clinic ___ on ___. ___. \nContinue the same. Last dose this hospitalization was on ___ \nat 07:57 AM. \n\n# Antisocial personality disorder: \n- cont home Depakote \n- cont home bupropion \n- cont home clonidine \n- continue home gabapentin\n- cont home Adderall', 'medications_prescribed': ['FoLIC Acid 1 mg PO DAILY \nRX *folic acid 1 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*5', 'Multivitamins 1 TAB PO DAILY', 'BuPROPion (Sustained Release) 150 mg PO BID', 'Amphetamine-Dextroamphetamine 10 mg PO DAILY', 'ClonazePAM 0.5 mg PO BID', 'CloNIDine 0.2 mg PO TID', 'Divalproex (DELayed Release) 500 mg PO BID', 'Gabapentin 800 mg PO TID', 'Methadone 75 mg PO DAILY \nConsider prescribing naloxone at discharge', 'Naloxone Nasal Spray 4 mg IH ONCE MR1', 'QUEtiapine Fumarate 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': 91, 'gender': 'F', 'symptoms': 'Palpitations', 'medical_history': ['1. CARDIAC RISK FACTORS \n - Diabetes: none \n - Hypertension: none \n - Dyslipidemia: none \n2. CARDIAC HISTORY \n-mod-mild AI\n-Hx of SVT in ___, briefly on Metop\n - CABG: None \n - PERCUTANEOUS CORONARY INTERVENTIONS: None \n - PACING/ICD: None \n3. OTHER PAST MEDICAL HISTORY \n-Hot Flashes with menopause'], 'family_history': 'Mother with 2x silent MIs, earliest may have been ___\nSister pSVT\n___ aunt MI in ___', 'present_illness': 'Ms ___ is a ___ w/hx of mild-mod AI, remote hx of SVT \np/w\npalpitations, strange chest sensations\n\nPt reports that in last few weeks she recently had lots of hot\nflashes, increased from baseline hot flashes ___ menopause, and\nhas reported diff to describe episodic sensations of blood\nflowing in her body/palpitations. Sx worsened last night, lasted\nlonger and were stronger. Initially presented to BID-N, EKG \nthere\nwith reported nonspecific ST-Depressions, trops x2 neg, given \nASA\n324 and transferred to ___ for potential cath.\n\nIn the ED initial vitals were: T97 78 170/69 16 98% RA \n ___ EKG: HR 78, NSR, QW I, otherwise no ischemic changes\n ___ EKG: HR 93 1mm depressions II, III, V3. sub-mm depressions\nV4,V5 \n Labs/studies notable for: Trop x3 neg, WBC 5.3, Hb 13.7, BUN/Cr\n___\n Patient was given: 324mg ASA at ___\n Vitals on transfer: HR 97 157/78 20 100% RA \n \nOn the floor, pt unsure if heart had been beating fast or\nstronger. +weird sensations. Been going on for a few wks, short\nacting. Last night, sensation stronger, lasted ~20min. No chest\npain. No N/V/D/C. No SOB, DOE, orthopnea, LH/dizziness.\n+diaphoresis/hot flashes occurring for no reason for a few \nweeks.\nNo syncope. No cough, dysuria. No F/C. Has apt with Dr ___ month with TTE scheduled then as well. Reports increased\nstress recently ___ caring for her elderly mother with dementia\n24hr/day.', 'medications': [{'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': 'Aztreonam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Aztreonam', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', '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': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ethacrynic Acid', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ethacrynate Sodium', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Influenza Vaccine Quadrivalent', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NEB', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', '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 MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q48H', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 38.0, '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': '2.0', 'valuenum': 2.0, '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 2.0,. Estimated GFR = 23 if non African-American (mL/min/1.73 m2). Estimated GFR = 28 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': 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': '261', 'valuenum': 261.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 9242.0, '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': '5.9', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.92', 'valuenum': 3.92, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '563', 'valuenum': 563.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.14, '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': '110', 'valuenum': 110.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '400', 'valuenum': 400.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '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': '17', 'valuenum': 17.0, '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': '43', 'valuenum': 43.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.19, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '5.0', 'valuenum': 5.0, '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': '62', 'valuenum': 62.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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, 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'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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, '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': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '116', 'valuenum': 116.0, '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': 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': '265', 'valuenum': 265.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '33.2', 'valuenum': 33.2, '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': '158', 'valuenum': 158.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAMINATION\nVITALS: 97.8 PO 132 / 77 70 16 97 RA \nGENERAL: Well-developed, well-nourished. NAD. Mood, affect\nappropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva pink, no\npallor or cyanosis of the oral mucosa. No xanthelasma. \nNECK: Supple with JVP of *** cm. \nCARDIAC: PMI located in ___ intercostal space, midclavicular\nline. RRR, normal S1, S2. No murmurs/rubs/gallops. No thrills,\nlifts. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp\nwere unlabored, no accessory muscle use. No crackles, wheezes or\nrhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: Distal pulses palpable and symmetric \n\nDISCHARGE PHYSICAL EXAMINATION\nVS: ___ 0814 Temp: 97.6 PO BP: 120/74 HR: 76 RR: 20 O2 sat:\n97% O2 delivery: Ra \nGENERAL: Well-developed, well-nourished woman, laying in bed\ncomfortably in NAD\nHEENT: NC/AT, EOMI, anicteric sclera, MMM \nNECK: Supple, no JVD at 90 degrees\nCARDIAC: Irregular, normal S1/S2, no m/r/g\nLUNGS: CTAB, breathing comfortably on RA without use of \naccessory\nmm, no wheezes/rhonchi/rales \nABDOMEN: Soft, non-tender to palpation without rebound/guarding,\nnon-distended, active bowel sounds\nEXTREMITIES: No c/c/e \nSKIN: Warm and well-perfused, no visible rashes \nNEURO: Alert, oriented, moving all extremities with purpose, no\nfacial asymmetry ', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '51851', 'desc': 'Acute respiratory failure following trauma and surgery'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '5761', 'desc': 'Cholangitis'}, {'icd_code': '56781', 'desc': 'Choleperitonitis'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': '45829', 'desc': 'Other iatrogenic hypotension'}, {'icd_code': 'E9383', 'desc': 'Intravenous anesthetics causing adverse effects in therapeutic use'}, {'icd_code': '515', 'desc': 'Postinflammatory pulmonary fibrosis'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '57450', 'desc': 'Calculus of bile duct without mention of cholecystitis, without mention of obstruction'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': 'V5866', 'desc': 'Long-term (current) use of aspirin'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '7885', 'desc': 'Oliguria and anuria'}, {'icd_code': 'V462'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': 'ADMISSION LABS\n==============\n___ 05:40AM BLOOD WBC-3.9* RBC-4.35 Hgb-13.8 Hct-41.7 \nMCV-96 MCH-31.7 MCHC-33.1 RDW-13.1 RDWSD-46.5* Plt ___\n___ 05:40AM BLOOD ___ PTT-29.5 ___\n___ 05:40AM BLOOD Glucose-84 UreaN-12 Creat-0.7 Na-143 \nK-5.0 Cl-104 HCO3-27 AnGap-12\n___ 05:40AM BLOOD Calcium-9.7 Phos-4.0 Mg-2.3\n\nSTUDIES\n=======\n___ EKG: HR 93 1mm depressions II, III, V3. sub-mm depressions \nV4,V5 \n\n___ EKG: HR 78, NSR, QW I, otherwise no ischemic changes\n\nTTE ___\nThe left atrial volume index is normal. No atrial septal defect \nis seen by 2D or color Doppler. The estimated right atrial \npressure is ___ mmHg. Normal left ventricular wall thickness, \ncavity size, and regional/global systolic function (3D LVEF = 58 \n%). The estimated 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) appear structurally normal \nwith good leaflet excursion and no aortic stenosis. Mild (1+) \naortic regurgitation is seen. The mitral valve appears \nstructurally normal with trivial mitral regurgitation. There is \nno mitral valve prolapse. The estimated pulmonary artery \nsystolic pressure is high normal. There is no pericardial \neffusion. \n\n IMPRESSION: Normal biventricular cavity sizes with preserved \nregional and global biventricular systolic function. Mild aortic \nregurgitation. \n\n CLINICAL IMPLICATIONS: \n Based on ___ AHA endocarditis prophylaxis recommendations, the \necho findings indicate prophylaxis is NOT recommended. Clinical \ndecisions regarding the need for prophylaxis should be based on \nclinical and echocardiographic data. \n\nExercise Stress TTE ___:\nThe patient exercised for 8 minutes and 30 seconds according to \na Gervino treadmill protocol ___ METS) reaching a peak heart \nrate of 162 bpm and a peak blood pressure of 176/74 mmHg. The \ntest was stopped because of fatigue. This level of exercise \nrepresents a fair exercise tolerance for age and gender. In \nresponse to stress, the ECG showed no ST-T wave changes (see \nexercise report for details). There is resting mild systolic \nhypertension with normal blood pressure and heart rate responses \nto stress. \n .\n Resting images were acquired at a heart rate of70 bpm and a \nblood pressure of 144/84 mmHg. These demonstrated normal \nregional and global left ventricular systolic function. Biplane \nLVEF = 58 %. Right ventricular free wall motion is normal. .\n\n Echo images were acquired within 32 seconds after peak stress \nat heart rates of 146 - 133 bpm. These demonstrated appropriate \naugmentation of all left ventricular segments. There was normal \nright ventricular free wall augmentation. \n\n IMPRESSION: Fair functional exercise capacity for age and \ngender. No ECG or 2D echocardiographic evidence of inducible \nischemia to achieved workload. Resting mild systolic \nhypertension with normal hemodynamic response to exercise. \n***\nPATIENT SUMMARY\n===============\nMs. ___ is a ___ year-old lady with h/o mild-moderate AI, \nremote h/o SVT who presented with palpitations and odd \nsensation, was found to have brief ST depressions at ___ \nwhich resolved, and was transferred to ___. Here she underwent \nexercise stress echo test which showed no signs of ischemia, TTE \nw/o RWMAs and only mild AI\n\n# Palpitations\n# ST-Depressions\nPresented with palpitations and strange chest sensation \ndifficult to describe. Initial EKG at ___ had 1mm ST \ndepressions in several leads. Trops negative x3. Had a few \nepisodes of sinus tachycardia over admission. TTE showed only \nmild AI, no RWMAs. Exercise stress TTE showed no signs of \nischemia. \n\n# Aortic Insufficency\nPer pt, reportedly mild to moderate and has not progressed with \nserial TTEs. On TTE here, only mild AI\n\nTRANSITIONAL ISSUES\n===================\n-please check K at outpatient f/u appointment, had K of 5.4 on \nDC, unclear precipitant, counseled on low-K diet until f/u appt\n-consider event ___ tele monitoring for \npotential sinus arrhythmia\n-consider further workup for difficult to describe head \nsensation Sx\n-consider outpatient SW referral, pt with increased recent \nstress ___ caring for elderly mother\n\n# DC WEIGHT: 55.5kg (122.35 lbs)'}}
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{'final_diagnoses': ['Non Ischemic Chest Pain ', 'Mild Aortic Insufficiency'], 'procedures': ['Exercise stress echocardiogram ___'], 'visit_summary': 'PATIENT SUMMARY\n===============\nMs. ___ is a ___ year-old lady with h/o mild-moderate AI, \nremote h/o SVT who presented with palpitations and odd \nsensation, was found to have brief ST depressions at ___ \nwhich resolved, and was transferred to ___. Here she underwent \nexercise stress echo test which showed no signs of ischemia, TTE \nw/o RWMAs and only mild AI\n\n# Palpitations\n# ST-Depressions\nPresented with palpitations and strange chest sensation \ndifficult to describe. Initial EKG at ___ had 1mm ST \ndepressions in several leads. Trops negative x3. Had a few \nepisodes of sinus tachycardia over admission. TTE showed only \nmild AI, no RWMAs. Exercise stress TTE showed no signs of \nischemia. \n\n# Aortic Insufficency\nPer pt, reportedly mild to moderate and has not progressed with \nserial TTEs. On TTE here, only mild AI\n\nTRANSITIONAL ISSUES\n===================\n-please check K at outpatient f/u appointment, had K of 5.4 on \nDC, unclear precipitant, counseled on low-K diet until f/u appt\n-consider event ___ tele monitoring for \npotential sinus arrhythmia\n-consider further workup for difficult to describe head \nsensation Sx\n-consider outpatient SW referral, pt with increased recent \nstress ___ caring for elderly mother\n\n# DC WEIGHT: 55.5kg (122.35 lbs)', 'medications_prescribed': ['None']}
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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': 'chest pain', 'medical_history': ['CARDIAC RISK FACTORS: (-)Diabetes, (+)Dyslipidemia, (-)Hypertension', 'CARDIAC HISTORY:', '-CABG:', '-PERCUTANEOUS CORONARY INTERVENTIONS:', '-PACING/ICD:', 'OTHER PAST MEDICAL HISTORY:', 'Severe AS (valve area 0.5cm2, peak gradient ___', 'Alzheimers (baseline AAOx1)', 'Anemia', 'CHF'], 'family_history': 'Mother died of CHF at age ___. No DM.', 'present_illness': "The patient is an ___ female brought in by EMS for chest pain. \nPt has received all past care at ___ and was recently discharged \nfrom there on ___ for acute on chronic heart failure \nsecondary to AS. Pt has critical AS (valve area 0.4, gradient \n___. Pt started having chest pain ___ hrs before ED \npresentation today. Pain was substernal and bothersome enough \nthat she was concerned she was having a heart attack. Due to her \nAlzeheimers she has some difficulty understanding and answering \ncertain questions and gives a vague history of pain \ncharacteristics but no obvious radiation. No nausea or vomiting. \nNo diaphoresis. She did feel concerned that something bad was \nhappening. Her family called EMS. At time of EMS arrival she was \nstill having some chest pain and was given 325mg ASA. However, \nher chest pain had disappeared spontaneously while EMS was \npresent so she did not receive any nitro or morphine. \n. \nIn the ED initial vitals were not recorded. EKG showed STE in \ninferior leads (III and AFV) of 1.5 mm. On exam HR 70-80s, BPs \n95-115 systolic, sats mid-high ___ on 2L NC. Harsh mid systolic \nearly peaking murmur heard in the RUSB. Stool guaiac was \nnegative. Labs significant for CHEM-7 WNL, trop 0.05, CK 80, \nCK-MB 4, Hct 26.2 (Hct was 28.7 on ___ ___), INR \n1.2. CXR was obtained; read pending but appears to have pulm \ncongestion/edema, no focal consolidations. ___ did not want \naggressive care and have previously refused valvuloplasty. After \ndiscussion with the cardiologist, the family deferred on \ncatheterization and would like to pursue medical management. Pt \nwas plavix loaded with 300mg and started on heparin gtt at 800 \nunits/hr. Repeat EKG showed resolution of STE along with \nbiphasic t-waves in V3-V5 stable from prior (i.e., no new EKG \nchanges). She has been without CP for an hr and has been \nhemodynamically stable. Vitals on transfer were 98.1, 60, \n101/48, 22, 100% 2L NC. \n. \nOf note, Pt has received all past care at ___ and was recently \ndischarged from there on ___. Recent admission was for heart \nfailure ___ to aortic stenosis. Family refused valve \nintervention at that time as didn't want open heart surgery and \nthere apparently was some vascular anatomy reason why she \ncouldn't have a percutaneous proceedure. Was DNR/DNI during \nprevious admission at ___.", 'medications': [{'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE: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': '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 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 via patient discharge', 'route': 'IV', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, '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': 'STAT', 'comments': '___'}, {'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': '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': 0.4, '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 0.9,. Estimated GFR = 59 if non African-American (mL/min/1.73 m2). Estimated GFR = 71 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': 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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '4.3', 'valuenum': 4.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80.9', 'valuenum': 80.9, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '217', 'valuenum': 217.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '1', 'valuenum': 1.0, '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': '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': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.021', 'valuenum': 1.021, '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': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'VS - Temp 97.5F, BP 112/59, HR 86, R 24, O2-sat 97% on 2L NC\nGENERAL - Alert in NAD\nHEENT - EOMI, sclerae anicteric, MMM\nNECK - Supple, JVP 8cm\nHEART - RRR, ___ SEM heard best at RUSB, normal S1, difficult to auscultate S2.\nLUNGS - Bilateral crackles to mid-lung field, no wheezes. Good respiratory effort with no accessory muscle use\nABDOMEN - NABS, soft/NT/ND, no masses or HSM\nEXTREMITIES - WWP, 2+ edema to knees bilaterally.\nSKIN - no rashes or lesions\nLYMPH - no cervical LAD\nNEURO - awake, alert, CNs II-XII grossly intact, gait deferred, no focal deficits', 'diagnoses': [{'icd_code': '81352', 'desc': 'Other open fractures of distal end of radius (alone)'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}], 'summary': "___ 05:55PM BLOOD WBC-12.5* RBC-2.95* Hgb-8.2* Hct-26.2* \nMCV-89 MCH-28.0 MCHC-31.4 RDW-15.0 Plt ___\nLABORATORY DATA:\n___ 07:15AM BLOOD WBC-13.4* RBC-2.82* Hgb-7.8* Hct-25.0* \nMCV-89 MCH-27.7 MCHC-31.3 RDW-15.1 Plt ___\n___ 05:55PM BLOOD Neuts-85* Bands-0 Lymphs-6* Monos-5 Eos-0 \nBaso-1 Atyps-3* ___ Myelos-0\n___ 05:55PM BLOOD ___ PTT-20.1* ___\n___ 07:15AM BLOOD ___ PTT-34.5 ___\n___ 05:55PM BLOOD Glucose-151* UreaN-30* Creat-0.8 Na-136 \nK-4.3 Cl-95* HCO3-26 AnGap-19\n___ 07:15AM BLOOD CK(CPK)-311*\n___ 02:21AM BLOOD CK(CPK)-247*\n___ 05:55PM BLOOD CK(CPK)-80\n___ 05:55PM BLOOD CK-MB-4 cTropnT-0.05*\n___ 02:21AM BLOOD CK-MB-26* MB Indx-10.5* cTropnT-0.26*\n___ 07:15AM BLOOD CK-MB-35* MB Indx-11.3* cTropnT-0.35*\nEKG ___: sinus rhythm with multiple PACs, rate 73, normal \naxis, q-waves in V4-V6, I, II, RBBB \n.\nCXR ___\nSingle portable view of the chest. No prior. There are bibasilar \nopacities, larger on the left than right. These are suggestive \nof pleural \neffusions with probable underlying airspace opacity as well. \nThere is \nengorgement of the central pulmonary vasculature with indistinct \npulmonary vascular markings peripherally. Cardiac silhouette \nappears enlarged; however, is not well seen secondary to \nsilhouetting from airspace disease. Osseous and soft tissue \nstructures are grossly unremarkable. \nIMPRESSION: Findings are suggestive of failure. Two-view chest \nmay help \nfurther characterize. \n.\n___ female with CHF, critical AS who presented with STEMI and \nprogressive dyspnea. \n. \n# Goals of care - Given patient's poor general health condition \nand prognosis and after discussion with the family, goals of \ncare where focused on comfort measures only. Morphine was given \nfor control of pain and dyspnea with good response. Pt was \ndischarged to ___ facility.\n.\n# Chest pain: DDx includes transient occlusion vs NSTEMI vs \nSTEMI with recanulization. Given family's desire of non-invasive \ntherapy, will medically manage the patient. ST-elevations had \nresolved by the time pt was admitted to the floor. She had \nreceived full dose aspirin, plavix load and was started on \nheparin gtt in the ED. On arival to the floor was chest pain \nfree and did not require any nitroglycerin. Cardiac enzymes \ncontinued to rise, but trending was discontinued as family made \nthe decision to make her CMO. Pt was given morphine for chest \npain and sensation of air hunger. Maintained on metoprolol and \nlasix as these were felt to be comfort measures.\n.\n# Anemia: Uncertain etiology but patient appeared to be near her \nbaseline based on records from ___ on ___. HCT was \nnot trended and no further workup pursued as pt's status was \nCMO.\n. \n# Aortic stenosis- severe with a valve area 0.5cm2 and \nsymptomatic dyspnea with minimal exertion (going to the \nbathroom, scratching her leg, etc). Patient's family has not \nwanted any surgical intervention to date. She was transitioned \nto CMO during this hospitalization with supplemental O2 for \ncomfort. \n. \n# CHF- patient on low dose prn lasix. Was recently discharged \nfrom ___ with CHF exacerbation. Lasix was continued for symptom \ncontrol given crackles and bilateral ___ edema on exam. Would \nsuggest obtaining records from ___ as EF will be a helpful \nprognostic indicator.\n.\n# Alheizmers- at baseline, patient is AAO x 1. She was not on \nany medications for this on admission. at this time \nTRANSITIONAL ISSUES\nFollow with hospice nurse."}}
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{'final_diagnoses': ['ST elevation MI', 'Critical Aortic Stenosis'], 'procedures': ['none'], 'visit_summary': "___ female with CHF, critical AS who presented with STEMI and \nprogressive dyspnea. \n. \n# Goals of care - Given patient's poor general health condition \nand prognosis and after discussion with the family, goals of \ncare where focused on comfort measures only. Morphine was given \nfor control of pain and dyspnea with good response. Pt was \ndischarged to ___ facility.\n.\n# Chest pain: DDx includes transient occlusion vs NSTEMI vs \nSTEMI with recanulization. Given family's desire of non-invasive \ntherapy, will medically manage the patient. ST-elevations had \nresolved by the time pt was admitted to the floor. She had \nreceived full dose aspirin, plavix load and was started on \nheparin gtt in the ED. On arival to the floor was chest pain \nfree and did not require any nitroglycerin. Cardiac enzymes \ncontinued to rise, but trending was discontinued as family made \nthe decision to make her CMO. Pt was given morphine for chest \npain and sensation of air hunger. Maintained on metoprolol and \nlasix as these were felt to be comfort measures.\n.\n# Anemia: Uncertain etiology but patient appeared to be near her \nbaseline based on records from ___ on ___. HCT was \nnot trended and no further workup pursued as pt's status was \nCMO.\n. \n# Aortic stenosis- severe with a valve area 0.5cm2 and \nsymptomatic dyspnea with minimal exertion (going to the \nbathroom, scratching her leg, etc). Patient's family has not \nwanted any surgical intervention to date. She was transitioned \nto CMO during this hospitalization with supplemental O2 for \ncomfort. \n. \n# CHF- patient on low dose prn lasix. Was recently discharged \nfrom ___ with CHF exacerbation. Lasix was continued for symptom \ncontrol given crackles and bilateral ___ edema on exam. Would \nsuggest obtaining records from ___ as EF will be a helpful \nprognostic indicator.\n.\n# Alheizmers- at baseline, patient is AAO x 1. She was not on \nany medications for this on admission. at this time \nTRANSITIONAL ISSUES\nFollow with hospice nurse.", 'medications_prescribed': ['Metoprolol succinate- 12.5mg daily', 'Lasix- 40mg PO prn fluid buildup, difficulty breathing', 'Aspirin 81mg daily', 'Atorvastatin 20mg daily', 'Vitamin D- 2000U daily', 'Senna BID', 'Miralax daily', 'Ferrous sulfate 325mg every other day']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'F', 'symptoms': 'Probable Acute Lymphoma', 'medical_history': ['Foot Surgery'], 'family_history': 'Mother: healthy\nFather: ___', 'present_illness': '___ year old Male who presents with 1 month of dyspnea, nightly \nheadaches, neck pain and fevers. The patient reports that he has \nhad some decreased appetite and states he has lost 40lbs over \nthe month prior to admission. Patient denies any cough or \nhemoptysis. The patient is originally from ___ but has \nnot been there recently. The patient has no PCP, so is coming in \nfor expedited workup of presumed acute lymphoma.\n\nThe patient reports difficulty walking, although it was unclear \nif this was due to back pain or dyspnea (he ascribed both). On \nobservation he walked to the bathroom while I was present and \nrequired assistance from his wife to do so. This seems in \ncontrast to his work at a car ___. He does note occupation \nexposure to solvents.\n\nInitial vitals in the ED 97.8, 97.8, 130, 104/64, 18, 97%. In \nthe ED he subsequently spiked to 102.2. He was given 1L of IV \nfluid and tylenol.', 'medications': [{'medication': 'Ferrous Sulfate', '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': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Azathioprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', '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': 'IM', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydroxychloroquine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': '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}]}, 'clinical_findings': {'labs': [{'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38.8', 'valuenum': 38.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '9.6', 'valuenum': 9.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '31.3', 'valuenum': 31.3, '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': '6.3', 'valuenum': 6.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83.5', 'valuenum': 83.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, '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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mm/hr', 'ref_range_lower': 0.0, 'ref_range_upper': 20.0, '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': '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': '37', 'valuenum': 37.0, 'valueuom': 'mg/dL', 'ref_range_lower': 90.0, 'ref_range_upper': 180.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 40.0, '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', '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': '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': '5.8', 'valuenum': 5.8, '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.0, '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': '___', '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': '44', 'valuenum': 44.0, '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': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE *.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1:320 PATTERN-DIFFUSE. ROUGHLY 20% OF HEALTHY INDIVIDUALS HAVE ANA TITERS OF 1:40 OR 1:80. HIGHER TITERS(1:160 AND ABOVE) ARE SEEN IN ONLY 5% OF NORMALS.'}, {'value': None, 'valuenum': None, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE *. TITER - 1:320.'}, {'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': '___', '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': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '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': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'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': '11.5', 'valuenum': 11.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '8.4', 'valuenum': 8.4, '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': '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': '91', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, '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': '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': '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': '35', 'valuenum': 35.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, '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': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '18', 'valuenum': 18.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '212', 'valuenum': 212.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '31.2', 'valuenum': 31.2, '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': '99', 'valuenum': 99.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.51', 'valuenum': 3.51, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ROS:\nGEN: + fevers, - Chills, + 40lb Weight Loss\nEYES: - Photophobia, - Visual Changes\nHEENT: - Oral/Gum bleeding\nCARDIAC: - Chest Pain, - Palpitations, - Edema\nGI: - Nausea, - Vomitting, - Diarhea, - Abdominal Pain, - \nConstipation, - Hematochezia\nPULM: - Dyspnea, - Cough, - Hemoptysis\nHEME: - Bleeding, - Lymphadenopathy\nGU: - Dysuria, - hematuria, - Incontinence\nSKIN: - Rash\nENDO: - Heat/Cold Intolerance\nMSK: - Myalgia, - Arthralgia, - Back Pain\nNEURO: - Numbness, - Weakness, - Vertigo, + Headache\n\nPHYSICAL EXAM:\nVSS: Tmax 102.2, 97.9, 94, 26, 97%\nGEN: NAD\nPain: ___\nHEENT: EOMI, MMM, - OP Lesions, No supraclavicular or cervical \nlymphadenopathy appreciated\nPUL: CTA B/L\nCOR: RRR, S1/S2, Prominent impulse, I/VI HSM\nABD: NT/ND, +BS, - CVAT\nEXT: - CCE\nNEURO: CAOx3, Motor ___ ___ Flex/Ext/Finger Spread\nDERM: Possible nodule on 2 fingers, unable to determine if \nsplinter hemorrhages due to nail staining from work, \nonchonmycosis.', 'diagnoses': [{'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '2841', 'desc': 'Pancytopenia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '78791', 'desc': 'Diarrhea'}, {'icd_code': '51889', 'desc': 'Other diseases of lung, not elsewhere classified'}, {'icd_code': '4430', 'desc': "Raynaud's syndrome"}, {'icd_code': '7102', 'desc': 'Sicca syndrome'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '7100', 'desc': 'Systemic lupus erythematosus'}, {'icd_code': '58281', 'desc': 'Chronic glomerulonephritis in diseases classified elsewhere'}], 'summary': '___ 11:13PM BLOOD WBC-13.8* RBC-4.17* Hgb-12.4* Hct-35.3* \nMCV-85 MCH-29.7 MCHC-35.1* RDW-13.2 Plt ___\n___ 11:13PM BLOOD Neuts-76* Bands-0 Lymphs-16* Monos-6 \nEos-1 Baso-0 Atyps-1* ___ Myelos-0\n___ 11:13PM BLOOD Hypochr-NORMAL Anisocy-NORMAL \nPoiklo-NORMAL Macrocy-NORMAL Microcy-NORMAL Polychr-NORMAL\n___ 11:13PM BLOOD Glucose-93 UreaN-11 Creat-1.0 Na-131* \nK-4.2 Cl-99 HCO3-22 AnGap-14\n___ 11:13PM BLOOD Calcium-9.3 Phos-3.3 Mg-2.5\n___ 11:23PM BLOOD Lactate-1.1\n___ 12:40AM URINE Color-Yellow Appear-Clear Sp ___\n___ 12:40AM URINE Blood-TR Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-4* pH-6.0 Leuks-NEG\n___ 12:40AM URINE RBC-1 WBC-2 Bacteri-FEW Yeast-NONE Epi-0\n\n___ 11:15 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending):\nMr ___ presented with fevers, weight loss, and fatigue. He \napparently had difficulty with walking briefly on presentation, \nhowever this quickly resolved at the time of my assessment. On \nexamination, he had a loud diastolic murmur. Blood cultures \nquickly grew out multiple positive cultures of strep viridans. \nHe was started on ceftriaxone. 2D echo was performed which \nrevealed severe aortic regurgitation and a moderately sized \nascending aortic aneurysm in association with a bicuspid valve. \n___ confirmed these findings with no obvious vegetation or \nabscess. However, in the setting of high grade bacteremia and \nunderlying fatigue, its likely he has native valve endocarditis \nnot visualized by echo. He probably did have aortic \nregurgitation longer than this, with acute worsening in the past \nseveral weeks. Symptomatically, after initiation of \nantibiotics, his fevers and sweats immediately resolved. He \ndid not describe chest pain, shortness of breath. He did have \ntachycardia at rest (90 - 110 bpm) exacerbated immediately after \nactivity (110-120). He was started on lisinopril 5 mg for \nreduction of afterload. Cardiac surgery saw the patient who \nrecommended valve replacement after antibiotics completed \nGentamycin was added to ceftriaxone to complete two week course \non ___. Given he does not have insurance, he received a \nfree care plan with a plan for daily infusions as an outpatient \nin our pheresis unit for daily dosing of both antibiotics \nthrough the above date. He should follow up with cardiology on \n___, and ID on ___. Cardiac surgery will see him while he is \nin house for cath to obtain consent and schedule surgery. He \nstarted pre-op clearance during his hospitalization with panorex \nand dental eval. They recommended several teeth be extracted. \nThe patient was advised to schedule an appointment thru ___ \nto have this completed.'}}
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{'final_diagnoses': ['Subacute Strep Viridans bacterial endocarditis'], 'procedures': ['___ placement'], 'visit_summary': 'Mr ___ presented with fevers, weight loss, and fatigue. He \napparently had difficulty with walking briefly on presentation, \nhowever this quickly resolved at the time of my assessment. On \nexamination, he had a loud diastolic murmur. Blood cultures \nquickly grew out multiple positive cultures of strep viridans. \nHe was started on ceftriaxone. 2D echo was performed which \nrevealed severe aortic regurgitation and a moderately sized \nascending aortic aneurysm in association with a bicuspid valve. \n___ confirmed these findings with no obvious vegetation or \nabscess. However, in the setting of high grade bacteremia and \nunderlying fatigue, its likely he has native valve endocarditis \nnot visualized by echo. He probably did have aortic \nregurgitation longer than this, with acute worsening in the past \nseveral weeks. Symptomatically, after initiation of \nantibiotics, his fevers and sweats immediately resolved. He \ndid not describe chest pain, shortness of breath. He did have \ntachycardia at rest (90 - 110 bpm) exacerbated immediately after \nactivity (110-120). He was started on lisinopril 5 mg for \nreduction of afterload. Cardiac surgery saw the patient who \nrecommended valve replacement after antibiotics completed \nGentamycin was added to ceftriaxone to complete two week course \non ___. Given he does not have insurance, he received a \nfree care plan with a plan for daily infusions as an outpatient \nin our pheresis unit for daily dosing of both antibiotics \nthrough the above date. He should follow up with cardiology on \n___, and ID on ___. Cardiac surgery will see him while he is \nin house for cath to obtain consent and schedule surgery. He \nstarted pre-op clearance during his hospitalization with panorex \nand dental eval. They recommended several teeth be extracted. \nThe patient was advised to schedule an appointment thru ___ \nto have this completed.', 'medications_prescribed': ['CeftriaXONE 2 gm IV Q24H', 'Gentamicin 220 mg IV Q24H', 'Lisinopril 5 mg PO DAILY \nRX *lisinopril 5 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 52, 'gender': 'F', 'symptoms': 'Exacerbation of secondary progressive multiple sclerosis, with \nupper extremity weakness and worsening dysarthria', 'medical_history': ['Secondary progressive multiple sclerosis', 'Bilateral knee surgery', 'Rhinoplasty for recurrent sinusitis', 'Baclofen pump placement'], 'family_history': 'No history of multiple sclerosis. Father is an ___ and \n___ descent, and mother is ___. Family history of \ndepression, hypertension, high cholesterol, and coronary artery \ndisease. No family history of multiple sclerosis.', 'present_illness': '___ is ___ right-handed man with advanced secondary \nprogressive multiple sclerosis admitted after worsening of his \nmedical condition. Patient reported that for the past couple of \nmonths he notice gradual decline in his arms motor function. He \nstated that he is having difficulties to hold objects and mainly \nto let them go; his arms are not extending and remained mostly \nin\nflexion position. He also noticed weakness involving proximal \nmuscles. On ___ he noticed significant changes in his \nspeech which became slurred and low tone. He denied difficulties \nin swallowing. He contact his primary neurologist Dr ___ \n___ who recommended in hospital care. ___ was admitted for \nmedical assessment and IV infusion of steroids high dose.\n\nPatient has been having progressive neurological deficits \ndespite of the treatment. He stopped walking in ___.', 'medications': [{'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': '2', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', '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': '1', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '2', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'ED', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IH', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}]}, 'clinical_findings': {'labs': [{'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': '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': 'SM .'}, {'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': '13', 'valuenum': 13.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FEW.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': 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': 'BEGINNING ___, ALL POSITIVE AMPHETAMINE SCREENS;WILL BE SENT FOR CONFIRMATION BY GC/MS;FINAL RESULTS SHOULD BE AVAILABLE IN SEND-OUT SYSTEM 7-10 DAYS LATER.'}, {'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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', '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': 'STAT', '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, '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': '196', 'valuenum': 196.0, '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': '10.3', 'valuenum': 10.3, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, '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': '7.36', 'valuenum': 7.36, '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': '4.0', 'valuenum': 4.0, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '171', 'valuenum': 171.0, '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': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '326', 'valuenum': 326.0, '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': '137', 'valuenum': 137.0, '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': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.7,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 158.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '25.8', 'valuenum': 25.8, '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': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '780', 'valuenum': 780.0, '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': '4.19', 'valuenum': 4.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.7', 'valuenum': 19.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '-2', 'valuenum': -2.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '214', 'valuenum': 214.0, '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': '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', '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': '4.5', 'valuenum': 4.5, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.3', 'valuenum': 25.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '592', 'valuenum': 592.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.70', 'valuenum': 3.7, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'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': '8.9', 'valuenum': 8.9, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '3.3', 'valuenum': 3.3, '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': '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': '135', 'valuenum': 135.0, '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': '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': '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': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.9', 'valuenum': 24.9, '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '570', 'valuenum': 570.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.58', 'valuenum': 3.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Physical Examination:\nVS: \nGenl: Awake, alert, non acute distress\nHEENT: oropharynx clear, mucous membrane moist\nCV: Regular rate, Nl S1, S2, no murmurs, rubs, or gallops\nChest: CTA bilaterally, no wheezes, rhonchi\nAbd: +BS, soft, NTND abdomen\nExt: No lower extremity edema bilaterally\n\nNeurologic examination: \nMental status: Awake and alert, cooperative with exam, normal \naffect. Oriented to person, place, and date. Attentive. Speech \nis fluent however hypophonia and monotonal/nasal voice was noted \nwith clear perioral spasticity. Normal comprehension and \nrepetition; naming intact. Registers ___, recalls ___ in 5\nminutes. No right-left confusion. \n\nCranial Nerves: Pupils equally round and reactive to light, 4 to \n2 mm bilaterally however mild signs of APD was noted at the left \neye with first response dilation followed by pupillary \nconstriction. Proximal estimative for visual acuity is -2OD -2 \nOS. No red desaturation. Visual fields are full to \nconfrontation.\n\nExpanded blind spot over the left eye (in the inferior edge) and \nnormal in the right eye. Extraocular movements intact \nbilaterally without nystagmus or signs of INO. Sensation intact \nV1-V3. Mild inferior quadrant left flatness. Hearing intact to \nfinger rub bilaterally. Palate elevation symmetric \nSternocleidomastoid and trapezius full strength bilaterally. \nTongue midline, movements intact.\n\nMotor: Wasting in interosseous bilaterally, mild spasticity in \nboth legs and moderate spasticity in both arms. No observed \nmyoclonus, asterixis, or tremor. No pronator drift. \n Del Tri Bi WE FE FF IP \nR -4 3 +4 -___ 1 \nL -4 3 -5 ___ 1 \nwiggle his toes bilaterally \n\nSensation: Intact to light touch, pinprick, vibration and cold \nsensation throughout. \n\nReflexes: 3+ and symmetric throughout. Toes upgoing bilaterally, \nwith left>right ankle clonus.\n\nCoordination: Finger-nose-finger, finger-to-nose, fine finger \nmovements. \n\nGait: Unable to ambulate', 'diagnoses': [{'icd_code': '1622', 'desc': 'Malignant neoplasm of main bronchus'}, {'icd_code': '49390', 'desc': 'Asthma, unspecified type, unspecified'}, {'icd_code': '33818', 'desc': 'Other acute postoperative pain'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}], 'summary': "___ 12:55PM BLOOD WBC-8.5 RBC-5.09 Hgb-15.1 Hct-44.1 MCV-87 \nMCH-29.7 MCHC-34.3 RDW-14.1 Plt ___\n___ 12:55PM BLOOD Neuts-80.5* Lymphs-14.8* Monos-3.9 \nEos-0.3 Baso-0.5\n___ 12:55PM BLOOD ___ PTT-30.3 ___\n___ 12:55PM BLOOD Glucose-99 UreaN-14 Creat-0.8 Na-142 \nK-4.3 Cl-104 HCO3-29 AnGap-13\n___ 12:55PM BLOOD ALT-12 AST-11 AlkPhos-50 Amylase-42 \nTotBili-0.3\n___ 12:55PM BLOOD Lipase-30\n___ 12:55PM BLOOD Calcium-9.8 Phos-3.6 Mg-2.2\n___ 12:55PM BLOOD TSH-0.83\n___ 12:16PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 12:16PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-TR BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\nNeurology - Mr. ___ was directly admitted for further \nevaluation and management of his upper extremity weakness and \ndysarthria, likely MS exacerbation. Started 9 day course of IV \nsteroid taper on ___. He received methylprednisolone 1000mg IV \nx2 days (___. He should complete his course of steroids at \nrehab as follows: 1 more day of 1000mg IV qday x1 day (___), \nthen 500mg IV x3 days, then 250mg IV x3 days. No po steroid \ntaper needed. On HD 2, the patient's exam was notable for \nclearer speech and an increase in strength in the right hand. \nFinger extension on the right 4-, ___ on left. Other muscle \ngroups were unchanged. \n\nFunctional status decline from baseline, requires ___ \nrehabilitation. \n\nID - No evidence of infection. UA negative, Urine culture \npending on discharege. CXR clear, no pneumonia, final report \npending on discharge. \n\nEndo - On insulin sliding scale while on steroids, blood sugars \nwere max 199. \n\nFEN/GI - Electrolytes wnl. \n\nHeme - heparin ppx while inpatient."}}
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{'final_diagnoses': ['Secondary progressive MS'], 'procedures': ['None'], 'visit_summary': "Neurology - Mr. ___ was directly admitted for further \nevaluation and management of his upper extremity weakness and \ndysarthria, likely MS exacerbation. Started 9 day course of IV \nsteroid taper on ___. He received methylprednisolone 1000mg IV \nx2 days (___. He should complete his course of steroids at \nrehab as follows: 1 more day of 1000mg IV qday x1 day (___), \nthen 500mg IV x3 days, then 250mg IV x3 days. No po steroid \ntaper needed. On HD 2, the patient's exam was notable for \nclearer speech and an increase in strength in the right hand. \nFinger extension on the right 4-, ___ on left. Other muscle \ngroups were unchanged. \n\nFunctional status decline from baseline, requires ___ \nrehabilitation. \n\nID - No evidence of infection. UA negative, Urine culture \npending on discharege. CXR clear, no pneumonia, final report \npending on discharge. \n\nEndo - On insulin sliding scale while on steroids, blood sugars \nwere max 199. \n\nFEN/GI - Electrolytes wnl. \n\nHeme - heparin ppx while inpatient.", 'medications_prescribed': ['1. Alendronate 70 mg Tablet Sig: One (1) Tablet PO QSAT (every \n___. ', '2. Mycophenolate Mofetil 500 mg Tablet Sig: Two (2) Tablet PO \nBID (2 times a day). ', '3. Sertraline 50 mg Tablet Sig: 2.5 Tablets PO DAILY (Daily). ', '4. Tolterodine 1 mg Tablet Sig: Two (2) Tablet PO BID (2 times a \nday). ', '5. Baclofen Intrathecal', '6. Zolpidem 5 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). ', '7. Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '8. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO BID (2 times a day). ', '9. Insulin Regular Human 100 unit/mL Solution Sig: One (1) \ninjection Injection ASDIR (AS DIRECTED) for 7 days: Insulin \nsliding scale while receiving IV steroids. ', '10. Omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: Two (2) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily) for 7 days: \nwhile receiving IV steroids. ', '11. Methylprednisolone Sodium Succ 1,000 mg Recon Soln Sig: 1000 \n(1000) mg in 1000mL D5W IV Injection Q24H (every 24 hours) for 1 \ndays: ___', 'Give over 8 hours. ', '12. Methylprednisolone Sodium Succ 1,000 mg Recon Soln Sig: Five \nHundred (500) mg in 500mL D5W IV Injection every ___ \nhours for 3 days: ___', 'Give over ___ hours. ', '13. Methylprednisolone Sodium Succ 1,000 mg Recon Soln Sig: Two \nHundred Fifty (250) mg in 250mL D5W IV Injection every \n___ hours for 3 days: ___ - ___', 'give over ___ hours. ', '14. Heparin (Porcine) 5,000 unit/mL Solution Sig: 5000 (5000) \nunits Injection TID (3 times a day) for 7 days: DVT prophylaxis. ', '15. Adderall 20 mg Tablet Sig: One (1) Tablet PO QAM. ', '16. Baclofen 10 mg Tablet Sig: One (1) Tablet PO twice a day as \nneeded for spasms.']}
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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': 'acute cholecystitis', 'medical_history': ['Type II diabetes', 'Morbid obesity', 'Hypertension', 'CAD, native vessel', 'CHF, systolic', 'Sarcoid ', 'History of stroke'], 'family_history': 'Diabetes, CHF, cataracts', 'present_illness': 'Mr. ___ is a ___ year old gentleman with a history of obesity, \ndiabetes, CAD, CHF, COPD, and what appears to be untreated OSA \nwho presented to an OSH for abdominal pain. He was transferred \nto ___ for ERCP with procedure aborted in the setting of \nhemodynamic instability, transferred to the ICU for further \nmonitoring.\n\nMr. ___ presented to ___ with three days of \nepigastric pain. His PCP have him ___ course of quinolone \nantibiotic on ___ for abdominal pain. His symptoms \nprogressed and he was found to have radiographic evidence of \nacalculous cholecystitis, though LFTS were initially WNL. No \nevidence of pancreatitis, appendicitis, or sepsis per OSH \nreport. He underwent placement of percutaneous cholecystostomy \ntube, though today total bilirubin was noted to rise from 1.3--> \n5.4. There was concern for stone in the bile duct and he was \ntransferred to ___ for ERCP.\n\nDuring ERCP he was sedated with propofol, ketamine, and versed. \nERCP procedure was notable for hypoxemia approximately 15 \nminutes into the procedure to the mid ___ requiring increasing \n02 requirement. His blood pressure subsequently dropped to the \n___. He was not tachycardic at the time and received ephedrine \n10 mg bolus x3 given sustained BP in the ___. The procedure was \ncalled off at this time. The patient had been lying in the prone \nposition. Once he was flipped to supine his HR jumped to the \n130s-140s. Hypoxemia resolved once supine. Blood pressure was in \nthe ___ systolic at this time and he received phenylephrine. He \nreceived 40 mg IV esmolol and HR decreased to 100-105 and SBP \nrose to the 120s shrotly after the esmolol bolus.\n\nOn arrival to the ICU: \nVS: HR 110 BP 127/96 100% on ___', 'medications': [{'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'TiCAGRELOR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'QUEtiapine Fumarate', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', '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', 'route': 'PO/NG', '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': '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': 'Fludrocortisone Acetate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'NORepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 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', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', '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', 'route': 'PO/NG', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Senna', '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 Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', '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': None, 'proc_type': 'IV Large Volume', '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': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', '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': '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': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Sodium Chloride', '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 via patient discharge', 'route': 'IH', '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': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', '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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'NEB', 'frequency': 'Q6H:PRN', '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': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Senna', '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': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE:PRN', 'doses_per_24_hrs': None}, {'medication': 'NORepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID: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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'QUEtiapine Fumarate', '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 (Powder)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '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': 'Clindamycin', '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': 'Thiamine', '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': 'Fludrocortisone Acetate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'LevETIRAcetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', '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': 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': 'Fludrocortisone Acetate', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 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 Piggyback', 'status': 'Inactive (Due to a change order)', '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': 'QHS', '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': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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 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', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', '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': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 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', 'route': 'PO', 'frequency': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', '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': 'Discontinued', 'route': 'IV', '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': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CloNIDine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', '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': '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': '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': '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': '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': None, 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q2H', 'doses_per_24_hrs': 12.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Fluticasone Propionate 110mcg', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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/NG', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Sodium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'NiMODipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR1', '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': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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}]}, 'clinical_findings': {'labs': [{'value': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '33.7', 'valuenum': 33.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '355', 'valuenum': 355.0, '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': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19.8', 'valuenum': 19.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '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': '21.4', 'valuenum': 21.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 189.0, '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': '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': '___', 'valuenum': 3.3, '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': 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': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-4', 'valuenum': -4.0, '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': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '165', 'valuenum': 165.0, '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': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, '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': '349', 'valuenum': 349.0, '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': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, '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': '1.2', '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': '22.2', 'valuenum': 22.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, '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': '4', 'valuenum': 4.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '278', 'valuenum': 278.0, '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': 3.4, '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '0.71', 'valuenum': 0.71, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.13, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.1, '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': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': None, 'priority': 'ROUTINE', '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': '___', 'valuenum': 0.97, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '25', 'valuenum': 25.0, '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': '121', 'valuenum': 121.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '9.3', 'valuenum': 9.3, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 41.0, 'ref_range_upper': 999.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '185', 'valuenum': 185.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 80.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '80', 'valuenum': 80.0, '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': 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': 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': '368', 'valuenum': 368.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', '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': '3', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '7.49', 'valuenum': 7.49, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '64', 'valuenum': 64.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', '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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 143.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', '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': 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': 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': '4', 'valuenum': 4.0, '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': '1.2', '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': '22.2', 'valuenum': 22.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, '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': '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '282', 'valuenum': 282.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, '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': '11.2', 'valuenum': 11.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44.8', 'valuenum': 44.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '-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': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'NO CALLS MADE - NOT ARTERIAL BLOOD.'}, {'value': 'CENTRAL VENOUS.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.0, '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '4', 'valuenum': 4.0, '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': '26.9', 'valuenum': 26.9, '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': '30.6', 'valuenum': 30.6, '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': '95', 'valuenum': 95.0, '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': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.84', 'valuenum': 2.84, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': 'sec', 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'priority': 'STAT', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 134.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 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'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.2, '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': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'mg/dL', 'ref_range_lower': 15.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 64.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 2950.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 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'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'RARE*.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 145.0, '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': '2.2', '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': 3.2, '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': 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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, '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': '330', 'valuenum': 330.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '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': '24.2', 'valuenum': 24.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', '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': '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': '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': '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': '___', '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': 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': '9', 'valuenum': 9.0, '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': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, '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': '31.3', 'valuenum': 31.3, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45.1', 'valuenum': 45.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '33.6', 'valuenum': 33.6, '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': '314', 'valuenum': 314.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '45.6', 'valuenum': 45.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': 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': '348', 'valuenum': 348.0, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test. New reference range as of ___.'}, {'value': '___', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, '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': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'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': '279', 'valuenum': 279.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '88', 'valuenum': 88.0, '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': '___', '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': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 144.0, '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': '125', 'valuenum': 125.0, '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': '277', 'valuenum': 277.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test. 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': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '2034', 'valuenum': 2034.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 24.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.5', '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': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.023', 'valuenum': 1.023, '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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 229.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference interval as of ___:. 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{'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': 4.0, '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': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.010', 'valuenum': 1.01, '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': '16', 'valuenum': 16.0, 'valueuom': 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'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '271', 'valuenum': 271.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.032', 'valuenum': 1.032, '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': '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': '276', 'valuenum': 276.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '328', 'valuenum': 328.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '285', 'valuenum': 285.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': 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': '24.2', 'valuenum': 24.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '36', 'valuenum': 36.0, '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': '282', 'valuenum': 282.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '___', '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '4', 'valuenum': 4.0, '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': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, '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': '400', 'valuenum': 400.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '285', 'valuenum': 285.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '573', 'valuenum': 573.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '256', 'valuenum': 256.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '___', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.4, 'ref_range_upper': 5.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '18', 'valuenum': 18.0, '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': '___', 'valuenum': 160.0, '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', 'valuenum': 1.0, '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': 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': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.7, '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': 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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'STAT', 'comments': '<0.01. cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': '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': '31.9', 'valuenum': 31.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '355', 'valuenum': 355.0, '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': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.2', 'valuenum': 51.2, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '286', 'valuenum': 286.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, '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': '288', 'valuenum': 288.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40', 'valuenum': 40.0, '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': '278', 'valuenum': 278.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '8', 'valuenum': 8.0, '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': 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': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '21', 'valuenum': 21.0, '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': '275', 'valuenum': 275.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': 3.3, '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': 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', 'valuenum': 3.0, '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': '30.2', 'valuenum': 30.2, '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': '31.0', 'valuenum': 31.0, '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '449', 'valuenum': 449.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.13', 'valuenum': 3.13, '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': '49.0', 'valuenum': 49.0, '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': '12.9', 'valuenum': 12.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '277', 'valuenum': 277.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '13', 'valuenum': 13.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.4, . estimated GFR (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': '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '278', 'valuenum': 278.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', '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': 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': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '26.1', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, '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': '31.1', 'valuenum': 31.1, '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '433', 'valuenum': 433.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.15', 'valuenum': 3.15, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.9', 'valuenum': 47.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '12', 'valuenum': 12.0, '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': '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': '25.5', 'valuenum': 25.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '538', 'valuenum': 538.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, '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': '___', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '78', 'valuenum': 78.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '7', 'valuenum': 7.0, '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': 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': '25.2', 'valuenum': 25.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '561', 'valuenum': 561.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.9', 'valuenum': 48.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, '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': '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': 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': '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': '2.4', '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': '___', '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': '4', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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}], 'exams': 'ADMISSION PHYSICAL EXAM\nVitals- T: HR 110 BP 127/96 100% on ___\nWeight: 105.1kg\n___: Alert, oriented, no acute distress \nHEENT: Right eye lid droop, mild scleral icterus, poor \ndentition, dry mucous membranes \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: Obese, soft, mildly distended, diffusely tender to \npalpation, normoactive BS, no rebound or guarding. \nGU: no foley \nExt: warm, well perfused, 2+ pulses, mild chronic venous stasis \nchanges, ___ pitting edema in the ___ bilaterally\nNeuro: Right eyelid droop (chronic), otherwise CNs intact, \nstrength ___ in upper and lower extremities bilaterally \n\nDISCHARGE PHYSICAL EXAM\nVS: 98 97.6 ___ 18 100%RA \nWeight 96.8kg\n___: NAD. Oriented x3. Mood, affect appropriate. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\nNECK: Supple with JVP of 10cm. \nCARDIAC: distant heart sounds, +S1/S2, no m/r/g \nLUNGS: faint crackles at bases, but otherwise CTAB/L no wheezes, \nrhonchi, \nABDOMEN: Soft, obese. +RUQ tenderness, with perc chole tube \nc/d/i \nEXTREMITIES: 2+ ___ edema to thighs \nSKIN: chronic stasis changes \nPULSES: slightly cool lower extremities', 'diagnoses': [{'icd_code': 'I6052', 'desc': 'Nontraumatic subarachnoid hemorrhage from left vertebral artery'}, {'icd_code': 'I63532', 'desc': 'Cerebral infarction due to unspecified occlusion or stenosis of left posterior cerebral artery'}, {'icd_code': 'I6329', 'desc': 'Cerebral infarction due to unspecified occlusion or stenosis of other precerebral arteries'}, {'icd_code': 'G919', 'desc': 'Hydrocephalus, unspecified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'F10239', 'desc': 'Alcohol dependence with withdrawal, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'R402133', 'desc': 'Coma scale, eyes open, to sound, at hospital admission'}, {'icd_code': 'R402213', 'desc': 'Coma scale, best verbal response, none, at hospital admission'}, {'icd_code': 'R402363', 'desc': 'Coma scale, best motor response, obeys commands, at hospital admission'}, {'icd_code': 'R509', 'desc': 'Fever, unspecified'}, {'icd_code': 'D72829', 'desc': 'Elevated white blood cell count, unspecified'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'R0789', 'desc': 'Other chest pain'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R109', 'desc': 'Unspecified abdominal pain'}], 'summary': "ON ADMISSION:\n___ 01:35PM BLOOD WBC-8.6 RBC-5.72 Hgb-14.2 Hct-46.8 MCV-82 \nMCH-24.9* MCHC-30.4* RDW-14.8 Plt ___\n___ 01:35PM BLOOD ___ PTT-30.0 ___\n___ 01:35PM BLOOD Glucose-219* UreaN-21* Creat-1.2 Na-136 \nK-3.9 Cl-95* HCO3-24 AnGap-21*\n___ 01:35PM BLOOD ALT-58* AST-86* CK(CPK)-123 AlkPhos-119 \nTotBili-5.7*\n___ 01:35PM BLOOD Calcium-8.5 Phos-4.4 Mg-2.3\n\nDischarge Labs\n=============\n___ 08:15AM BLOOD WBC-6.8 RBC-6.26* Hgb-15.1 Hct-50.2 \nMCV-80* MCH-24.1* MCHC-30.1* RDW-14.8 Plt ___\n___ 08:15AM BLOOD Glucose-122* UreaN-28* Creat-1.1 Na-138 \nK-4.7 Cl-96 HCO3-31 AnGap-16\n___ 07:40AM BLOOD ALT-31 AST-30 AlkPhos-139* TotBili-1.3\n___ 08:15AM BLOOD Calcium-9.7 Phos-4.1 Mg-2.3\n\nIMAGING:\nCXR ___: Cardiomegaly is accompanied by pulmonary vascular \ncongestion and mild interstitial edema. Possible small right \npleural effusion. No visible pneumothorax.\n\nRUQ US ___: IMPRESSION: Decompressed gallbladder with \ncholecystostomy tube in place showing mural edema compatible \nwith known acute cholecystitis. There is no evidence of \ncholelithiasis or choledocholithiasis.\n\nTTE: The left atrium is moderately dilated. Left ventricular \nwall thicknesses are normal. The left ventricular cavity is \nmoderately dilated with severe global hypokinesis (LVEF = 20 %). \nNo masses or thrombi are seen in the left ventricle, but apical \nviews are suboptimal. The right ventricular cavity is mildly \ndilated with moderate global free wall hypokinesis. The \nascending aorta and aortic arch are mildly dilated. 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. There is no mitral valve \nprolapse. Mild to moderate (___) mitral regurgitation is seen. \nThere is mild pulmonary artery systolic hypertension. There is \nno pericardial effusion. IMPRESSION: Suboptimal image quality. \nLeft ventricular cavity dilation with extensive systolic \ndysfunction c/w multivessel CAD or other diffuse process. Right \nventricular cavity dilation with free wall hypokinesis. \nMild-moderate mitral regurgitation. Pulmonary artery \nhypertension. Dilated thoracic aorta. \n\nCCATH: 1. Severe diffuse 3 vessel CAD with no targets for PCI or\nsurgical revascularization. 2. Markedly elevated LVEDP.\n___ y/o M with PMHx obesity, diabetes, CAD, CHF, COPD, OSA who \nwas initially admitted to OSH for cholecystitis, transferred \nhere for ERCP which was aborted ___ hypoxia and hypotension, now \nto transferred to heart failure service for optimization of \ncardiac function.\n\n# Acute on chronic diastolic heart failure: The patient was \ninitially seen by cardiology when he became hypotensive when \nundergoing ERCP. He became tachycardic when given ephedrine, he \nwas then given phenylephrine for persistent hypotension. For his \nheart rate he was then given esmolol. Afterwards he became \nstable. He had a troponin checked which was 0.36 with a normal \nMB index. It was thought to be in teh setting of demand. He had \na TTE which was grossly abnormal with EF roughly 20%. The \npatient was grossly volume overloaded but never in respiratory \ndistress on the floor. He was transferred to the heart failure \nservice after stabilizing and he was started on a lasix drip. He \ndid well throughout and was diuresed down to a weight of 96.8kg \non discharge from 105kg when first presenting to the cardiology \nservice. He was started on lisinopril and spironolactone. He was \ncontinued on his metoprolol. His diuretic was changed to \ntorsemide. He had no symptoms on day of discharge. His \nAmlodipine was discontinued completely\n- He was setup with close cardiac follow up with Dr. ___ on \n___\n- He was given a script to check electrolytes on ___ as he had \nbeen switched from furosemide to torsemide.\n\n# CAD with multivessel diffuse disease: Patient not a candidate \nfor surgical intervention. Currently only a candidate for \nmedical management given the severity of his disease. He has \nbeen told this by multiple providers previously. His cath in \nhospital was consistent with the previous findings and he was \ncontinued to be medically managed with metoprolol, lisinopril, \nspironolactone, a baby aspirin, and atorvastatin. He was started \non lisinopril, he had previously been on an ___, and \nspironolactone, and his atorvastatin was increased to full dose.\n\n# Transaminitis: Patient had elevated bilirubin note at OSH with \nperc chole tube place ___. He then had further rise in his \nbilirubin levels with minimal transaminitis. Radiographic \nimaging was consistent with acalculous cholecystitis. He was \ntransferred to ___ for ERCP but was unable to tolerate the \nprocedure due to a drop in his blood pressure and tachycardia. \nHe was transferred to the ICU for a few hours before being \ncalled out to the floor. He was started on Unasyn on ___ per \nOSH records and was continued on it in hospital. Initially there \nwas some thought that his gallbladder findings may be due to \ndecompensated heart failure but a second read of the CT was most \nconsistent with acalculous cholecystitis. The patient's LFTs \ndowntrended throughout his stay. His abdominal pain resolved. \n- He was to continue with Augmentin for a 14 day course to \nfinish on ___\n- He was to follow up with ___ at ___ for determination of when \nto pull the perc chole tube. ___ was contacted and was planning \nto call him within a day of discharge. He was given their \ncontact information as well.\n \n# DM type II, uncontrolled, with complications: On lantus, \nmetformin, glipizide at home. He was continued on his home dose \nof lantus with an insulin sliding scale. His oral agents were \nheld in house \n\n# COPD: He was on spiriva, he remained stable throughout."}}
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{'final_diagnoses': ['Acalculous Cholecystitis', 'Acute Heart Failure Exacerbation', 'Coronary Artery Disease', 'Systolic Heart Failure'], 'procedures': ['___ ERCP, aborted ___', '___ CCATH'], 'visit_summary': "___ y/o M with PMHx obesity, diabetes, CAD, CHF, COPD, OSA who \nwas initially admitted to OSH for cholecystitis, transferred \nhere for ERCP which was aborted ___ hypoxia and hypotension, now \nto transferred to heart failure service for optimization of \ncardiac function.\n\n# Acute on chronic diastolic heart failure: The patient was \ninitially seen by cardiology when he became hypotensive when \nundergoing ERCP. He became tachycardic when given ephedrine, he \nwas then given phenylephrine for persistent hypotension. For his \nheart rate he was then given esmolol. Afterwards he became \nstable. He had a troponin checked which was 0.36 with a normal \nMB index. It was thought to be in teh setting of demand. He had \na TTE which was grossly abnormal with EF roughly 20%. The \npatient was grossly volume overloaded but never in respiratory \ndistress on the floor. He was transferred to the heart failure \nservice after stabilizing and he was started on a lasix drip. He \ndid well throughout and was diuresed down to a weight of 96.8kg \non discharge from 105kg when first presenting to the cardiology \nservice. He was started on lisinopril and spironolactone. He was \ncontinued on his metoprolol. His diuretic was changed to \ntorsemide. He had no symptoms on day of discharge. His \nAmlodipine was discontinued completely\n- He was setup with close cardiac follow up with Dr. ___ on \n___\n- He was given a script to check electrolytes on ___ as he had \nbeen switched from furosemide to torsemide.\n\n# CAD with multivessel diffuse disease: Patient not a candidate \nfor surgical intervention. Currently only a candidate for \nmedical management given the severity of his disease. He has \nbeen told this by multiple providers previously. His cath in \nhospital was consistent with the previous findings and he was \ncontinued to be medically managed with metoprolol, lisinopril, \nspironolactone, a baby aspirin, and atorvastatin. He was started \non lisinopril, he had previously been on an ___, and \nspironolactone, and his atorvastatin was increased to full dose.\n\n# Transaminitis: Patient had elevated bilirubin note at OSH with \nperc chole tube place ___. He then had further rise in his \nbilirubin levels with minimal transaminitis. Radiographic \nimaging was consistent with acalculous cholecystitis. He was \ntransferred to ___ for ERCP but was unable to tolerate the \nprocedure due to a drop in his blood pressure and tachycardia. \nHe was transferred to the ICU for a few hours before being \ncalled out to the floor. He was started on Unasyn on ___ per \nOSH records and was continued on it in hospital. Initially there \nwas some thought that his gallbladder findings may be due to \ndecompensated heart failure but a second read of the CT was most \nconsistent with acalculous cholecystitis. The patient's LFTs \ndowntrended throughout his stay. His abdominal pain resolved. \n- He was to continue with Augmentin for a 14 day course to \nfinish on ___\n- He was to follow up with ___ at ___ for determination of when \nto pull the perc chole tube. ___ was contacted and was planning \nto call him within a day of discharge. He was given their \ncontact information as well.\n \n# DM type II, uncontrolled, with complications: On lantus, \nmetformin, glipizide at home. He was continued on his home dose \nof lantus with an insulin sliding scale. His oral agents were \nheld in house \n\n# COPD: He was on spiriva, he remained stable throughout.", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Glargine 30 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Metoprolol Succinate XL 50 mg PO DAILY', 'Tiotropium Bromide 1 CAP IH DAILY', 'Atorvastatin 80 mg PO DAILY \nRX *atorvastatin 80 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'GlipiZIDE 10 mg PO BID', 'MetFORMIN (Glucophage) 500 mg PO QID', 'Spironolactone 25 mg PO DAILY \nRX *spironolactone 25 mg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Torsemide 40 mg PO DAILY \nRX *torsemide 20 mg 2 tablet(s) by mouth daily Disp #*60 Tablet \nRefills:*0', 'Amoxicillin-Clavulanic Acid ___ mg PO Q12H \nRX *amoxicillin-pot clavulanate 875 mg-125 mg 1 tablet by mouth \ntwice a day Disp #*9 Tablet Refills:*0', 'Outpatient Lab Work\nPlease check a Chem10 panel and fax the results to Dr. ___ at \n___', 'Lisinopril 10 mg PO DAILY \nRX *lisinopril 10 mg 1 tablet(s) by mouth daily Disp #*30 Tablet \nRefills:*0']}
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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': 'Right-Sided Paresthesias and Weakness', 'medical_history': ['- Multiple sclerosis diagnosed in ___. H/o 2 attacks, L leg\ntingling and weakness and L optic neuritis as above'], 'family_history': '- negative for seizure, stroke, MS, myasthenia ___', 'present_illness': "___ yo R handed F with h/o multiple sclerosis seen in the ED for \n3\nwk h/o progressive R sided numbness tingling and incoordination \nR\narm and leg. She was worried she might be having an MS flare. \n\nShe has a history of only 2 attacks, one in ___ consisting of L\nleg tingling and weakness, and one in ___ consisting of L optic\nneuritis. She was previously on ___ but quit taking it in\n___ due to side effects, flu like symptoms after \ndoses.\nShe was recently prescribed ___ but has not yet started to\ntake it. \n\nThree weeks ago while on a backpacking trip in ___ with her\nhusband, she had onset of R arm numbness/tingling. She had been\ncarrying a heavy (~30lb) backpaci and ___ d prior the strap had\nbeen too tight on the R and she didn't fix it. The numbness\ntingling was the whole arm and it persisted. She saw her home\nneurologist, ___, on ___. She reports he thought it\nwas likley a backpacking injury and referred her to ___. Since\nthen symptoms have evolved. Over the last 5 days she has had a\nnubmness sensation on the plantar surface of both feet R>L and\nthe lateral R ankle. She has notided poor coordination with R\narm and leg. Her biggest concern was that her walking was \nclumsy\nespecially with the R foot/leg seeming floppy. Her husband\nthought her gait looked ok until last evening after a glass of\nwine, when her poor coordination was exagerated and she had an\neven harder time walking. \n\nIn addition, she had a few days of R temporal headache just\nbefore and after neurology visit on ___ which is now resolved. \nShe has an intermittent itchy sensation on hr R frontotemporal\nscalp however over the last few days.\n\nToday when wiping in the bathroom she noticed she didn't feel as\nwell in her vaginal area. \n\nShe has noticed R sided neck/shoulder pain worse over the last\nseveral weeks, even before the trip to ___. This is not worse\nin the last several days. She attributes this to chronic \nstress,\nand is not a new problem for her. \n\nROS: Denies fevers, congestion/cough, shortness of breath, chest\npain, palpitations, rashes, vomiting/diarrhea, abdominal pain. \nNo recent illnesses. Denies trauma. Denies back pain.", 'medications': [{'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'STAT', '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': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CeftazIDIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Phenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'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': '4.4', 'valuenum': 4.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 616.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY INCREASES THIS RESULT.'}, {'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': '7.2', 'valuenum': 7.2, 'valueuom': 'umol/L', 'ref_range_lower': 4.5, 'ref_range_upper': 12.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 433.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS ELEVATES LDH.'}, {'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': '3.4', 'valuenum': 3.4, 'valueuom': 'GPL', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'MPL', 'ref_range_lower': 0.0, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'GPL', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'MPL', 'ref_range_lower': 0.0, 'ref_range_upper': 12.5, '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': '22.0', 'valuenum': 22.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': '%', 'ref_range_lower': 69.0, 'ref_range_upper': 121.0, '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': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': 70.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': '%', 'ref_range_lower': 70.0, 'ref_range_upper': 140.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.39', 'valuenum': 4.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '36.7', 'valuenum': 36.7, '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': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '197', 'valuenum': 197.0, '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': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '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': '109', 'valuenum': 109.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '167', 'valuenum': 167.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, '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': 0.5, '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': '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': '11.8', 'valuenum': 11.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, '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': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '191', 'valuenum': 191.0, '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': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, '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': '226', 'valuenum': 226.0, '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': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '8.5', 'valuenum': 8.5, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, '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': '3.0', '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': 'ON ADMISSION:\nT98.3 Hr 69 BP 120/75 RR16 O2 100% RA\nGen: Awake, alert, not in distress, lying in bed. Non-toxic\nappearance.\nSkin: No rashes\nHeent: NCAT, no conjunctival injection, mucous membranes moist,\noropharynx clear. Ear drums clear, normal light conus reflexes. \n\nNeck: Supple, no meningismus. No cervical bruit. No midline\nspinal tenderness.\nBack: no spinal tenderness\nRectum: normal rectal tone and sacral sensation to touch and\nsharp.\nResp: Clear to auscultation bilaterally\nCV: Regular rate, normal S1/S2, no murmurs, rubs, or gallops\nAbd: Bowel sounds present, abdomen soft, non-tender, and\nnon-distended. No hepatosplenomegaly or masses palpable.\nExtrem: Warm and well-perfused. No arthralgia. ROM full.\nNeuro:\nMS - Awake, alert, interactive. Oriented to person, place, and\ndate. Speech is fluent, with intact registration/recall,\nrepetition, naming, comprehension. Attentions is considered to \nbe\nappropriate. No left-right confusion.\nCranial Nerves - Pupils equal and reactive (5 to 3mm), no RAPD;\nEOM smooth and full, no diplopia; no nystagmus; optic disc\nmargins sharp on funduscopic exam, Visual field full with\nconfrontation test, intact facial sensation to LT and temp, face\nsymmetric with full strength of facial muscles, hearing intact \nto\nfinger rub bilaterally, palate elevation is symmetric, and \ntongue\nprotrusion is symmetric and full movement. Sternocleidomastoid\nand trapezius are strong and normal volume.\nTone - Normal\nStrength -\n Delt Bi Tri WrEx FEx FFlx IO / IP Quad Ham Gastr TA ___\n\nR 4+ 5 4+ 5 5- 5 5 4+ ___ ___- \n\nL 5 5 5 5 ___ 5 ___ ___ \n\nReflexes -\n Biceps Triceps Brachioradialis Patellar Ankle \nR 2+ 2+ 2+ 3+ 2+\nL 2+ 2+ 2+ 3+ 2+ \nPlantar responses flexor bilaterally\nSensation - Intact to LT. Decreased sensation to temperature R\nlateral upper arm (~C5 dermatome) and also R lateral foot and\nankle (S1 dermatome). Patchy very mildly decreased sensation to\ntemperature L more than R in distal hand and lower extremity but\nnot consistently decreased. Mildly decreased JPS R big toe and\nunable to tell position sense R ___ toe, intact JPS L ___ and \n___\ntoes. Intact JPS in thumbs and ___ fingers bilat. Vibration\nmildly decreased R big toe compared to the L. Romberg negative.\nCoordination - Very slight dysmetria and slower with finger to\nnose R compared to L intact. RAMs slower and clumsier on the R. \n\nHKS poorly coordinated on the R, intact with L heal. \nGait - Wide based. Slight circumduction of R leg. Difficulty\nwith tandem gait.', 'diagnoses': [{'icd_code': '85300', 'desc': 'Other and unspecified intracranial hemorrhage following injury without mention of open intracranial wound, unspecified state of consciousness'}, {'icd_code': '80507', 'desc': 'Closed fracture of seventh cervical vertebra'}, {'icd_code': '8052', 'desc': 'Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury'}, {'icd_code': '78039', 'desc': 'Other convulsions'}, {'icd_code': '7455', 'desc': 'Ostium secundum type atrial septal defect'}, {'icd_code': 'E8849'}, {'icd_code': '37854', 'desc': 'Sixth or abducens nerve palsy'}, {'icd_code': '34600', 'desc': 'Migraine with aura, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '7820', 'desc': 'Disturbance of skin sensation'}, {'icd_code': '3682', 'desc': 'Diplopia'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': 'V1259', 'desc': 'Personal history of other diseases of circulatory system'}], 'summary': "Admission Labs:\nGLUCOSE-82 UREA N-16 CREAT-0.9 SODIUM-138 POTASSIUM-3.8 \nCHLORIDE-104 TOTAL CO2-24 ANION GAP-14\nWBC-5.8 RBC-4.19* HGB-12.5 HCT-37.1 MCV-88 PLT-304\n.\nURINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG GLUCOSE-NEG KETONE-TR \nBILIRUBIN-NEG UROBILNGN-NEG PH-5.0 LEUK-NEG\n.\nIMAGING:\n.\nMRI Head (___):\nIMPRESSION:\n1. No new foci of signal abnormalities or enhancement within the \nbrain.\nPeriventricular and subcortical abnormalities consistent with \ndiagnosis of\nmultiple sclerosis are again seen as on ___ outside study.\n.\n2. Focus of new signal and enhancement of the right posterior \naspect of the\nspinal cord at C1 level is better evaluated on the cervical \nspine MRI and\nindicates a new multiple sclerosis plaque.\n.\nMRI Cervical Spine (___):\nIMPRESSION: Subtle signal abnormality in the posterior portion \nof the spinal\ncord on inversion-recovery images at T10 and T11 level could be \ndue to a\nchronic demyelinating plaque, but it is not conform on the \nsagittal T2 or\naxial T2-weighted images. No enhancement is seen in this region. \nNo other\nabnormalities.\n.\nMRI Thoracic Spine (___):\nIMPRESSION: Subtle signal abnormality in the posterior portion \nof the spinal\ncord on inversion-recovery images at T10 and T11 level could be \ndue to a\nchronic demyelinating plaque, but it is not conform on the \nsagittal T2 or\naxial T2-weighted images. No enhancement is seen in this region. \nNo other\nabnormalities.\n.\nChest X-ray (___):\nIMPRESSION: No acute intrathoracic process.\nMs. ___ is a ___ year-old right-handed woman with a past \nmedical history including Multiple Sclerosis who presented to \nthe ___ with a three-week history of right-sided paresthesias, \nweakness, and incoordination. She was admitted to the general \nneurology service from ___ to ___. \n.\nAs the patient's presenting syndrome raised concern for an MS \nflare, MRIs of the head, cervical spine, and thoracic spine were \nperformed. The cervical spine imaging demonstrated increased \nsignal in the right side of the spinal cord at the level of C1. \nEnhancement of the lesion was thought to be consistent with a \nnew demyelinating plaque. Accordingly, a three-day course of IV \nsolumedrol was given. With the treatment, the patient reported \nfeeling better. Objectively, there were improvements in \nstrength, coordination, and gait steadiness.\n.\nThe patient was discharged home with plans to follow-up with \noutpatient neurologist Dr. ___ pursue ___ \nadministration teaching with coordinated nursing services."}}
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{'final_diagnoses': ['Multiple Sclerosis Flare'], 'procedures': ['None'], 'visit_summary': "Ms. ___ is a ___ year-old right-handed woman with a past \nmedical history including Multiple Sclerosis who presented to \nthe ___ with a three-week history of right-sided paresthesias, \nweakness, and incoordination. She was admitted to the general \nneurology service from ___ to ___. \n.\nAs the patient's presenting syndrome raised concern for an MS \nflare, MRIs of the head, cervical spine, and thoracic spine were \nperformed. The cervical spine imaging demonstrated increased \nsignal in the right side of the spinal cord at the level of C1. \nEnhancement of the lesion was thought to be consistent with a \nnew demyelinating plaque. Accordingly, a three-day course of IV \nsolumedrol was given. With the treatment, the patient reported \nfeeling better. Objectively, there were improvements in \nstrength, coordination, and gait steadiness.\n.\nThe patient was discharged home with plans to follow-up with \noutpatient neurologist Dr. ___ pursue ___ \nadministration teaching with coordinated nursing services.", 'medications_prescribed': ['1. Ortho-Novum ___ (28) ___ mg-mcg Tablet Sig: One (1) Tablet \nPO once a day.']}
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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': 'nausea and vomiting', 'medical_history': ['1. EtOH Cirrhosis diagnosed ___ with history of grade I \nvarices.', '2. Atypical chest discomfort.', '3. Anxiety.', '4. Plantar fasciitis.', '5. Cataracts.', '6. Neck pain.', '7. Atypical chest discomfort.', '8. Gallstones.', '9. Valvular heart disease.', '10. Osteopenia.', '11. Trichomonas vaginitis.', '12. Syphilis ___.', '13. Insulin resistance.'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death; otherwise non-contributory. ', 'present_illness': 'Mrs. ___ is a ___ year old female with a history of alcoholic \ncirrhosis, and atypical chest discomfort who presents with 3 \ndays of nausea, vomiting, and extreme weakness. She denies \nshortness of breath, chest pain, fevers, chills, or diarrhea. \nShe was found by her daughters at home with the heat off, poorly \ncared for. They called ___. \n. \nOn review of systems, she denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, myalgias, joint \npains, hemoptysis, black stools or red stools. She denies recent \nfevers, chills or rigors. She had a little bit of thick white \nsputum with cough this morning and she currently feels dizzy. \nAll of the other review of systems were negative. \n. \nCardiac review of systems is notable for absence of chest pain, \ndyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, \nankle edema, palpitations, or syncope. \n. \nIn the ED, initial vitals were T 98.1, HR 78, BP 138/82, RR 16, \nO2 sat 100% RA. Her physical exam was unremarkable. She had one \nepisode of non-bloody, non-bilious emesis while in the ED. Chest \nx-ray was unchanged from prior. EKG was NSR with new lateral T \nwave inversions. First troponin was negative. She was given 1L \nNS and 325 mg of aspirin. Vital signs on sign-out were T 98.1, \nHR 64, BP 170/76, RR 16, O2 sat 100% RA. \n. \n.', 'medications': [{'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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID: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': 'Eptifibatide', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Escitalopram Oxalate', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Valsartan', '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': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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}]}, 'clinical_findings': {'labs': [{'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': '1.023', 'valuenum': 1.023, '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': 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': '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': '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': '40.1', 'valuenum': 40.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.7', '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': '226', 'valuenum': 226.0, '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': '4.63', 'valuenum': 4.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.4', 'valuenum': 25.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'Ratio', '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': '73', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', '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': '___', 'valuenum': 226.0, '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': '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': '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': 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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '259', 'valuenum': 259.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 41.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, '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': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '246', 'valuenum': 246.0, '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': '4.50', 'valuenum': 4.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '30', 'valuenum': 30.0, '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': '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': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': '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': '39.3', 'valuenum': 39.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 47.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission:\nVS: T 98.4, BP 188/108 (L), 185/92 (R), HR 64, RR 16, O2 sat \n100% RA. \nGENERAL: WDWN elderly ___ female in NAD. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink. MM dry. \nNECK: Supple, JVP not appreciated. \nCARDIAC: RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 \nor S4. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN: Soft, mild tenderness in the RLQ. No rebound tenderness \nor guarding. No HSM. Abd aorta not enlarged by palpation. No \nabdominial bruits. \nEXTREMITIES: No c/c/e. DP 1+ bilaterally. \nSKIN: Very dry, flaking skin on the lower extremities. \nNEURO: Slow to answer some questions, oriented x3, but answers \nsome questions inappropriately (Do you know why you are in the \nhospital - "because my feet are dry"). Moves all extremities. \n.\nDISCHARGE PHYSICAL:\nVS: 98.5 98 122/76 (100-126)/(68-92) ___ 18 98% RA\ni/o NR\nGENERAL: sleeping, arousable to voice, A&Ox3, NAD \nHEENT: NCAT. Sclera anicteric. MM dry. \nNECK: Supple, JVP not appreciated. \nCARDIAC: RRR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 \nor S4. \nLUNGS: Resp were unlabored, no accessory muscle use. CTAB, no \ncrackles, wheezes or rhonchi. \nABDOMEN: +BS, Soft, nd, nt. No rebound tenderness or guarding. \nNo HSM. No abdominial bruits. \nEXTREMITIES: warm, No c/c/e. DP 1+ bilaterally. \nSKIN: Very dry, flaking skin on the lower extremities. \nNEURO: oriented x3, though unable to state name of hospital, \nslow to respond to questions, no asterixis', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': 'V4582', 'desc': 'Percutaneous transluminal coronary angioplasty status'}, {'icd_code': '4139', 'desc': 'Other and unspecified angina pectoris'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '51889', 'desc': 'Other diseases of lung, not elsewhere classified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "ADMISSION LABS:\n___ 04:17PM GLUCOSE-147* UREA N-8 CREAT-0.7 SODIUM-133 \nPOTASSIUM-3.3 CHLORIDE-88* TOTAL CO2-28 ANION GAP-20\n___ 04:17PM ALT(SGPT)-18 AST(SGOT)-30 ALK PHOS-65 TOT \nBILI-0.9\n___ 04:17PM cTropnT-<0.01\n___ 04:17PM LIPASE-26\n___ 04:17PM WBC-5.2 RBC-4.74 HGB-14.4 HCT-43.1 MCV-91 \nMCH-30.4 MCHC-33.4 RDW-16.3*\n___ 04:17PM PLT COUNT-332\n.\nDISCHARGE LABS: none on day of discharge \n.\nStudies:\nCt head w/o ___:\nFINDINGS: There is no hemorrhage, edema, mass effect, or \nevidence for acute vascular territorial infarction. There are \nperiventricular white matter changes. There is prominence of the \nventricles and sulci, compatible with atrophy. There is \ncalcification of the vertebral arteries, and carotid siphons \nbilaterally. The visualized sinuses are well pneumatized. \n \nIMPRESSION: Chronic changes, but no acute findings. \n.\nPERSANTINE-MIBI STRESS TEST ___:\nStress: IMPRESSION: No anginal symptoms or ECG changes from \nbaseline. \nAppropriate hemodynamic response to the Persantine infusion. \nNuclear \nreport sent separately. \n\nImaging:\nINTERPRETATION: \nThe image quality is satisfactory. \nLeft ventricular cavity size is normal with EDV=31 ml. \nRest and stress perfusion images reveal uniform tracer uptake \nthroughout the left ventricular myocardium. \nGated images reveal normal wall motion. \nThe calculated left ventricular ejection fraction is 76%. \nCompared with the study of ___ there is no change \n \nIMPRESSION: \n1. Normal myocardial perfusion study. \n2. Normal left ventricular size and systolic function.\n.\nMICRO:\nRAPID PLASMA REAGIN TEST (Final ___: \n REACTIVE. \n Reference Range: Non-Reactive. \n\n QUANTITATIVE RPR (Final ___: \n REACTIVE AT A TITER OF 1:1. \n Reference Range: Non-Reactive. \n\nThis is a ___ year old female with a history of alcoholic \ncirrhosis and atypical chest discomfort who presents with 3 days \nof nausea, vomiting, recurrent chest pain, and feeling unwell, \nTWI and ST depressions on lateral leads, CE neg x 2.\n. \n# Nausea, vomiting, weakness, CP: Differential included ACS vs. \nintoxication vs. dehydration. Her initial symptoms were \nconcerning for ACS given TWI and ST depressions in the lateral \nleads. However, her CE's were negative, and her presentation was \nnot consistent with cardiac chest pain. She was treated with \nhydration and her symptoms completely resolved. She was \ninitially started on ASA 325mg daily. She had a persantine \nstress Mibi which showed normal stress test without EKG changes \nor angina and normal imaging. She was continued on her home \npropranolol for beta blockade. Her lipids were checked and LDL \nwas 108, for which pravastatin 10mg po daily was initially \nstarted. However, after results of p-mibi, this was \ndiscontinued. She was discharged on ASA 81mg and to continue her \npropranolol.\nHer chest pain completely resolved, and on the day of discharge \nshe was without complaints.\n. \n# CORONARIES: She has history of atypical chest pain with \nnegative ETT ___ years ago. No prior cardiac caths. As above, \nthere were TWI and ST depressions in the lateral leads but \nnegative CE's and clinical picture not consistent with cardiac \nchest pain. She had a p-mibi stress as above with normal \nfindings. She was discharged to continue on ASA 81mg daily and \npropranolol.\n.\n# PUMP: EF >55% on echo from ___, euvolemic on exam.\n.\n# Confusion: The patient presented with some confusion and did \nnot appear to know the reason for why she was admitted. \nDifferential included hepatic encephalopathy vs. infection vs. \nalcohol intoxication. She was placed on a CIWA scale but did not \nrequire benzos. She was started on thiamine, folic acid, and \nMVI. She was also started on lactulose, without much change, and \nthis was subsequently discontinued. TSH, B12 and folate were \nsent, which were all normal. A CT head without was negative for \nacute process but showed chronic periventricular white matter \nchanges.\nAn RPR was reactive with a 1:1 titer. However, given that she \nhad previous 1:2 titer in ___, several years after treatment \nfor syphilis, this was suspected not to be an indication of new \ninfection. FTA-Abs were considered, but were not sent given that \nshe was at her baseline mental status and again the 1:1 titer \nwas not particularly indicative of infection. Her family was \ncontacted, and she was thought to be at baseline. Per her PCP, \nshe was also at her baseline mental status. She was evaluated by \nsocial work, who stated that her family was concerned regarding \nher continued drinking despite not being able to care for \nherself. She will be cared for at a rehab facility for the time \nbeing. \nShe will follow-up with her PCP ___ as an outpatient for \nfurther neuro-cognitive testing.\n. \n# Anion Gap Acidosis: On admission was hypochloremic, likely ___ \nvomiting. She was treated with IVF. The AG closed after her \nnausea and vomiting resolved. \n. \n# Hypertension: Patient hypertensive on arrival up to 169 \nsystolic. Her Lisinopril had been recently stopped as an \noutpatient due to cough. She was continued on her home dose of \nlasix and propranolol. We considered adding an ___ however, her \nBP normalized and she remained normotensive and did not require \nanother medication for BP control. \n. \n# Alcoholic Cirrhosis: She is seen in the ___ with Dr. \n___ seen in ___. Her INR was 1.2 and her LFTs within \nnormal limits. She appeared to be confused initially, and there \nwas concern for possible hepatic encephalopathy. She had no \nasterixis, but was started on Lactulose, with no apparent change \nin her mental status, and this was discontinued on ___. She \nwas started on Thiamine, folate and MVI. She was strongly \nencouraged to discontinue drinking. She was continued on her \npropranolol and instructed to follow-up with Dr. ___ in the \n___ as per previously scheduled. \n. \n# Anxiety: No active issues. Continued on home dose citalopram. \n\n. \n# Chronic cough: No acute change, chronic stable. Continue \nfluticasone, omeprazole, guiafenesin prn. \n."}}
|
{'final_diagnoses': ['Atypical Chest pain', 'Nausea, vomiting, dehydration', 'Confusion', 'Hypertension', 'Cirrhosis', 'Anxiety', 'Chronic Cough'], 'procedures': ['none'], 'visit_summary': "This is a ___ year old female with a history of alcoholic \ncirrhosis and atypical chest discomfort who presents with 3 days \nof nausea, vomiting, recurrent chest pain, and feeling unwell, \nTWI and ST depressions on lateral leads, CE neg x 2.\n. \n# Nausea, vomiting, weakness, CP: Differential included ACS vs. \nintoxication vs. dehydration. Her initial symptoms were \nconcerning for ACS given TWI and ST depressions in the lateral \nleads. However, her CE's were negative, and her presentation was \nnot consistent with cardiac chest pain. She was treated with \nhydration and her symptoms completely resolved. She was \ninitially started on ASA 325mg daily. She had a persantine \nstress Mibi which showed normal stress test without EKG changes \nor angina and normal imaging. She was continued on her home \npropranolol for beta blockade. Her lipids were checked and LDL \nwas 108, for which pravastatin 10mg po daily was initially \nstarted. However, after results of p-mibi, this was \ndiscontinued. She was discharged on ASA 81mg and to continue her \npropranolol.\nHer chest pain completely resolved, and on the day of discharge \nshe was without complaints.\n. \n# CORONARIES: She has history of atypical chest pain with \nnegative ETT ___ years ago. No prior cardiac caths. As above, \nthere were TWI and ST depressions in the lateral leads but \nnegative CE's and clinical picture not consistent with cardiac \nchest pain. She had a p-mibi stress as above with normal \nfindings. She was discharged to continue on ASA 81mg daily and \npropranolol.\n.\n# PUMP: EF >55% on echo from ___, euvolemic on exam.\n.\n# Confusion: The patient presented with some confusion and did \nnot appear to know the reason for why she was admitted. \nDifferential included hepatic encephalopathy vs. infection vs. \nalcohol intoxication. She was placed on a CIWA scale but did not \nrequire benzos. She was started on thiamine, folic acid, and \nMVI. She was also started on lactulose, without much change, and \nthis was subsequently discontinued. TSH, B12 and folate were \nsent, which were all normal. A CT head without was negative for \nacute process but showed chronic periventricular white matter \nchanges.\nAn RPR was reactive with a 1:1 titer. However, given that she \nhad previous 1:2 titer in ___, several years after treatment \nfor syphilis, this was suspected not to be an indication of new \ninfection. FTA-Abs were considered, but were not sent given that \nshe was at her baseline mental status and again the 1:1 titer \nwas not particularly indicative of infection. Her family was \ncontacted, and she was thought to be at baseline. Per her PCP, \nshe was also at her baseline mental status. She was evaluated by \nsocial work, who stated that her family was concerned regarding \nher continued drinking despite not being able to care for \nherself. She will be cared for at a rehab facility for the time \nbeing. \nShe will follow-up with her PCP ___ as an outpatient for \nfurther neuro-cognitive testing.\n. \n# Anion Gap Acidosis: On admission was hypochloremic, likely ___ \nvomiting. She was treated with IVF. The AG closed after her \nnausea and vomiting resolved. \n. \n# Hypertension: Patient hypertensive on arrival up to 169 \nsystolic. Her Lisinopril had been recently stopped as an \noutpatient due to cough. She was continued on her home dose of \nlasix and propranolol. We considered adding an ___ however, her \nBP normalized and she remained normotensive and did not require \nanother medication for BP control. \n. \n# Alcoholic Cirrhosis: She is seen in the ___ with Dr. \n___ seen in ___. Her INR was 1.2 and her LFTs within \nnormal limits. She appeared to be confused initially, and there \nwas concern for possible hepatic encephalopathy. She had no \nasterixis, but was started on Lactulose, with no apparent change \nin her mental status, and this was discontinued on ___. She \nwas started on Thiamine, folate and MVI. She was strongly \nencouraged to discontinue drinking. She was continued on her \npropranolol and instructed to follow-up with Dr. ___ in the \n___ as per previously scheduled. \n. \n# Anxiety: No active issues. Continued on home dose citalopram. \n\n. \n# Chronic cough: No acute change, chronic stable. Continue \nfluticasone, omeprazole, guiafenesin prn. \n.", 'medications_prescribed': ['1. citalopram 20 mg Tablet Sig: 0.5 Tablet PO DAILY (Daily).', '2. fluticasone 50 mcg/Actuation Spray, Suspension Sig: Two (2) \nSpray Nasal DAILY (Daily).', '3. furosemide 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '4. multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily).', '5. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '6. propranolol 10 mg Tablet Sig: One (1) Tablet PO BID (2 times \na day).', '7. thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '8. folic acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '9. guaifenesin 100 mg/5 mL Syrup Sig: ___ MLs PO Q6H (every 6 \nhours) as needed for cough.', '10. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '11. Calcium 500 + D 500 mg(1,250mg) -400 unit Tablet Sig: One \n(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': 45, 'gender': 'M', 'symptoms': 'Pacemaker replacement', 'medical_history': ['CARDIAC RISK FACTORS: Diabetes, Dyslipidemia, Hypertension', 'CARDIAC HISTORY: -CABG: -PERCUTANEOUS CORONARY INTERVENTIONS: -PACING/ICD: Pacemaker placement ___ w/ xplant ___ infection, then reimplant on ___ w/ revision after lead displaced', 'OTHER PAST MEDICAL HISTORY: - chronic ___ s/p evacuation via craniotomy on ___ - s/p IVC filter at the time of her craniotomy - h/o asymptomatic PE and DVT and went off coumadin ___, then presented ___ with recurrent, small PE diagnosed in the setting of syncope (of note, it was thought the syncope was most likely vasovagal and not due to PE) and was thought to be due to recent surgery/immobilization - CAD s/p biliary stenting of the LCx and PTCA of OM1 in ___ - HTN - proximal descending thoracic aortic aneurysm (last measured at 5.2cm in ___, with mural thrombus in the descending aortic artery ___ - lupus anticoagulant upper limit normal - diverticular disease - hyperlipidemia - GERD - anxiety - osteoarthritis s/p total-knee replacement - carpal tunnel s/p release surgeries and prior hysterectomy - 3 lumbar spine surgeries - congenital UPJ obstruction c/b bilateral renal cysts and chronic left hydronephrosis, s/p ureteral stent ___ as a trial to see if it would improve her chronic flank pain. It did not so the stent was removed ___'], 'family_history': 'No FH of clotting, PE, stroke, or known autoimmune illness. \nPositive FH of CABG in 6 siblings, M/I in father.', 'present_illness': 'Ms. ___ is an ___ year old female with past medical history \nof CAD s/p PCI in ___ to lcx and OM1, ___ s/p evacuation ___ \nwho has a recent admission for complete heart block, found to \nhave ucx +MRSA, on ___ had a PPM placement, ___ BCx +MSSA, she \nhad an extraction on ___ of ppm and a temporary ppm placed. She \nthen completed 2 week course of daptomycin. A PICC line was \nplaced for IV daptomycin, last dose was ___. Two sets of blood \ncultures were drawn on ___, and have remained negative. \n\nShe transfers today from ___ for planned pacemaker \nimplant. Now has reimplant of another pacemaker today \nCardiac review of systems is notable for absence of chest pain, \ndyspnea on exertion, paroxysmal nocturnal dyspnea, orthopnea, \nankle edema, palpitations, syncope or presyncope.', 'medications': [{'medication': 'Metoprolol Tartrate', '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': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Senna', '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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Captopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', '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': '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', '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': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'QID:PRN', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Citrate', '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': 'Discontinued via patient discharge', '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': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': '35', 'valuenum': 35.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', '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': '17.4', 'valuenum': 17.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '60', 'valuenum': 60.0, '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': 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': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '51', 'valuenum': 51.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 131.0, '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': 7.1, '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': '108', 'valuenum': 108.0, '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': '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': '3', 'valuenum': 3.0, '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': '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': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '50', 'valuenum': 50.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 77.0, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.26', 'valuenum': 7.26, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '79', 'valuenum': 79.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '37.0', 'valuenum': 37.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '550', 'valuenum': 550.0, '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': 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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 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'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': 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': '1.8', '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': '4.1', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.9', 'valuenum': 42.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, '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': '327', 'valuenum': 327.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.0', 'valuenum': 44.0, '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': '31.0', 'valuenum': 31.0, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '365', 'valuenum': 365.0, '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': '4.50', 'valuenum': 4.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Exam\nVS: T= 98.4 BP= 126/72 HR= 80 RR= 22 O2 sat=91% RA \nGeneral: elderly female resting in bed, NAD \nHEENT: sclera anicteric, MMM, \nNeck: no JVD \nCV: RRR, no m/r/g \nChest: L PPM dressing C/D/I, mild tendernes \nLungs: Expiratory Wheeze, good air movement \nAbdomen: obese, Soft, NT \nGU: no foley \nExt: no edema, 2+ DP pulses, L arm in slinh \nNeuro: Alert, Conversant, memory intact, able to move all \nextremities \n\nDischarge Exam\nVS: 98.3 67 (60s) 138/65 (100-130/49-60s) 20 93% RA \nI/O 1100/600 \nGeneral: elderly female resting in bed, NAD \nHEENT: sclera anicteric, MMM, \nNeck: no JVD \nCV: RRR, no m/r/g \nChest: L PPM dressing C/D/I, mild tendernes, small hematoma \nLungs: soft end expiratory Wheeze anteriorly, good air movement \n\nAbdomen: obese, Soft, NT \nGU: no foley \nExt: no edema, \nNeuro: Alert, Conversant, memory intact, able to move all \nextremities', 'diagnoses': [{'icd_code': '82020', 'desc': 'Closed fracture of trochanteric section of neck of femur'}, {'icd_code': '51884', 'desc': 'Acute and chronic respiratory failure'}, {'icd_code': '27803', 'desc': 'Obesity hypoventilation syndrome'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '5180', 'desc': 'Pulmonary collapse'}, {'icd_code': 'E8844', 'desc': 'Accidental fall from bed'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'V8537', 'desc': 'Body Mass Index 37.0-37.9, adult'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '71943', 'desc': 'Pain in joint, forearm'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '4739', 'desc': 'Unspecified sinusitis (chronic)'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}], 'summary': '___ 08:09AM WBC-5.4 RBC-3.65*# HGB-10.9* HCT-33.3*# \nMCV-91 MCH-29.9 MCHC-32.8 RDW-15.0\n___ 08:09AM PLT COUNT-184\n___ 08:09AM ___ PTT-31.2 ___\n___ 08:09AM estGFR-Using this\n___ 08:09AM GLUCOSE-134* UREA N-37* CREAT-1.2* SODIUM-141 \nPOTASSIUM-5.1 CHLORIDE-104 TOTAL CO2-24 ANION GAP-18\n\nDischarge Labs\n\n___ 05:50AM BLOOD WBC-5.3 RBC-3.11* Hgb-9.3* Hct-28.0* \nMCV-90 MCH-29.9 MCHC-33.3 RDW-14.9 Plt ___\n___ 05:50AM BLOOD Glucose-124* UreaN-42* Creat-1.2* Na-136 \nK-4.8 Cl-103 HCO3-23 AnGap-15\n___ 05:50AM BLOOD Calcium-9.0 Phos-3.7 Mg-1.9\n\nReports\n\nAnkle XRay\nIMPRESSION: No fracture.\nImpression: ___ yo with planned admission for pacemaker \nre-implant s/p device and lead explant for + MSSA bacteremia \nhere for post-op monitoring complicated by RV lead displacement \ns/p lead revision. \n\n# Complete heart Block s/p PPM reimplantation: Patient had \nrecent complete heart block with temporary pacemaker after she \nhad explantation of prior ppm due to MSSA bacteremia. She had a \ndual chamber pacemaker implant on ___ then on ___ had \nbradycardia to the ___. CXR showed the ventricular lead was \npossibly misplaced. Patient was then taken back with EP and had \nfixation of the lead without complication. Patient received IV \nvancomycin for antibiotic prophylaxis to complete a 5 day \ncourse. She was monitored on tele without any recurrent \nbradycardia, normal V paced rhythm.\n\n#Mobility- patient was admitted from rehab. A ___ evaluation \nshowed the patient continued to be deconditioned. The first \nassessment she slowly fell (without trauma). She was \nre-evaluated by ___ in subsequent days which recommended futher \nPhysical therapy.\n\n# Ankle pain: Pt was complaining of worsening pain after working \nwith ___ with tenderness over lateral malleolus. Xray showed no \nevidence of fracture. She received oxycodone prn for pain. \n\n# CAD: Patient has history of Coronary Artery Disease s/p \nstenting of the LCx and PTCA of OM1 in ___. She was continued \non asa, atenolol, and simvastatin \n \n# Hypertension: continued nifedipine and atenolol\n \n# Hyperlipidemia: continued simvastatin 20 mg daily \n\n# GERD: continued omeprazole \n\nTRANSITIONAL ISSUES \n-f/u outpt with EP\n-home physical therapy\n-CODE: full \n-CONTACT: Patient, Husband ___ ___ Son ___ \n___'}}
|
{'final_diagnoses': ['Complete heart block', 'pacemaker reimplant', 'pacemaker revision', 'Coronary Artery Disease', 'Hypertension', 'CAD', 'HTN'], 'procedures': ['Pacemaker placement', 'Pacemaker Revision', 'Pacemaker reimplant'], 'visit_summary': 'Impression: ___ yo with planned admission for pacemaker \nre-implant s/p device and lead explant for + MSSA bacteremia \nhere for post-op monitoring complicated by RV lead displacement \ns/p lead revision. \n\n# Complete heart Block s/p PPM reimplantation: Patient had \nrecent complete heart block with temporary pacemaker after she \nhad explantation of prior ppm due to MSSA bacteremia. She had a \ndual chamber pacemaker implant on ___ then on ___ had \nbradycardia to the ___. CXR showed the ventricular lead was \npossibly misplaced. Patient was then taken back with EP and had \nfixation of the lead without complication. Patient received IV \nvancomycin for antibiotic prophylaxis to complete a 5 day \ncourse. She was monitored on tele without any recurrent \nbradycardia, normal V paced rhythm.\n\n#Mobility- patient was admitted from rehab. A ___ evaluation \nshowed the patient continued to be deconditioned. The first \nassessment she slowly fell (without trauma). She was \nre-evaluated by ___ in subsequent days which recommended futher \nPhysical therapy.\n\n# Ankle pain: Pt was complaining of worsening pain after working \nwith ___ with tenderness over lateral malleolus. Xray showed no \nevidence of fracture. She received oxycodone prn for pain. \n\n# CAD: Patient has history of Coronary Artery Disease s/p \nstenting of the LCx and PTCA of OM1 in ___. She was continued \non asa, atenolol, and simvastatin \n \n# Hypertension: continued nifedipine and atenolol\n \n# Hyperlipidemia: continued simvastatin 20 mg daily \n\n# GERD: continued omeprazole \n\nTRANSITIONAL ISSUES \n-f/u outpt with EP\n-home physical therapy\n-CODE: full \n-CONTACT: Patient, Husband ___ ___ Son ___ \n___', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atenolol 50 mg PO DAILY', 'Calcium Carbonate 500 mg PO TID:PRN heartburn', 'Fluoxetine 20 mg PO DAILY', 'NIFEdipine CR 60 mg PO DAILY', 'Omeprazole 20 mg PO DAILY', 'Simvastatin 20 mg PO DAILY', 'Nystatin Cream 1 Appl TP BID apply to breast under rash']}
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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': 'CC: lethargy, fevers \nREASON FOR MICU: UTI secondary to L renal stone', 'medical_history': ['___ ___ s/p coiling L supraclinoid ICA aneurysm then \ndeveloped secondary bleed and required VP shunt', 'hypertension', 'hyperlipidemia', 'GERD', 'hiatal hernia', 'osteoporosis', 'hyperparathyroidism', 'constipation', 'h/o delirium', 'hx of UTIs', 'hx of pneumonia'], 'family_history': 'positive for colon cancer and hypertension, MI in father at \n___', 'present_illness': '___ woman with HTN, HLD, GERD, dementia, ___ s/p coiling \nin ___, VP shunt, ischemic stroke, h/o UTI\'s, h/o staghorn \ncalculi in the past, who was brought to ___ from her \nassisted living facility with 4 days of lethargy and fevers, and \nfound to have a UTI. Given her hx of renal stones, a CT \nabdomen/pelvis was obtained, which showed a R-sided Staghorn \ncalculus, and incidentally a left ventricular mass vs thrombus. \nHer EKG was concerning for ST elevations in V2-V3: initial \ntroponin at ___ was negative, and per discussion with the \nfamily a cardiac cath would not be within her goals of care. She \nwas transferred to ___ for cardiology consult prior to urology \nplacing a stent. \n\nIn the ED:\n- initial vitals: 98.2 113 107/59 28 97% Nasal Cannula \n- exam: abd soft, ttp in epigastrium, no rebound, no guarding\n- labs notable for: WBC 23, lactate 1.8 \n- ___ abd/pelvis: New obstructing staghorn calculus \nwithin the right renal pelvis causing moderate upstream \nhydronephrosis \n- received 1 g ceftriaxone, 1 L NS, and Tylenol at ___\n- Urology consulted at ___, who recommended stent \nplacement after cardiology evaluation for LV thrombus: she was \ntherefore transferred to ___ \n- received 1 L NS at ___ \n- cardiology consult: no indication for anticoagulation now, \nrecommend formal ECHO in the AM \n\nOn arrival to the MICU, pt feels "clammy," but otherwise no \ncomplaints.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Infatab', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Brimonidine Tartrate 0.15% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Inactive (Due to a change order)', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Hyoscyamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'QID', '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': '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': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CefePIME', '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', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Metoprolol Tartrate', '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': '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium (IV)', '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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': 'Metoprolol Tartrate', '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Brimonidine Tartrate 0.15% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'BOTH EYES', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', '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': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin Sodium (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '2.6', 'valuenum': 2.6, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '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': '1.5', 'valuenum': 1.5, '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': '139', 'valuenum': 139.0, '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': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.14', 'valuenum': 3.14, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '113', 'valuenum': 113.0, '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': 0.5, 'ref_range_upper': 1.2, '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': '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': '14.2', 'valuenum': 14.2, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, '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': '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, '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': '81', 'valuenum': 81.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, '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': '26.1', 'valuenum': 26.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '204', 'valuenum': 204.0, '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': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '25.6', 'valuenum': 25.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, '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': '210', 'valuenum': 210.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', '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': '28', 'valuenum': 28.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'SM', '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': '50', 'valuenum': 50.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, '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': '0-2', 'valuenum': None, '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': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8.4', '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': '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': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.8', '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': '139', 'valuenum': 139.0, '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': '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': '26.7', 'valuenum': 26.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '284', 'valuenum': 284.0, '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': '3.49', 'valuenum': 3.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '8.4', 'valuenum': 8.4, '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': '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': 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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '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': '112', 'valuenum': 112.0, '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': 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': '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': 5642.0, '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '311', 'valuenum': 311.0, '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': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '13.4', 'valuenum': 13.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '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': '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': '48', 'valuenum': 48.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, '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': '90', 'valuenum': 90.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '56', 'valuenum': 56.0, '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': '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': '8.4', 'valuenum': 8.4, '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': '___', 'valuenum': 295.0, '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': '9', 'valuenum': 9.0, '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': '___', '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': '372', 'valuenum': 372.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '___', 'valuenum': 0.01, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', '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': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '364', 'valuenum': 364.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '43', 'valuenum': 43.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, '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': '47', 'valuenum': 47.0, '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': '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': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '356', 'valuenum': 356.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '579', 'valuenum': 579.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '100', 'valuenum': 100.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.32', 'valuenum': 7.32, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '92', 'valuenum': 92.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '/36.', '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': '-3', 'valuenum': -3.0, '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': '1.2', 'valuenum': 1.2, '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': '___', 'valuenum': 7.24, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '259', 'valuenum': 259.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81.3', 'valuenum': 81.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '522', 'valuenum': 522.0, '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': '3.53', 'valuenum': 3.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '99', 'valuenum': 99.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 287.0, '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': '10', 'valuenum': 10.0, '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': 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 1.5,. Estimated GFR = 44 if non African-American (mL/min/1.73 m2). Estimated GFR = 53 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '5.0', 'valuenum': 5.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '29', 'valuenum': 29.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 18.0, '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': 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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': 'FEW', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'MOD', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3-5', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, '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': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21-50', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'OCC', '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': '336', 'valuenum': 336.0, 'valueuom': 'mm Hg', 'ref_range_lower': None, 'ref_range_upper': None, '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': '22', 'valuenum': 22.0, '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': '100', 'valuenum': 100.0, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '372', 'valuenum': 372.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '37.9', 'valuenum': 37.9, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', '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': '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': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '26.4', 'valuenum': 26.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39', 'valuenum': 39.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '82', 'valuenum': 82.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 156.0, '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': '386', 'valuenum': 386.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, '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': '25.8', 'valuenum': 25.8, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '390', 'valuenum': 390.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '19.6', 'valuenum': 19.6, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': 'STAT', 'comments': None}, {'value': 'POS', '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.'}], 'exams': 'ON ADMISSION:\n\nVitals: Temp 98 BP 89/55 RR 28 O2sat 97% On nasal Cannula\nGENERAL: somnolent, oriented x2, NAD\nHEENT: Sclera anicteric, dry MM \nNECK: supple, JVP not elevated, no LAD \nLUNGS: CTAB\nCV: RRR, no murmurs\nABD: soft, non-tender, non-distended, no rebound, no guarding, \nno CVA tenderness \nEXT: WWP, 2+ pulses, no clubbing, cyanosis or edema \nNEURO: somnolent, CN grossly intact, moving all limbs, limited \nverbal capacity (at baseline per family) \n\nDISCHARGE EXAM:\nVS: 98.4 ___ 98%RA\nGen: awake, interactive, NAD\nHEENT: Atraumatic, neck supple\nCV: RRR w/ no m/r/g\nPulm: nonlabored symmetric breathing, clear to auscultation\nAbd: soft, nontender, nondistended, no rebound or guarding, no \norganomegaly\nExt: warm, well perfused, no cyanosis or edema\nSkin: no rashes, lesions, or jaundice\nPsych: Appropriate mood and behavior', 'diagnoses': [{'icd_code': '80321', 'desc': 'Other closed skull fracture with subarachnoid, subdural, and extradural hemorrhage, with no loss of consciousness'}, {'icd_code': '43491', 'desc': 'Cerebral artery occlusion, unspecified with cerebral infarction'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '4820', 'desc': 'Pneumonia due to Klebsiella pneumoniae'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '4251', 'desc': 'Hypertrophic obstructive cardiomyopathy'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '3481', 'desc': 'Anoxic brain damage'}, {'icd_code': 'V667'}, {'icd_code': '8730', 'desc': 'Open wound of scalp, without mention of complication'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': 'E8889'}, {'icd_code': 'E8498', 'desc': 'Accidents occurring in other specified places'}, {'icd_code': '34889', 'desc': 'Other conditions of brain'}, {'icd_code': '78720', 'desc': 'Dysphagia, unspecified'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '5533', 'desc': 'Diaphragmatic hernia without mention of obstruction or gangrene'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}], 'summary': "___ 01:41AM BLOOD WBC-23.4*# RBC-4.32# Hgb-12.8# Hct-38.5 \nMCV-89 MCH-29.6 MCHC-33.2 RDW-14.4 RDWSD-46.5* Plt ___\n___ 01:41AM BLOOD Neuts-88* Bands-2 Lymphs-2* Monos-8 Eos-0 \nBaso-0 ___ Myelos-0 AbsNeut-21.06* AbsLymp-0.47* \nAbsMono-1.87* AbsEos-0.00* AbsBaso-0.00*\n___ 11:31AM BLOOD ___ PTT-27.7 ___\n___ 01:41AM BLOOD Glucose-210* UreaN-40* Creat-1.4* Na-140 \nK-3.3 Cl-107 HCO3-19* AnGap-17\n___ 01:41AM BLOOD ALT-51* AST-26 CK(CPK)-13* AlkPhos-156* \nTotBili-0.3\n___ 01:41AM BLOOD Albumin-2.6*\n___ 01:49AM BLOOD Lactate-1.8\n___ 11:31AM BLOOD Calcium-8.1* Phos-2.8 Mg-2.4\n\nEKG (___): Sinus tachycardia. Inferior myocardial infarction, \nage indeterminate. Anterolateral myocardial infarction, age \nindeterminate. Prolonged Q-T interval. Compared to the previous \ntracing of ___ sinus tachycardia and anterolateral \nmyocardial infarction and prolonged Q-T interval are new. \n\nECHO (___): IMPRESSION: Severe regional left ventricular \nsystolic dysfunction with large apical left ventricle thrombus \n(large LAD infarct versus takotsubo cardiomyopathy in context of \nreported infection). Discussed with Dr. ___ in person and ECG \nreportedly with anterior q-waves suggesting missed anterior MI. \n\nRenal U/S (___): IMPRESSION: Multiple large right intrarenal \nstones, as seen on the comparison CT examination, however no \nhydronephrosis. \n\nMICROBIOLOGY:\nPer OSH records on ___: Bcx with pansensitive Ecoli\n___ UCx: negative\n___ Bcx x2: negative\n___ Bcx: NGTD, pending at time of discharge\n\nOTHER IMPORTANT RESULTS:\nNone\n\nDISCHARGE RESULTS:\n___ 05:36AM BLOOD WBC-16.9* RBC-4.37 Hgb-12.6 Hct-38.9 \nMCV-89 MCH-28.8 MCHC-32.4 RDW-14.9 RDWSD-49.1* Plt ___\n___ 05:36AM BLOOD Glucose-139* UreaN-36* Creat-1.1 Na-144 \nK-4.2 Cl-108 HCO3-21* AnGap-19\n___ 05:36AM BLOOD Calcium-8.5 Phos-2.3* Mg-2.___\nwoman HTN, HLD, GERD, dementia, SAH s/p coiling in \n___, ischemic stroke, h/o UTI's, and h/o staghorn calculi, \ninitially presenting to ___ with urosepsis likely \nsecondary to recurrent infected right-sided staghorn calculus, \nand transferred to ___ after incidental finding of possible LV \nthrombus for cardiology risk stratification prior to stenting. \n\n# UTI: likely secondary to infected recurrent R-sided staghorn \ncalculus. HD stable, s/p 1 g ceftriaxone at ___ and 2L \nIVF. Prior micro data: per ___ note from ___, has grown \nceftriaxone-resistant enterobacter in ___, but not able to find \ndocumentation of this in ___ micro data. Otherwise at \n___ and at ___, has grown pan-sensitive E.coli and \nProteus. Urology evaluated patient and felt that there was no \nurgent need for procedure, since her hydronephrosis was minimal. \nWould consider procedure if she clinically deteriorates. \nCardiology evaluated patient and felt that her cardiac issues do \nno present an excessive risk to a procedure to attain infectious \nsource control. Due to bacteremia, dose of ceftriaxone was \nincreased to 2gm Q24H. No intervention was made per ___ \nconversations as below. Patient started on IV ceftriaxone for ___s below with plans to transition to suppressive abx \nthereafter.\n\n#Bacteremia- GNR grown from blood ctx from ___ at ___, \ndiscussed with daughter the recommendation of two weeks IV abx. \nCultures speciated pansensitive E. Coli and patient was \ncontinued on IV ceftriaxone for 2 weeks with plans for PO Keflex \n(ppx) thereafter.\n\n# LV thrombus/mass: incidental finding on CT abd/pelvis at ___ \n___ on ___- Per Cardiology, no indication for \nanticoagulation at this time due to goals of care conversation \nas below.\n\n#Goals of care- Family meeting held: Goals of care is to limit \n___ medical interventions but continue medical management \n(but to keep meds to minimum ___ pt resistance). DNR/DNI. No \nhospice. The patient, as such received no anticoagulation for LV \nthrombus or surgery for nephrolithiasis but continued treatment \nfor infection with plans as above. She was discharged back to \nfacility per her wishes.\n\n#Nephrolithiasis: History of recurrent UTI's due to known \nstaghorn calculi. Eval by Urology, but no intervention per ___ \nas above.\n\n___: Likely pre-renal due to sepsis, poor hydration, responsive \nto IVF. STable at time of discharge.\n\n#Hypernatremia; likely due to poor free water intake I/s/o acute \nillness. Improved with one bolus of D5W and patient able to \nmaintain eunatremia with PO intake prior to discharge.\n\n#HTN: medications were discontinued per goals of care.\n\n#Dementia: Patient was at her baseline at time of discharge \nafter possible slight worsening of mental status due to acute \nillness."}}
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{'final_diagnoses': ['Sepsis due to Urinary Tract Infection in the setting of Kidney \nStones', 'Left Ventricular Thrombus', 'Nephrolithiasis', 'Acute Kidney Injury', 'Hypernatremia', 'h/o subarachnoid hemorrhage', 'h/o ischemic strokes', 'Dementia', 'Hypertension'], 'procedures': ['none'], 'visit_summary': "woman HTN, HLD, GERD, dementia, SAH s/p coiling in \n___, ischemic stroke, h/o UTI's, and h/o staghorn calculi, \ninitially presenting to ___ with urosepsis likely \nsecondary to recurrent infected right-sided staghorn calculus, \nand transferred to ___ after incidental finding of possible LV \nthrombus for cardiology risk stratification prior to stenting. \n\n# UTI: likely secondary to infected recurrent R-sided staghorn \ncalculus. HD stable, s/p 1 g ceftriaxone at ___ and 2L \nIVF. Prior micro data: per ___ note from ___, has grown \nceftriaxone-resistant enterobacter in ___, but not able to find \ndocumentation of this in ___ micro data. Otherwise at \n___ and at ___, has grown pan-sensitive E.coli and \nProteus. Urology evaluated patient and felt that there was no \nurgent need for procedure, since her hydronephrosis was minimal. \nWould consider procedure if she clinically deteriorates. \nCardiology evaluated patient and felt that her cardiac issues do \nno present an excessive risk to a procedure to attain infectious \nsource control. Due to bacteremia, dose of ceftriaxone was \nincreased to 2gm Q24H. No intervention was made per ___ \nconversations as below. Patient started on IV ceftriaxone for ___s below with plans to transition to suppressive abx \nthereafter.\n\n#Bacteremia- GNR grown from blood ctx from ___ at ___, \ndiscussed with daughter the recommendation of two weeks IV abx. \nCultures speciated pansensitive E. Coli and patient was \ncontinued on IV ceftriaxone for 2 weeks with plans for PO Keflex \n(ppx) thereafter.\n\n# LV thrombus/mass: incidental finding on CT abd/pelvis at ___ \n___ on ___- Per Cardiology, no indication for \nanticoagulation at this time due to goals of care conversation \nas below.\n\n#Goals of care- Family meeting held: Goals of care is to limit \n___ medical interventions but continue medical management \n(but to keep meds to minimum ___ pt resistance). DNR/DNI. No \nhospice. The patient, as such received no anticoagulation for LV \nthrombus or surgery for nephrolithiasis but continued treatment \nfor infection with plans as above. She was discharged back to \nfacility per her wishes.\n\n#Nephrolithiasis: History of recurrent UTI's due to known \nstaghorn calculi. Eval by Urology, but no intervention per ___ \nas above.\n\n___: Likely pre-renal due to sepsis, poor hydration, responsive \nto IVF. STable at time of discharge.\n\n#Hypernatremia; likely due to poor free water intake I/s/o acute \nillness. Improved with one bolus of D5W and patient able to \nmaintain eunatremia with PO intake prior to discharge.\n\n#HTN: medications were discontinued per goals of care.\n\n#Dementia: Patient was at her baseline at time of discharge \nafter possible slight worsening of mental status due to acute \nillness.", 'medications_prescribed': ['Acetaminophen 325 mg PO Q6H:PRN pain', 'Aspirin 325 mg PO DAILY', 'Ranitidine 150 mg PO QHS', 'Senna 8.6 mg PO BID:PRN constipation', 'Sertraline 50 mg PO DAILY', 'CefTRIAXone 2 gm IV Q24H \nRX *ceftriaxone in dextrose,iso-os 2 gram/50 mL 1 bag IV once a \nday Disp #*12 Intravenous Bag Refills:*0', 'Clopidogrel 75 mg PO DAILY', 'Cephalexin 125 mg PO DAILY \nPlease start after completion of IV antibiotics. First day is \n___. \nRX *cephalexin 250 mg 0.5 (One half) tablet(s) by mouth once a \nday 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': 48, 'gender': 'F', 'symptoms': 'worsening pain', 'medical_history': ['Ulcerative Colitis ___ years (gets GI care at ___ \n___)', 'Hx of latent TB s/p TX in ___', 'Strongyloidiasis in ___, s/p Ivermectin', 'CMV on colon biopsy with positive serum viral load in ___, \ns/p ganciclovir/valganciclovir', 'Difficult crossmatch', 'Iron deficiency anemia', 'Dynamic inter-atrial septum', 'Warm antibodies'], 'family_history': 'Mother: healthy\nFather: healthy\nDenies any family hx of IBD or other autoimmune disease.', 'present_illness': '___ with refractory UC s/p lap total proctocolectomy, J pouch,\nloop ileostomy, c/b bilateral segmental PEs &and PV thrombus (on\nXarelto) sent to ED by ___ for decreased ostomy output. \nRecently\ndischarged and noted over the past 2 days developing worsening\nabdominal pain along with poor appetite. Patient states that\npain has been constant and gradually worsening and cannot\nidentify any alleviating factors. Denies nausea or vomiting. \nStates that he has been able to tolerate p.o. intake, including\nchicken soup, water, and a banana today, without any nausea or\nemesis. Also states he has had some intermittent left groin \npain\nover the past few days along with groin cramping while \nurinating.\nOf note, patient does state that he has noted decrease in the\namount of output from his ileostomy. States that he had some\nliquid green-brown output yesterday, however today he noted only\nsome thicker chunky brown output and states that has not emptied\nhis bag today. When asked about what medication he takes at\nhome, had bag with all his pill bottles which was notable for\nonly oxycodone, Lomotil, Flomax, and Xarelto. Was seen by ___ \nat\nhome, who were concerned over decreased ostomy output and pain,\ntherefore presents to the emergency department for evaluation. \nColorectal surgery is consulted for ongoing evaluation and\nmanagement of this recent postop patient.', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Venlafaxine XR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Linezolid', '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', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Linezolid', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Penicillin G Potassium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush Port (10 units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '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': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '5.0', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '84.4', 'valuenum': 84.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '554', 'valuenum': 554.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '___', '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, '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': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.8', 'valuenum': 21.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.6', 'valuenum': 35.6, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77.2', 'valuenum': 77.2, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '533', 'valuenum': 533.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '2.22', 'valuenum': 2.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, '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': '33.3', 'valuenum': 33.3, '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': '641', 'valuenum': 641.0, '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': '2.80', 'valuenum': 2.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '86', 'valuenum': 86.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: 24 HR Data (last updated ___ @ 747)\n Temp: 98.0 (Tm 98.2), BP: 101/59 (94-101/54-59), HR: 73\n(72-78), RR: 18 (___), O2 sat: 99% (97-100), O2 delivery: Ra\nFluid Balance (last updated ___ @ 826)\n Last 8 hours Total cumulative -350ml\n IN: Total 200ml, PO Amt 200ml\n OUT: Total 550ml, Urine Amt 350ml, Ileostomy 200ml\n Last 24 hours Total cumulative -1100ml\n IN: Total 200ml, PO Amt 200ml\n OUT: Total 1300ml, Urine Amt 700ml, Ileostomy 600ml\nPhysical exam:\nGen: NAD, AxOx3\nCard: RRR, no m/r/g\nPulm: CTAB, no respiratory distress\nAbd: soft, non-distended, diffuse mild TTP. RLQ ostomy pink,\nnon-edematous, gas + liquid brown stool in bag.\nWounds: c/d/i\nExt: No edema, warm well-perfused', 'diagnoses': [{'icd_code': '99859', 'desc': 'Other postoperative infection'}, {'icd_code': '6822', 'desc': 'Cellulitis and abscess of trunk'}, {'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': 'V103'}, {'icd_code': '6930', 'desc': 'Dermatitis due to drugs and medicines taken internally'}, {'icd_code': 'E9308', 'desc': 'Other specified antibiotics causing adverse effects in therapeutic use'}], 'summary': '___ 06:15AM GLUCOSE-82 UREA N-5* CREAT-0.5 SODIUM-140 \nPOTASSIUM-4.3 CHLORIDE-102 TOTAL CO2-27 ANION GAP-11\n___ 06:15AM ALT(SGPT)-47* AST(SGOT)-26 ALK PHOS-66 TOT \nBILI-<0.2\n___ 06:15AM LIPASE-134*\n___ 06:15AM CALCIUM-8.8 PHOSPHATE-4.5 MAGNESIUM-1.7\n___ 06:15AM WBC-4.8 RBC-3.24* HGB-7.1* HCT-24.1* MCV-74* \nMCH-21.9* MCHC-29.5* RDW-19.9* RDWSD-54.0*\n___ 06:15AM PLT COUNT-283\n___ 06:15AM ___\n___ 03:15PM GLUCOSE-100 UREA N-7 CREAT-0.6 SODIUM-140 \nPOTASSIUM-3.9 CHLORIDE-102 TOTAL CO2-25 ANION GAP-13\n___ 03:15PM estGFR-Using this\n___ 03:15PM ALT(SGPT)-64* AST(SGOT)-41* ALK PHOS-76 TOT \nBILI-<0.2\n___ 03:15PM LIPASE-189*\n___ 03:15PM ALBUMIN-3.5\n___ 03:15PM WBC-6.0 RBC-3.83* HGB-8.3* HCT-29.6* MCV-77* \nMCH-21.7* MCHC-28.0* RDW-19.9* RDWSD-55.7*\n___ 03:15PM NEUTS-43.5 ___ MONOS-9.8 EOS-0.3* \nBASOS-0.8 IM ___ AbsNeut-2.60 AbsLymp-2.72 AbsMono-0.59 \nAbsEos-0.02* AbsBaso-0.05\n___ 03:15PM PLT COUNT-672*\n___ 03:14PM URINE HOURS-RANDOM\n___ 03:14PM URINE UHOLD-HOLD\n___ 03:14PM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 03:14PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-30* \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 03:14PM URINE RBC-1 WBC-1 BACTERIA-FEW* YEAST-NONE \nEPI-0\n___ 03:14PM URINE MUCOUS-MANY*\nMr. ___ was admitted to ___ through the ED on ___ \nfor pain control. Pain was well controlled on oxy dilaudid. On \n___, the patient was discharged to home with services. At \ndischarge, he was tolerating a regular diet, passing flatus, \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': ['abdominal pain'], 'procedures': ['___ with refractory UC s/p lap total proctocolectomy, J pouch,\nloop ileostomy, c/b bilateral segmental PEs &and PV thrombus (on\nXarelto), now w/ worsening pain'], 'visit_summary': 'Mr. ___ was admitted to ___ through the ED on ___ \nfor pain control. Pain was well controlled on oxy dilaudid. On \n___, the patient was discharged to home with services. At \ndischarge, he was tolerating a regular diet, passing flatus, \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': ['Acetaminophen 1000 mg PO Q8H', 'OxyCODONE (Immediate Release) 5 mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg 1 (One) tablet(s) by mouth every four (4) \nhours Disp #*30 Tablet Refills:*0', 'Pantoprazole 40 mg PO Q24H', 'Rivaroxaban 15 mg PO BID', 'Tamsulosin 0.4 mg PO DAILY', 'Vitamin D ___ UNIT PO 1X/WEEK (MO)']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 54, 'gender': 'M', 'symptoms': 'tracheal stenosis', 'medical_history': ['- HTN', '- Type 2 DM', '- Non-ischemic cardiomyopathy', '- ARF', '- Cardiac arrest', '- Intubation s/p trach/PEG (___)', '- GERD'], 'family_history': 'Father: heart disease, prediabetes\nMother: mitral valve prolapse', 'present_illness': '___ with h/o non-ischemic cardiomyopathy (EF60%), DM2, HTN, \nGERD;\nh/o complex admission for acute renal failure with course\ncomplicated by cardiac arrest requiring CPR, prolonged\nintubation, s/p trach/PEG c/b tracheal stenosis. He ___ had\nmultiple airway procedures in the past including dilations,\n___ t-tubes, tracheostomy exchanges, and ___\ncannulas. Most recently, he had his t-tube removed and replaced\nwith ___ cannula ___ however, this was \ncomplicated\nby respiratory distress, requiring tracheostomy replacement and\nultimately T-tube replacement (___). He presents today for\npre-admission before tracheal resection and reconstruction\ntomorrow morning.', 'medications': [{'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'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': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', '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': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', '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': 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}, {'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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', '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': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'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': 'Discontinued', 'route': 'SC', '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': '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': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin (CRRT Machine Priming)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DIALYS', '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': 'Neomycin-Polymyxin-Bacitracin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'EPINEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', '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': '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': 'Dexmedetomidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'QUEtiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, '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': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, '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': 'Insulin (Regular) for Hyperkalemia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Vancomycin', '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': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Activated Charcoal-Sorbitol', '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': 'DIALYS', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', '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': 'Alteplase 1mg/2mL ( Clearance ie. PICC, tunneled access line )', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Citrate Dextrose 3% (ACD-A) CRRT', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', '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 Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', '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', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neomycin-Polymyxin-Bacitracin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glycerin Supps', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Methylene Blue 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'J TUBE', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Gastroview (Diatrizoate Meglumine & Sodium)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Fat Emulsion 20%', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'AcetaZOLamide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Mineral Oil', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin (Regular) for Hyperkalemia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonidine Patch 0.1 mg/24 hr', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QFRI', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, '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': 'BREAKFAST', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Ibuprofen Suspension', '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', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', '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': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dexmedetomidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Dexmedetomidine', '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', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1% (For PICC/Midline Insertions)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'X1 PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', '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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium CITRATE 4%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'DWELL', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 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': 'IV', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Phosphate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (1000 units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DWELL', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'QUEtiapine Fumarate', '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': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Discontinued', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Rocuronium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Alteplase 1mg/2mL ( Clearance ie. PICC, tunneled access line )', 'proc_type': 'IV Piggyback', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'TPN', 'status': 'Expired', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'Citrate Dextrose 3% (ACD-A) CRRT', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'DIALYS', 'frequency': 'ASDIR', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Insulin (Regular) for Hyperkalemia', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 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': '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': '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'TPN', 'status': 'Discontinued', 'route': None, 'frequency': None, 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin (CRRT Machine Priming)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'DIALYS', '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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'BOTH EYES', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'CloniDINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Norepinephrine', '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': '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': 'Midazolam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.0', 'valuenum': 17.0, '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': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, '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': '4.0', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92.1', 'valuenum': 92.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.2', 'valuenum': 17.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, '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': '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': 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 4.5,. Estimated GFR = 14 if non African-American (mL/min/1.73 m2). Estimated GFR = 17 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 179.0, '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '33', 'valuenum': 33.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.37', '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-7', 'valuenum': -7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, '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': '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': '94', 'valuenum': 94.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.18, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-7', 'valuenum': -7.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '203', 'valuenum': 203.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '55', 'valuenum': 55.0, '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': '___', 'valuenum': 7.19, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'PROVIDER NOTIFIED PER CURRENT LAB POLICY.'}, {'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': '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '/15.', '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': '-9', 'valuenum': -9.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.01', 'valuenum': 1.01, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '208', 'valuenum': 208.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.2', 'valuenum': 11.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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, 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{'value': '29.4', 'valuenum': 29.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '424', 'valuenum': 424.0, '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': '3.22', 'valuenum': 3.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 194.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-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': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '200', 'valuenum': 200.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '38.9', 'valuenum': 38.9, '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': '62', 'valuenum': 62.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '57', 'valuenum': 57.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.9', 'valuenum': 1.9, '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, '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': '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': '8.1', 'valuenum': 8.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, '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': '90', 'valuenum': 90.0, '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': '86.1', 'valuenum': 86.1, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '518', 'valuenum': 518.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.35', 'valuenum': 3.35, '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': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, '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 2.7,. Estimated GFR = 25 if non African-American (mL/min/1.73 m2). Estimated GFR = 30 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': 211.0, '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': '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': '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '54', 'valuenum': 54.0, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'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': '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': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, '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': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '101', 'valuenum': 101.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '5.0', 'valuenum': 5.0, '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': '39.4', 'valuenum': 39.4, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '600', 'valuenum': 600.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'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': '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': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '___', 'valuenum': 258.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '___', 'valuenum': 6.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '61', 'valuenum': 61.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '596', 'valuenum': 596.0, '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': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 25.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'CHECKED FOR NRBCS.'}, {'value': '-4', 'valuenum': -4.0, 'valueuom': 'mEq/L', 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'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': '2.64', 'valuenum': 2.64, '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': '30', 'valuenum': 30.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70', 'valuenum': 70.0, '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': '34', 'valuenum': 34.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 160.0, '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': '137', 'valuenum': 137.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50', 'valuenum': 50.0, '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': '12.7', 'valuenum': 12.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 24.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.06', 'valuenum': 1.06, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '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': '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': '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': '24', 'valuenum': 24.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.08', 'valuenum': 1.08, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '186', 'valuenum': 186.0, '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': '22.4', 'valuenum': 22.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '32.7', 'valuenum': 32.7, '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': '513', 'valuenum': 513.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.46', 'valuenum': 2.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 2.7,. Estimated GFR = 25 if non African-American (mL/min/1.73 m2). Estimated GFR = 30 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': 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': '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': '6.3', 'valuenum': 6.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '7.35', 'valuenum': 7.35, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, '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': '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.20', 'valuenum': 1.2, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, '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': '94', 'valuenum': 94.0, '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': '1', 'valuenum': 1.0, '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': '___', 'valuenum': 63.0, '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': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 57.0, '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': '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 218.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '5.4', 'valuenum': 5.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '579', 'valuenum': 579.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.66', 'valuenum': 2.66, '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': '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': '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': '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': '70', 'valuenum': 70.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 73.0, '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': '12', 'valuenum': 12.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.22, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. 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'139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, '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': '29.3', 'valuenum': 29.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.57', 'valuenum': 2.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 144.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '52', 'valuenum': 52.0, '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': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.0', 'valuenum': 27.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22.6', 'valuenum': 22.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.2', 'valuenum': 7.2, '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': '32.0', 'valuenum': 32.0, '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': '221', 'valuenum': 221.0, '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': '2.53', 'valuenum': 2.53, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'IU/L', 'ref_range_lower': 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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, '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 = 58 if non African-American (mL/min/1.73 m2). Estimated GFR = 70 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 302.0, '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': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 168.0, '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': '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': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 47.0, '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': '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': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '43', 'valuenum': 43.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, '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': '288', 'valuenum': 288.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.95', 'valuenum': 2.95, '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': '18', 'valuenum': 18.0, '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': 10.3, '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.1', '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.1', 'valuenum': 25.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '8.9', 'valuenum': 8.9, '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': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.00', 'valuenum': 3.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, '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': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '29.6', 'valuenum': 29.6, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '288', 'valuenum': 288.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, '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': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '37', 'valuenum': 37.0, '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '18', 'valuenum': 18.0, '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': '0.6', 'valuenum': 0.6, '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1398', 'valuenum': 1398.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '17', 'valuenum': 17.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '251', 'valuenum': 251.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '247', 'valuenum': 247.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '112', 'valuenum': 112.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '193', 'valuenum': 193.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 294.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, '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': '252', 'valuenum': 252.0, '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': '2.81', 'valuenum': 2.81, '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 156.0, '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '19', 'valuenum': 19.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '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': '4.3', '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': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, '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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '3.0', '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '18', 'valuenum': 18.0, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 155.0, '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': '3.8', 'valuenum': 3.8, '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': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 147.0, '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': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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': '18', 'valuenum': 18.0, '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': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 177.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '22.5', 'valuenum': 22.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.6', 'valuenum': 28.6, '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': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '221', 'valuenum': 221.0, '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': '2.69', 'valuenum': 2.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': 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': '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': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: 98.3, 70, 126/70, 20, 97% RA\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, t-tube in place\nABD: Soft, mildly distended, nontender, no rebound or guarding,\nExt: No ___ edema, ___ warm and well perfused', 'diagnoses': [{'icd_code': '0389', 'desc': 'Unspecified septicemia'}, {'icd_code': '5570', 'desc': 'Acute vascular insufficiency of intestine'}, {'icd_code': '78552', 'desc': 'Septic shock'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '56722', 'desc': 'Peritoneal abscess'}, {'icd_code': '56983', 'desc': 'Perforation of intestine'}, {'icd_code': '56081', 'desc': 'Intestinal or peritoneal adhesions with obstruction (postoperative) (postinfection)'}, {'icd_code': '56729', 'desc': 'Other suppurative peritonitis'}, {'icd_code': '2760', 'desc': 'Hyperosmolality and/or hypernatremia'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '99604', 'desc': 'Mechanical complication of automatic implantable cardiac defibrillator'}, {'icd_code': '75311', 'desc': 'Congenital single renal cyst'}, {'icd_code': '9986', 'desc': 'Persistent postoperative fistula'}, {'icd_code': '56981', 'desc': 'Fistula of intestine, excluding rectum and anus'}, {'icd_code': '2639', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': '35981', 'desc': 'Critical illness myopathy'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '42832', 'desc': 'Chronic diastolic heart failure'}, {'icd_code': '99592', 'desc': 'Severe sepsis'}, {'icd_code': 'V4502', 'desc': 'Automatic implantable cardiac defibrillator in situ'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '04149', 'desc': 'Other and unspecified Escherichia coli [E. coli]'}, {'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': 'E8499', 'desc': 'Accidents occurring in unspecified place'}, {'icd_code': 'E8782', 'desc': 'Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': 'E8497', 'desc': 'Accidents occurring in residential institution'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': '27542', 'desc': 'Hypercalcemia'}, {'icd_code': '2752', 'desc': 'Disorders of magnesium metabolism'}, {'icd_code': '2753', 'desc': 'Disorders of phosphorus metabolism'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'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': 'V8537', 'desc': 'Body Mass Index 37.0-37.9, adult'}, {'icd_code': '78062', 'desc': 'Postprocedural fever'}], 'summary': " WBC RBC Hgb Hct MCV MCH MCHC RDW RDWSD \n Plt Ct \n___ 02:08 6.7 2.86* 8.2* 25.3* 89 28.7 32.4 14.4 45.3 \n 230 \n___ 01:39 6.8 2.77* 7.8* 24.5* 88 28.2 31.8* 14.1 45.0 \n 235 \n___ 01:51 6.4 2.73* 7.7* 24.1* 88 28.2 32.0 13.8 43.4 \n 222 \n___ 01:24 6.8 2.85* 8.1* 25.3* 89 28.4 32.0 13.6 43.6 \n 236\n___ 01:37 6.3 2.69* 8.0* 24.4* 91 29.7 32.8 14.2 45.8 \n 208 \n___ 01:39 4.6 2.69* 7.8* 24.6* 91 29.0 31.7* 14.2 \n46.7* 190 \n___ 01:39 5.0 2.68* 7.8* 23.9* 89 29.1 32.6 14.2 46.0 \n 203 \n___ 01:42 4.9 2.84* 8.1* 25.6* 90 28.5 31.6* 14.0 46.0 \n 215 \n___ 03:17 3.2* 2.78* 8.0* 25.2* 91 28.8 31.7* 14.1 \n46.7* 162\n___ 02:00 2.9* 2.74* 7.9* 25.1* 92 28.8 31.5* 14.6 \n48.8* 177 \n___ 13:49 2.7* 2.57* 7.3* 23.4* 91 28.4 31.2* 14.7 \n48.8* 176 \n___ 02:11 2.9* 2.67* 7.7* 24.7* 93 28.8 31.2* 14.8 \n50.3* 158 \n___ 01:30 3.2* 2.62* 7.5* 23.7* 91 28.6 31.6* 14.7 \n49.1* 178 \n___ 00:44 4.3 2.82* 8.0* 25.2* 89 28.4 31.7* 14.5 \n47.1* 188 \n___ 12:56 6.3 2.92* 8.3* 26.0* 89 28.4 31.9* 14.6 \n47.6* 205 \n___ 04:10 6.9 2.94* 8.5* 26.1* 89 28.9 32.6 14.4 \n46.4* 175 \n___ 02:49 10.6* 3.39* 9.8* 29.5* 87 28.9 33.2 13.9 \n44.0 150 \n___ 01:02 8.7 3.21* 9.5* 28.9* 90 29.6 32.9 14.5 \n47.4* 162 \n___ 02:01 9.9 3.15* 9.3* 28.2* 90 29.5 33.0 14.3 \n46.3 166 \n___ 15:50 10.8* 3.49* 9.9* 30.9* 89 28.4 32.0 14.6 \n46.5* 200 \n___ 01:36 6.5 3.74* 10.6* 32.8* 88 28.3 32.3 14.5 \n45.7 209 \n___ 12:50 8.7 4.04* 11.5* 34.5* 85 28.5 33.3 13.9 \n42.5 233 \n\n Glucose UreaN Creat Na K Cl HCO3 AnGap \n___ 04:00 ___ 1422 4.13 ___\n___ 05:30 ___ 1422 3.93 ___\n___ 02:08 ___ 1432 3.93 ___\n___ 01:39 176*1 21* 0.9 1442 3.73 ___\n___ 01:51 75*1 21* 0.9 1452 3.63 ___\n___ 01:24 132*1 21* 0.9 1412 ___ 112 \n___ 01:37 130*1 24* 1.0 1374 3.95 ___ 01:39 175*1 24* 1.0 1442 4.13 102 33 * 9*2 \n___ 01:39 ___ 1432 3.83 100 32 112 \n___ 01:42 ___ 1432 3.83 102 31 102 \n___ 03:17 ___ 1462 3.93 104 31 112 \n___ 02:00 ___ 1422 3.93 102 30 102 \n___ 13:49 ___ 1442 4.33 ___\n___ 02:11 ___ 1432 3.93 ___\n___ 01:30 ___ 1412 3.93 ___\n___ 00:44 ___ 1402 4.23 ___\n___ 12:56 ___ 1382 3.93 ___ \n___ 04:10 187*1 21* 1.3* 1382 4.03 ___\n___ 16:09 ___ 124*9 3.2*3 88* 22 147 \n___ 16:09 721 17 1.2 1382 5.9*10 101 19* 182 \n___ 02:49 ___ 1362 ___ 152 \n___ 01:02 ___ 1382 4.03 ___\n___ 02:01 ___ 1392 4.53 ___ \n___ 15:50 ___ 1392 5.03 ___\n___ 01:36 125*1 24* 1.3* 1402 4.43 ___\nMr ___ presented to ___ holding at ___ on ___ for \npreadmission testing prior to the OR ___ for cervical \nstenosis resection. He tolerated the procedure well. He was \ntransferred to the ICU for monitoring. He did well on post op \nday 1 and his diet was advanced to sips and ice chips. On POD 2 \nhis neck JP drain was removed. Later that day he become febrile \nand his blood, urine, and sputum were cultured. The following \nday his diet was advanced to regular with thicken liquids. \n\nOn POD 4, he developed acute respiratory distress and \nsubcutaneous emphysema. Emergent bronchoscopy revealed a defect \nin his tracheal anastomosis and he was taken to the ___ for neck \nexploration, tracheal repair and JP drain placement. He \ntolerated this procedure well and returned to the ICU. He was \nplaced on ciprofloxacin for a positive Proteus bronchoalveolar \nlavage.\n\nOn POD 6, the patient had a tonic clonic seizure. He was \nevaluated by Neurology. A head MRI revealed a meningioma, which \nwas deemed unrelated to his seizure. He will follow up with \nNeurology on an outpatient basis with a repeat MRI. The seizure \nwas attributed to ciprofloxacin lowering his seizure threshold \nand his antibiotics were transitions to unasyn and vancomycin. \nHe was also started on Keppra for seizure prophylaxis. \n\nOn POD ___, he underwent serial bronchoscopies which revealed a \npersistent defect in the tracheal anastomosis. The patient was \noffered a T-tube, and his family declined due to respect for the \npatient's wishes. \n\nOn POD 13, the patient was extubated. The patient tolerated this \nwell. Imaging on POD 16 revealed no persistent subcutaneous air \nand the patient was transferred to the floor.\n\nThe patient developed delirium and agitation while on the floor, \nand psychiatry was consulted. They advised ongoing treatment \nwith Seroquel. \n\nOn POD 20, the patient underwent a repeat bronchoscopy. There \nwas no evidence of the tracheal defect, and his neck JP drain \nwas removed. His antibiotics were discontinued at this time.\n\nOn POD ___, the decision was made to discharge the patient to a \nlong term care facility. At time of discharge, the patient was \nable to get up the chair with assist. He remained NPO and on ___ \ntube feeds until speech could re-evaluate the patient in the \noutpatient setting in one week. Follow up with Dr. ___ was \nscheduled for both the tracheal repair and the pulmonary \nnodules. His outpatient MRI was also scheduled."}}
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{'final_diagnoses': ['Tracheal stenosis', 'Tracheal wound dehiscence', 'Generalized tonic-clonic seizure', 'Proteus pneumonia', 'Delirium'], 'procedures': ['FLEXIBLE BRONCHOSCOPY WITH BRONCHOALVEOLAR LAVAGE, CERVICAL \nTRACHEAL RESECTION AND RECONSTRUCTION', 'Bronchoscopy', 'Bronchoscopy, neck exploration and drainage, repair of tracheal \nfistula', 'Bronchoscopy', 'Bronchoscopy', 'Bronchoscopy'], 'visit_summary': "Mr ___ presented to ___ holding at ___ on ___ for \npreadmission testing prior to the OR ___ for cervical \nstenosis resection. He tolerated the procedure well. He was \ntransferred to the ICU for monitoring. He did well on post op \nday 1 and his diet was advanced to sips and ice chips. On POD 2 \nhis neck JP drain was removed. Later that day he become febrile \nand his blood, urine, and sputum were cultured. The following \nday his diet was advanced to regular with thicken liquids. \n\nOn POD 4, he developed acute respiratory distress and \nsubcutaneous emphysema. Emergent bronchoscopy revealed a defect \nin his tracheal anastomosis and he was taken to the ___ for neck \nexploration, tracheal repair and JP drain placement. He \ntolerated this procedure well and returned to the ICU. He was \nplaced on ciprofloxacin for a positive Proteus bronchoalveolar \nlavage.\n\nOn POD 6, the patient had a tonic clonic seizure. He was \nevaluated by Neurology. A head MRI revealed a meningioma, which \nwas deemed unrelated to his seizure. He will follow up with \nNeurology on an outpatient basis with a repeat MRI. The seizure \nwas attributed to ciprofloxacin lowering his seizure threshold \nand his antibiotics were transitions to unasyn and vancomycin. \nHe was also started on Keppra for seizure prophylaxis. \n\nOn POD ___, he underwent serial bronchoscopies which revealed a \npersistent defect in the tracheal anastomosis. The patient was \noffered a T-tube, and his family declined due to respect for the \npatient's wishes. \n\nOn POD 13, the patient was extubated. The patient tolerated this \nwell. Imaging on POD 16 revealed no persistent subcutaneous air \nand the patient was transferred to the floor.\n\nThe patient developed delirium and agitation while on the floor, \nand psychiatry was consulted. They advised ongoing treatment \nwith Seroquel. \n\nOn POD 20, the patient underwent a repeat bronchoscopy. There \nwas no evidence of the tracheal defect, and his neck JP drain \nwas removed. His antibiotics were discontinued at this time.\n\nOn POD ___, the decision was made to discharge the patient to a \nlong term care facility. At time of discharge, the patient was \nable to get up the chair with assist. He remained NPO and on ___ \ntube feeds until speech could re-evaluate the patient in the \noutpatient setting in one week. Follow up with Dr. ___ was \nscheduled for both the tracheal repair and the pulmonary \nnodules. His outpatient MRI was also scheduled.", 'medications_prescribed': ['Heparin 5000 UNIT SC TID', 'LevETIRAcetam 1000 mg PO BID', 'Metoprolol Tartrate 12.5 mg PO Q6H', 'QUEtiapine Fumarate 50 mg PO QHS', 'QUEtiapine Fumarate 25 mg PO QAM', 'Senna 8.6 mg PO BID', 'Acetaminophen 1000 mg PO Q6H:PRN Pain - Mild', 'Acetylcysteine 20% ___ mL NEB Q4H:PRN wheezing/SOB', 'Albuterol 0.083% Neb Soln 1 NEB IH Q4H:PRN wheezing', 'Ipratropium-Albuterol Neb 1 NEB NEB Q6H', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Docusate Sodium 100 mg PO BID', 'Famotidine 20 mg PO Q12H', 'GuaiFENesin 15 mL PO Q6H', 'Lisinopril 5 mg PO DAILY', 'Multivitamins W/minerals 1 TAB PO DAILY']}
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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': 'Cholecystitis', 'medical_history': ['-DM-2 ', '-HTN', '-HLD', '-Hyperthyroidism', '-tobacco dependence', '-glaucoma', '-Prior Posterior circulation CVA ___', '-? h/o aspiration pna', '.'], 'family_history': 'Father-CAD in father', 'present_illness': 'The patient is an ___ year-old male with a history of diabetes, \nHTN, hyperlipidemia, and previous stroke who initially presented \nto ___ on ___ with painless jaundice. \nHe underwent ultrasound and MRCP studies which demonstrated \ncholedocholithiasis and underwent two ERCPs\nthat were successful in removing stones, however, he continued \nto\nhave symptoms of obstruction and was transferred to ___. At\n___ he underwent another ERCP where a purulent drainage was\nnoted from the biliary tree and a stent was placed. He\neventually recovered from his cholangitis episode and has been \nat\na rehab facility since his discharge from the hospital on \n___. The patient was consulted by Dr. ___ elective \ncholecystectomy. After discussion of all risks, benefits and \npossible outcome, the patient was scheduled for elective \noperation on ___.', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'ENTAcapone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': '5X/DAY', 'doses_per_24_hrs': 5.0}, {'medication': 'Rivaroxaban', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Artificial Tears', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'QID: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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Escitalopram Oxalate', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'ENTAcapone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carbidopa-Levodopa CR (50-200)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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': 'Acetaminophen', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Carbidopa-Levodopa (25-100)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Lactulose', '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': '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/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '78.1', 'valuenum': 78.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '2', 'valuenum': 2.0, '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': '23', 'valuenum': 23.0, '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': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 0.93, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', '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': '7.30', 'valuenum': 7.3, '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': '138', 'valuenum': 138.0, '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': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, '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': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.64', 'valuenum': 3.64, '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': '48.1', 'valuenum': 48.1, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 156.0, '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': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': 140.0, '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '8.9', 'valuenum': 8.9, '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': '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': '146', 'valuenum': 146.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.95', 'valuenum': 2.95, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '25.2', 'valuenum': 25.2, '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': '30.6', 'valuenum': 30.6, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, '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': '8.6', 'valuenum': 8.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.7', 'valuenum': 49.7, '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': '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': 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': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'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': '2', 'valuenum': 2.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.033', 'valuenum': 1.033, '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': 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}], 'exams': 'On Discharge:\nVS: 98.4, 76, 131/51, 16, 97% RA\nGEN: Somewhat confused\nCV: RRR\nPULM: Bibasilal crackles, diminished b/l on bases L>R. \nABD: Right subcostal incision with staples. Lateral part open \nand packed with moist-to-dry gauze. Minimal erythema, no \ndrainage or leak.\nGI: Foley catheter in place to gravity.\nEXTR: Warm, +pp', 'diagnoses': [{'icd_code': 'T84020A', 'desc': 'Dislocation of internal right hip prosthesis, initial encounter'}, {'icd_code': 'I824Z3', 'desc': 'Acute embolism and thrombosis of unspecified deep veins of distal lower extremity, bilateral'}, {'icd_code': 'Y838', 'desc': 'Other surgical procedures as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}, {'icd_code': 'G20', 'desc': "Parkinson's disease"}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'M9701XA', 'desc': 'Periprosthetic fracture around internal prosthetic right hip joint, initial encounter'}, {'icd_code': 'Z86718', 'desc': 'Personal history of other venous thrombosis and embolism'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z66', 'desc': 'Do not resuscitate'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}], 'summary': "___ 06:45AM BLOOD WBC-12.3* RBC-3.26* Hgb-10.7* Hct-32.9* \nMCV-101* MCH-32.8* MCHC-32.5 RDW-13.6 Plt ___\n___ 07:05AM BLOOD Glucose-138* UreaN-26* Creat-1.5* Na-140 \nK-4.5 Cl-112* HCO3-18* AnGap-15\n\n___ EKG: Sinus rhythm. Borderline left ventricular \nhypertrophy. Compared to the previous tracing of ___ no \nsignificant changes are noted.\n\n___ CRX:\nLeft lower lung is entirely airless. Since there has previously \nbeen some \nvolume loss on that side, I suspect this is chronic recurrent \ncollapse, but it raises questions about aspiration or retained \nsecretions. Heart is moderately enlarged, unchanged. The \ncalcified aortic knob is discernable and widened upper \nmediastinum which could be due to fat and dilated head and neck \nvessels. If there is clinical need to define vascular anatomy, \nCTA would be required.\nThe patient was admitted to the General Surgical Service for \nelective cholecystectomy. On ___, the patient underwent \nopen cholecystectomy with intraoperative cholangiogram, which \nwent well without complication (reader referred to the Operative \nNote for details). After a brief, uneventful stay in the PACU, \nthe patient arrived on the floor NPO, on IV fluids, with a foley \ncatheter, JP drain to bulb, and IV Dilaudid for pain control. \nThe patient's K was 6.2 in the PACU, he received gluconate and \ninsulin x 1, repeat K was 5.6. The patient was hemodynamically \nstable.\nNeuro: The patient received IV Dilaudid immediately with good \neffect and adequate pain control. When tolerating oral intake, \nthe patient was transitioned to oral pain medications. The \npatient was noticed to have episodes of altered mental status on \nPOD # 0, the patient was given IV Haloperidol and mental status \nreturned to baseline. The patient continued to have episodes of \nconfusion for next 2 day, he was easily converted back to \nbaseline with simple orientations and Haloperidol prn. Before \ndischarge back in Rehab, patient returned to his baseline mental \nstatus. \nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\nPulmonary: The patient was noticed to have adventitious breath \nsounds. CXR revealed LLL collapsed and he was started on \naggressive nebulizers treatment with Mycomycin, Albuterol and \nIpratropium, chest ___ was ordered. The patient's respiratory \nstatus improved, he will need to continue on nebulizers and \nintensive spirometry after discharge. \nGI: Post-operatively, the patient was made NPO with IV fluids. \nDiet was advanced on POD # 1 to clears and made NPO secondary to \nhigh risk for aspiration. Speech and swallow evaluation was \nordered, the patient failed on POD # 3 secondary to agitation. \nHe passed SS on POD # 4 and diet was advanced to ground solids \nwith thin liquids, diet was tolerated well. Electrolytes were \nroutinely followed, and repleted when necessary.\nGU: The patient arrived in the hospital with Foley catheter in \nplaced, his urine output was monitored during hospitalization. \nHe was discharged back in facility with Foley. \nID: Blanched erythema was noticed around incision on POD # 3. \nLateral part of right subcostal incision was open and ~ 20 cc of \npurulent fluid was expressed from the wound. The wound was \npacked with DSD and patient was started on Keflex ___ mg TID \nsecondary to his kidney clearance. The patient's erythema \nsubsided with packing and Abx treatment. He will continue on PO \nAbx x 7 days, last day of Keflex on ___. \nEndocrine: The patient has a history of DM and his ___ was \nmonitored throughout hospitalization. When diet was advanced, \npatient's Lantus was restarted at 25 units ___. The patient's \nblood sugars were within normal range and no SS Insulin was \nrequired. He was discharged in Rehab on 25 units of Lantus ___. \nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required. His Plavix and Aspirin \nwas restarted on POD # 1. \nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay. He was followed by \nPhysical Therapy during hospitalization.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ngrounded diet and pain was well controlled. The patient \nreceived discharge teaching and follow-up instructions with \nunderstanding verbalized and agreement with the discharge plan."}}
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{'final_diagnoses': ['Cholelithiasis', 'Choledocholithiasis', 'Wound infection'], 'procedures': ['Laparoscopic converted to open cholecystectomy.', 'Intraoperative cholangiogram.', 'Transcystic common bile duct exploration.'], 'visit_summary': "The patient was admitted to the General Surgical Service for \nelective cholecystectomy. On ___, the patient underwent \nopen cholecystectomy with intraoperative cholangiogram, which \nwent well without complication (reader referred to the Operative \nNote for details). After a brief, uneventful stay in the PACU, \nthe patient arrived on the floor NPO, on IV fluids, with a foley \ncatheter, JP drain to bulb, and IV Dilaudid for pain control. \nThe patient's K was 6.2 in the PACU, he received gluconate and \ninsulin x 1, repeat K was 5.6. The patient was hemodynamically \nstable.\nNeuro: The patient received IV Dilaudid immediately with good \neffect and adequate pain control. When tolerating oral intake, \nthe patient was transitioned to oral pain medications. The \npatient was noticed to have episodes of altered mental status on \nPOD # 0, the patient was given IV Haloperidol and mental status \nreturned to baseline. The patient continued to have episodes of \nconfusion for next 2 day, he was easily converted back to \nbaseline with simple orientations and Haloperidol prn. Before \ndischarge back in Rehab, patient returned to his baseline mental \nstatus. \nCV: The patient remained stable from a cardiovascular \nstandpoint; vital signs were routinely monitored.\nPulmonary: The patient was noticed to have adventitious breath \nsounds. CXR revealed LLL collapsed and he was started on \naggressive nebulizers treatment with Mycomycin, Albuterol and \nIpratropium, chest ___ was ordered. The patient's respiratory \nstatus improved, he will need to continue on nebulizers and \nintensive spirometry after discharge. \nGI: Post-operatively, the patient was made NPO with IV fluids. \nDiet was advanced on POD # 1 to clears and made NPO secondary to \nhigh risk for aspiration. Speech and swallow evaluation was \nordered, the patient failed on POD # 3 secondary to agitation. \nHe passed SS on POD # 4 and diet was advanced to ground solids \nwith thin liquids, diet was tolerated well. Electrolytes were \nroutinely followed, and repleted when necessary.\nGU: The patient arrived in the hospital with Foley catheter in \nplaced, his urine output was monitored during hospitalization. \nHe was discharged back in facility with Foley. \nID: Blanched erythema was noticed around incision on POD # 3. \nLateral part of right subcostal incision was open and ~ 20 cc of \npurulent fluid was expressed from the wound. The wound was \npacked with DSD and patient was started on Keflex ___ mg TID \nsecondary to his kidney clearance. The patient's erythema \nsubsided with packing and Abx treatment. He will continue on PO \nAbx x 7 days, last day of Keflex on ___. \nEndocrine: The patient has a history of DM and his ___ was \nmonitored throughout hospitalization. When diet was advanced, \npatient's Lantus was restarted at 25 units ___. The patient's \nblood sugars were within normal range and no SS Insulin was \nrequired. He was discharged in Rehab on 25 units of Lantus ___. \nHematology: The patient's complete blood count was examined \nroutinely; no transfusions were required. His Plavix and Aspirin \nwas restarted on POD # 1. \nProphylaxis: The patient received subcutaneous heparin and \nvenodyne boots were used during this stay. He was followed by \nPhysical Therapy during hospitalization.\nAt the time of discharge, the patient was doing well, afebrile \nwith stable vital signs. The patient was tolerating a regular \ngrounded diet and pain was well controlled. The patient \nreceived discharge teaching and follow-up instructions with \nunderstanding verbalized and agreement with the discharge plan.", 'medications_prescribed': ['Albuterol 0.083% Neb Soln 1 NEB IH Q4H ', 'Amlodipine 10 mg PO DAILY ', 'Aspirin 325 mg PO DAILY ', 'Brimonidine Tartrate 0.15% Ophth. 1 DROP BOTH EYES Q 12H ', 'Clopidogrel 75 mg PO DAILY ', 'Docusate Sodium 100 mg PO BID ', 'FoLIC Acid 1 mg PO DAILY ', 'Glargine 25 Units Bedtime', 'Insulin SC Sliding Scale using REG Insulin', 'Ipratropium Bromide Neb 1 NEB IH Q6H sob ', 'Methimazole 5 mg PO DAILY ', 'Multivitamins 1 TAB PO DAILY ', 'Simvastatin 20 mg PO DAILY ', 'Thiamine 100 mg PO DAILY ', 'Cephalexin 500 mg PO Q8H ', 'Famotidine 20 mg PO Q24H ', 'Acetaminophen 650 mg PO TID ', 'OxycoDONE (Immediate Release) 2.5-5 mg PO Q4H:PRN pain ', 'Acular *NF* (ketorolac) 0.5 % ___ TID ', 'travoprost *NF* 0.004 % ___ ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 23, 'gender': 'F', 'symptoms': 'Rash on feet bilaterally, hypotension', 'medical_history': ['Amyloid cardiomyopathy', 'Diastolic congestive heart failure, acute', 'Pneumonia', 'Gout', 'End-stage renal disease, dry weight 56 kg, ___ HD, L AVF', 'Mulitfocal atrial tachycardia', 'Sarcoidosis (___) skin involvement and kidney biopsy showing \nnon-necrotizing granulomas; started on prednisone', 'Monocloncal gammopathy of undetermined significance (___) ', 'Hypertension - resolved with hemodialysis-', 'Renal osteodystrophy', 'Anemia of chronic disease', 'Depression', 'Fibromyalgia', 'Anxiety', 'Left foot drop', 'Low back pain'], 'family_history': 'Father: ___ from lung cancer, was on dialysis, had AAA; \nSisters: lung cancer, breast cancer, CAD.', 'present_illness': 'Ms ___ is a ___ with complex PMH presenting to the BI ED \nwith bilateral foot swelling and blisters, now transferred to \nICU for acute hypotension. \n\nShe has a complex PMH and notable recent medication changes, \nspecifically:\n- sarcoidosis and ESRD (presumed ___ sarcoidosis, HD ___, L \nAVF), \n- MGUS (on chronic prednisone)\n- systemic amyloidosis (diagnosed ___ through cardiac and upper \nGI tissue biopsy; started on cyclophosphamide and bortezomib, \nand dexamethasone 8mg per week)\n- HSV esophagitis with ulcerations and stomach erythema \n(diagnosed with recent EGD, treatment with acyclovir started on \n___\n- gout flare at end of recent hospitalization, treated with \ncolchicine and prednisone\n\nTwo days prior to admission, four days after beginning \nchemotherapy with cyclophosphamide and bortezomib, she began to \nhave foot swelling with painful fluid-filled bullae and skin \nsloughing. Location is symmetric on dorsum of feet. Pain and \nitching is present with and without touching the area. She has \nbeen using lotions topically to soothe the itching. No history \nof similar rash, no other rashes on body. No leukocytosis or \nfever is present.\n\nWhile in the ED for evaluation, Ms ___ became hypotensive to \nSBP ___. Femoral line was placed for access, received 2L NS with \nSBP improving to 90-100s. Hct dropped from 43 to 33, 35 on \nrecheck. Given recent history of HSV esophagitis and EGD showing \nsuperficial ulcers and erythema in stomach, GI was consulted to \nassess for bleeding. Stool was brown, guiac positive but no \nhematemesis, melena, hematochezia, leading to the conclusion \nthat there was no clear evidence of active GI bleeding, and no \nneed for emergent endoscopy at the time. IV vancomycin, \ncefepime and pantoprazole were started. She was given dilaudid \nfor pain control.', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 7.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '___', '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': 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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '31.3', 'valuenum': 31.3, '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': '98', 'valuenum': 98.0, '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': '13.6', 'valuenum': 13.6, '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': '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': '49.0', 'valuenum': 49.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nGENERAL: Alert, oriented, tired\nHEENT: Pupils equal, round and reactive to light. Extraocular\nmuscles intact. Sclerae anicteric. Conjunctivae pink. \nOropharynx clear with multiple small ~10mm petechiae/ulcers on \nroof of mouth and in perioral area. No macroglossia noted.\nNECK: Supple, JVP ___\nLYMPH NODES: No palpable cervical, supraclavicular, or axillary\nlymphadenopathy.\nCHEST: Coarse inspiratory crackles at lung bases bilaterally. \nNo increased work of breathing or use of accessory muscles.\nHEART: Regular rate and rhythm, normal S1, S2.\nABDOMEN: Soft, nontender, nondistended.\nEXTREMITIES: AV fistula with thrill in L upper extremity. Lower \nextremities with 2+ pitting edema bilaterally. Foot reveals skin \nbreakdown on dorsum of feet extending to lower ankles. \nSymmetric, pruritic, flaccid, blistering lesions on dorsum of \nfeet, and extending up R ankle to calf\nNEUROLOGIC: The patient is oriented x 3. Cranial nerves \nintact. Gait not tested. Moving all four extremities.\n\nDISCHARGE PHYSICAL EXAM:\n ', 'diagnoses': [{'icd_code': 'N132', 'desc': 'Hydronephrosis with renal and ureteral calculous obstruction'}, {'icd_code': 'E213', 'desc': 'Hyperparathyroidism, unspecified'}], 'summary': "___ 08:00PM BLOOD WBC-10.1 RBC-4.23 Hgb-14.0 Hct-43.2 \nMCV-102* MCH-33.2* MCHC-32.4 RDW-17.5* Plt Ct-99*\n___ 08:00PM BLOOD Neuts-87.0* Lymphs-8.4* Monos-3.6 Eos-0.9 \nBaso-0.1\n___ 04:47AM BLOOD Hypochr-2+ Anisocy-1+ Poiklo-2+ \nMacrocy-1+ Microcy-NORMAL Polychr-NORMAL Target-2+\n___ 08:00PM BLOOD Plt Smr-LOW Plt Ct-99*\n___ 09:00PM BLOOD Glucose-88 UreaN-13 Creat-2.1*# Na-133 \nK-6.5* Cl-97 HCO3-26 AnGap-17\n___ 04:47AM BLOOD Ret Aut-PND\n___ 09:00PM BLOOD ALT-68* AST-98* LD(LDH)-778* AlkPhos-102 \nTotBili-0.6\n___ 09:00PM BLOOD Albumin-3.5 Calcium-8.7 Phos-1.6*# Mg-1.8\n___ 04:47AM BLOOD calTIBC-183* ___ Ferritn-1055* \nTRF-141*\n___ 09:07PM BLOOD Lactate-2.1*\n\nINTERVAL IMAGING, LABS & STUDIES\n___ TTE\nThere is moderate symmetric left ventricular hypertrophy. The \nleft ventricular cavity is small. Overall left ventricular \nsystolic function is low normal (LVEF= 50%). Tissue Doppler \nimaging suggests an increased left ventricular filling pressure \n(PCWP>18mmHg). The right ventricular free wall is hypertrophied. \nRight ventricular chamber size is normal. with mild global free \nwall hypokinesis. The mitral valve leaflets are mildly \nthickened. Trivial mitral regurgitation is seen. The tricuspid \nvalve leaflets are mildly thickened. The supporting structures \nof the tricuspid valve are thickened/fibrotic. The estimated \npulmonary artery systolic pressure is normal. There is a \ntrivial/physiologic pericardial effusion. There are no \nechocardiographic signs of tamponade. \n\nIMPRESSION: amyloid heart; trivial pericardial effusion\n\nCompared with the prior study (images reviewed) of ___, \nthe pericardial effusion is smaller (now trivial). Findings of \namyloid heart are again noted. \n\nDISCHARGE LABS\n\n___ with h/o sarcoidosis, ESRD, gout, recent HSV esophagitis on \nacyclovir, and recent diagnosis of systemic amyloidosis with \ncyclophosphamide, bortezomib, and dexamethasone, presenting to \nthe BI ED with foot blisters and hypotension, hospital stay \ncomplicated by a PEA arrest.\n\n#Hypotension: Sepsis and infection should be ruled out in this \nimmunosuppressed patient, despite the absence of fever and \nleukocytosis. Source of infection include cellulitis from \nblisters and viral causes of systemic infection. Inflammatory \nresponse to drug reaction is also possibility. GIB has been \nconsidered particularly i/s/o recent HSV esophagitis, but no \nsigns of overt GIB in form of hemotochezia, hematemesis, melena. \nCardiogenic causes may also be considered in the setting of HD \npatient with preload sensitivity and restrictive cardiomyopathy \n___ amyloidosis. In the past she has had fluid shifts leading to \npleural effusions, thoracentesis, and acute hypotensive \nepisodes. However, no fluid shifts were observed in the \nimmediate timing prior to hypotension. Diagnostic blood cultures \nwere obtained on admission. GI was consulted, and found no \nevidence of overt GIB but recommended IV pantoprazole. \nDermatology was consulted for assesment of rash. Access was \nsecured with a femoral line. She was started on IV vancomycin \nand cefipime for broad spectrum cellulitis coverage, pending \ndermatology recs and rash/wound assessment. Fluid resuscitation \nin the ED was in the volume of ~2L, and she was given no fluid \nor pressors in the ICU. Following initial resuscitation in the \nED, she maintained SBP>90 and MAP>60. On the floor patient's \nblood pressures improved to SBP ___ with 250cc IVF boluses. \nCardiology was consulted who though patient was dry, below ideal \ndry weight, previously documented at 51.5kg, during most recent \nHD session recorded at 49kg. As patient has amyloid \ncardiomyopathy and preload dependent, will likely need to be \nmaintained at weight 51.5kg which was discussed with inpatient \ndialysis team. \n\n#Blisters: Time course suggests reaction to initiation of \nchemotherapy, whether drug reaction or infection following \nfurther immunosuppression. Differential is broad for symmetric, \npruritic, flaccid, blistering lesions on dorsum of feet, and \nincludes pemphigus, bullous pemphigoid, drug-induced bullous \ndisorder, viral infection, tinea pedis. Dermatology consult was \nplaced. Pain was controlled initially with PO and IV dilaudid, \ntransitioned to PO dilaudid, acetaminophen, and gabapentin \nuptitrated to 200mg PO qhs. Dermatology felt this to be most \nlikely edema blisters. Wound cultures showed yeast, rare coag \nnegative staph. The blisters were treated initially with \nvancomycin and cefepime, however with low susicion for infection \nthese were discontinued on ___. Wound care per dermatology \nrecommendations: daily changing of Xeroform followed by Soft \nKerlix, can use topical Lidocaine for local pain control. Please \nelevate to help with edema. \n\n#Anemia: Contributing factor may be baseline anemia ___ ESRD or \niron deficiency, although baseline Hgb in recent hospitalization \nappears to be wnl (13 -> 10.7). Notably, all cell lines down \ncompared to initial CBC performed in ED. Possibly dilution from \nNS resuscitation. Another possibility is hemolysis due to viral \nillness, drug reaction to chemotherapy, or oncologic illness. \nCannot exclude volume loss in the setting of GI bleeding (stool \nis guiac positive but no signs of overt bleeding). Iron studies \n(Fe, TIBC, ferritin), hemolysis studies (LDH, indirect \nbilirubin) were sent. She did not receive any blood products in \nthe ICU.\n\n#ESRD: Dialysis continuing ___. She reports her dry weight \nmay be 56kg; on admission, weight was 49.5kg. Renal team was \nconsulted for dialysis, to be continued on schedule. Medications \nwere dose adjusted for dialysis. She continued home sucralfate \nbut home sevelamir was not continued since patient noted that \nthis medication has been discontinued. During HD ___ patient \nnoted to have difficult left AV fistula access. Underwent \nfistulogram ___ which showed several areas of tight stenosis \nwhich were opened with balloon dilatation without stenting. \n\n#Amyloidosis: She was continued on prednisone 5mg per her most \nrecent taper. She was due to receive port on ___ for further \nchemotherapy, but this was deferred in the setting of ICU \nadmission. She was seen by the ___ team. Her outpatient \noncologist was contacted regarding hospital events and further \ntreatment plan. \n\n#HSV esophagitis: She was placed on acyclovir 800mg q12hr 14 \ndays (___). Acyclovir was continued per her prior \ndischarge summary. \n\n#Mutifocal atrial tachycardia: Had been on amiodarone load, \ntransitioned to 200mg PO daily ___, at cardiology recommendation \ndecreased to 100mg PO daily ___. \n\n#Access: Patient has ESRD with difficult IV access. She \ninitially had R femoral IJ placed. Given patient was on \nantibiotics decision made not to place portacath at this time, \ninstead had temporary right IJ placed by ___ ___. \n\nChronic issues\n#HTN: continued home amlodipine and held home losartan in \nsetting of hypotension\n#Anxiety: continued home sertraline\n#GERD: cont home ranitidine in addition to pantoprazole\n#Gout: cont allopurinol\n\nICU Re-admission\n#PEA arrest: While on the ___ service following her initial FICU \nadmission, she triggered for hypotension early in the AM of ___, \nshe was give 250 cc of NS and AM cortisol was checked, which \nreturned normal. She had an echo on ___ that showed amyloid \nheart with a trivial pericardial effusion. Cardiology was \nconsulted and they recommended decreasing amiodarone for MAT, \navoiding other medications that slow heart rate, volume status \ncontrol with HD and to consider higher post-HD weight, given \nrestrictive cardiac disease and as such, is preload dependent. \nOn ___, antibiotics were stopped. In the early AM of ___, the \npatient was found to be pulseless. A code blue was called. After \nCPR and 3 rounds of epinephrine, the patient regained her pulse. \nShe was intubated, after multiple attempts. Her FSG was <20, \nwhich was treated with 2 ampoules of bicarbonate. She was \nurgently transferred to the FICU to begin post-cardiac arrest \ncooling, as she was non-responsive. Etiology of the PEA was \nthought to be hypoglycemia, exacerbated by the possible liver \namyloid disease. In the FICU, she underwent cooling and \nre-warming per the ___ Sun protocol. Neurology was consulted; \nEEG and MRI were promising, and she improved in ability to \nrespond to commands and open eyes to auditory stimuli. She had \n___ beat Vtach multiple times in the ICU without any acute drop \nin BP.\n\n#Fevers: While in the ICU, she spiked multiple fevers to ___. \nShe was pan-cultured with no infectious source identified, and \nshe was treated with 48hrs iv vanc/zosyn. Her R femoral line was \npulled on admission to ICU on ___. \n\n#Respiratory failure: In the ICU she maintained need for \nintubation. CXR revealed pleural effusions. Renal was consulted \nto remove extra fluid during HD, while allowing elevated pressor \nrequirement during dialysis.\n\n#Toe necrosis: Toes appeared to be dark blue/black in color; \nvascular surgery was consulted with concern for necrosis. \nBear-huggers were placed for warming. Pressors were slowly \nweaned in balance with HD pressor requirement.\n\nAs the patient made some improvement in mental status, she was \nstill unable to be weaned from the ventilator. After 10 days of \nintubation with ETT, discussions with Mrs. ___ husband, \n___, were had. He expressed that she would not want to be \ntrached and kept alive on a ventilator. It was decided to \npalliatively extubate her, and transition her to comfort-focused \ncare. She expired shortly after discontinuing the endotracheal \ntube and pressors."}}
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{'final_diagnoses': ['hypoxemic respiratory failure', 'pulseless electrical activity cardiac arrest', 'amyloidosis', 'sarcoidosis'], 'procedures': ['R femoral dialysis catheter', 'R radial arterial line', 'endotracheal intubation', 'R IJ CVL'], 'visit_summary': "___ with h/o sarcoidosis, ESRD, gout, recent HSV esophagitis on \nacyclovir, and recent diagnosis of systemic amyloidosis with \ncyclophosphamide, bortezomib, and dexamethasone, presenting to \nthe BI ED with foot blisters and hypotension, hospital stay \ncomplicated by a PEA arrest.\n\n#Hypotension: Sepsis and infection should be ruled out in this \nimmunosuppressed patient, despite the absence of fever and \nleukocytosis. Source of infection include cellulitis from \nblisters and viral causes of systemic infection. Inflammatory \nresponse to drug reaction is also possibility. GIB has been \nconsidered particularly i/s/o recent HSV esophagitis, but no \nsigns of overt GIB in form of hemotochezia, hematemesis, melena. \nCardiogenic causes may also be considered in the setting of HD \npatient with preload sensitivity and restrictive cardiomyopathy \n___ amyloidosis. In the past she has had fluid shifts leading to \npleural effusions, thoracentesis, and acute hypotensive \nepisodes. However, no fluid shifts were observed in the \nimmediate timing prior to hypotension. Diagnostic blood cultures \nwere obtained on admission. GI was consulted, and found no \nevidence of overt GIB but recommended IV pantoprazole. \nDermatology was consulted for assesment of rash. Access was \nsecured with a femoral line. She was started on IV vancomycin \nand cefipime for broad spectrum cellulitis coverage, pending \ndermatology recs and rash/wound assessment. Fluid resuscitation \nin the ED was in the volume of ~2L, and she was given no fluid \nor pressors in the ICU. Following initial resuscitation in the \nED, she maintained SBP>90 and MAP>60. On the floor patient's \nblood pressures improved to SBP ___ with 250cc IVF boluses. \nCardiology was consulted who though patient was dry, below ideal \ndry weight, previously documented at 51.5kg, during most recent \nHD session recorded at 49kg. As patient has amyloid \ncardiomyopathy and preload dependent, will likely need to be \nmaintained at weight 51.5kg which was discussed with inpatient \ndialysis team. \n\n#Blisters: Time course suggests reaction to initiation of \nchemotherapy, whether drug reaction or infection following \nfurther immunosuppression. Differential is broad for symmetric, \npruritic, flaccid, blistering lesions on dorsum of feet, and \nincludes pemphigus, bullous pemphigoid, drug-induced bullous \ndisorder, viral infection, tinea pedis. Dermatology consult was \nplaced. Pain was controlled initially with PO and IV dilaudid, \ntransitioned to PO dilaudid, acetaminophen, and gabapentin \nuptitrated to 200mg PO qhs. Dermatology felt this to be most \nlikely edema blisters. Wound cultures showed yeast, rare coag \nnegative staph. The blisters were treated initially with \nvancomycin and cefepime, however with low susicion for infection \nthese were discontinued on ___. Wound care per dermatology \nrecommendations: daily changing of Xeroform followed by Soft \nKerlix, can use topical Lidocaine for local pain control. Please \nelevate to help with edema. \n\n#Anemia: Contributing factor may be baseline anemia ___ ESRD or \niron deficiency, although baseline Hgb in recent hospitalization \nappears to be wnl (13 -> 10.7). Notably, all cell lines down \ncompared to initial CBC performed in ED. Possibly dilution from \nNS resuscitation. Another possibility is hemolysis due to viral \nillness, drug reaction to chemotherapy, or oncologic illness. \nCannot exclude volume loss in the setting of GI bleeding (stool \nis guiac positive but no signs of overt bleeding). Iron studies \n(Fe, TIBC, ferritin), hemolysis studies (LDH, indirect \nbilirubin) were sent. She did not receive any blood products in \nthe ICU.\n\n#ESRD: Dialysis continuing ___. She reports her dry weight \nmay be 56kg; on admission, weight was 49.5kg. Renal team was \nconsulted for dialysis, to be continued on schedule. Medications \nwere dose adjusted for dialysis. She continued home sucralfate \nbut home sevelamir was not continued since patient noted that \nthis medication has been discontinued. During HD ___ patient \nnoted to have difficult left AV fistula access. Underwent \nfistulogram ___ which showed several areas of tight stenosis \nwhich were opened with balloon dilatation without stenting. \n\n#Amyloidosis: She was continued on prednisone 5mg per her most \nrecent taper. She was due to receive port on ___ for further \nchemotherapy, but this was deferred in the setting of ICU \nadmission. She was seen by the ___ team. Her outpatient \noncologist was contacted regarding hospital events and further \ntreatment plan. \n\n#HSV esophagitis: She was placed on acyclovir 800mg q12hr 14 \ndays (___). Acyclovir was continued per her prior \ndischarge summary. \n\n#Mutifocal atrial tachycardia: Had been on amiodarone load, \ntransitioned to 200mg PO daily ___, at cardiology recommendation \ndecreased to 100mg PO daily ___. \n\n#Access: Patient has ESRD with difficult IV access. She \ninitially had R femoral IJ placed. Given patient was on \nantibiotics decision made not to place portacath at this time, \ninstead had temporary right IJ placed by ___ ___. \n\nChronic issues\n#HTN: continued home amlodipine and held home losartan in \nsetting of hypotension\n#Anxiety: continued home sertraline\n#GERD: cont home ranitidine in addition to pantoprazole\n#Gout: cont allopurinol\n\nICU Re-admission\n#PEA arrest: While on the ___ service following her initial FICU \nadmission, she triggered for hypotension early in the AM of ___, \nshe was give 250 cc of NS and AM cortisol was checked, which \nreturned normal. She had an echo on ___ that showed amyloid \nheart with a trivial pericardial effusion. Cardiology was \nconsulted and they recommended decreasing amiodarone for MAT, \navoiding other medications that slow heart rate, volume status \ncontrol with HD and to consider higher post-HD weight, given \nrestrictive cardiac disease and as such, is preload dependent. \nOn ___, antibiotics were stopped. In the early AM of ___, the \npatient was found to be pulseless. A code blue was called. After \nCPR and 3 rounds of epinephrine, the patient regained her pulse. \nShe was intubated, after multiple attempts. Her FSG was <20, \nwhich was treated with 2 ampoules of bicarbonate. She was \nurgently transferred to the FICU to begin post-cardiac arrest \ncooling, as she was non-responsive. Etiology of the PEA was \nthought to be hypoglycemia, exacerbated by the possible liver \namyloid disease. In the FICU, she underwent cooling and \nre-warming per the ___ Sun protocol. Neurology was consulted; \nEEG and MRI were promising, and she improved in ability to \nrespond to commands and open eyes to auditory stimuli. She had \n___ beat Vtach multiple times in the ICU without any acute drop \nin BP.\n\n#Fevers: While in the ICU, she spiked multiple fevers to ___. \nShe was pan-cultured with no infectious source identified, and \nshe was treated with 48hrs iv vanc/zosyn. Her R femoral line was \npulled on admission to ICU on ___. \n\n#Respiratory failure: In the ICU she maintained need for \nintubation. CXR revealed pleural effusions. Renal was consulted \nto remove extra fluid during HD, while allowing elevated pressor \nrequirement during dialysis.\n\n#Toe necrosis: Toes appeared to be dark blue/black in color; \nvascular surgery was consulted with concern for necrosis. \nBear-huggers were placed for warming. Pressors were slowly \nweaned in balance with HD pressor requirement.\n\nAs the patient made some improvement in mental status, she was \nstill unable to be weaned from the ventilator. After 10 days of \nintubation with ETT, discussions with Mrs. ___ husband, \n___, were had. He expressed that she would not want to be \ntrached and kept alive on a ventilator. It was decided to \npalliatively extubate her, and transition her to comfort-focused \ncare. She expired shortly after discontinuing the endotracheal \ntube and pressors.", 'medications_prescribed': []}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 63, 'gender': 'F', 'symptoms': 'Right leg swelling', 'medical_history': ['Relasping/Remitting Multiple Sclerosis: Optic neuritis, \nbladder dysfunction, sensory deficits and motor dysfunction. \nUses motorized wheelchair for ___ the day', 'Osteonecrosis of knees and hip', 'chronic pain', 'hypersomnia', 'myoclonic', 'osteoporosis (status post T6 compression fracture)', 'chronic UTIs', 'anemia', 'hx of rheumatic fever', 'PUD', 'trigeminal neuralgia', 'hx of esophageal erosion', 'pseudogout', 'hoarseness', 's/p appy', 's/p TAH/BSO', 'hx of recto-vaginal fistula', 'Hx of PE with anticardiolipin Ab', '? bacterial bronchitis ___ with MRSA growth on throat \nculture', 'History of urinary retention ___'], 'family_history': 'non-contributory', 'present_illness': '___ y/o F s/p Right ___ complicated by cellulitis of \nright distal \nshin w Keflex x 10 days but still looks erythematous, seen ___ \nin clinic by Dr ___/ focal erythema at 3 vicryls at intact \nincision, sent to ED from clinic for Arthrocentesis and \nadmission to Ortho service with ID consult and further work-up. \n\nPrior h/o extremity cellulitis. Seen in clinic ___ w/ RLE \ncellulitis and admitted for IV antibiotics.', 'medications': [{'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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Nystatin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', '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': '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': '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': 'DAILY', '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': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LOPERamide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate sliding scale (Critical Care-Ionized calcium)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Valsartan', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q24H', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 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': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H: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': 'Loratadine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextromethorphan Polistirex', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': 2.0}, {'medication': 'RisperiDONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Vitamin D', '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': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'BuPROPion', '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', 'route': 'PO/NG', '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': 'Dextromethorphan Polistirex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H: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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.94', 'valuenum': 1.94, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, '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': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '70.8', 'valuenum': 70.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '234', 'valuenum': 234.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.02', 'valuenum': 3.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '0.30', 'valuenum': 0.3, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.28', 'valuenum': 1.28, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.81', 'valuenum': 8.81, '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': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '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': '___', 'valuenum': 18.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '112', 'valuenum': 112.0, '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': 0.02, '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': '41', 'valuenum': 41.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely decreases this test.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 68.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.4', 'valuenum': 10.4, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.9, . estimated GFR (eGFR) is likely between 26 and 32 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': 56.0, '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': '424', 'valuenum': 424.0, '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': '15', 'valuenum': 15.0, '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': '___', 'valuenum': 459.0, 'valueuom': 'pg/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 353.0, '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': '___', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '___', 'valuenum': 4.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'Hemolysis falsely elevates this test.'}, {'value': '136', 'valuenum': 136.0, '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': '25', 'valuenum': 25.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 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': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.004', 'valuenum': 1.004, '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': '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': 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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', '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': '9', 'valuenum': 9.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 82.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '16', 'valuenum': 16.0, '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': '281', 'valuenum': 281.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '3.3', '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': '1.6', 'valuenum': 1.6, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, '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': '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': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.96', 'valuenum': 2.96, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '60.0', 'valuenum': 60.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87.8', 'valuenum': 87.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '73.5', 'valuenum': 73.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.89', 'valuenum': 0.89, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', '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': '5.5', 'valuenum': 5.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.4', 'valuenum': 24.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '98', 'valuenum': 98.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67.4', 'valuenum': 67.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.48', 'valuenum': 2.48, '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': '0.02', 'valuenum': 0.02, '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': '0.71', 'valuenum': 0.71, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.13', 'valuenum': 4.13, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 0.7, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '___', 'valuenum': 3.3, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Normal diurnal pattern: 7-10am 6.2-19.4 / 4-8pm 2.3-11.9.'}, {'value': '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': 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': '7', 'valuenum': 7.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77.1', 'valuenum': 77.1, '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': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '98', 'valuenum': 98.0, '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': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.52', 'valuenum': 2.52, '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': '55.6', 'valuenum': 55.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, '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': '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': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63.3', 'valuenum': 63.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', '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': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.70', 'valuenum': 2.7, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '0.39', 'valuenum': 0.39, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.66', 'valuenum': 0.66, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.83', 'valuenum': 3.83, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '55.3', 'valuenum': 55.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 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': '7', 'valuenum': 7.0, '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': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '84.3', 'valuenum': 84.3, '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': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '210', 'valuenum': 210.0, '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': '2.76', 'valuenum': 2.76, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '57.5', 'valuenum': 57.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '7', 'valuenum': 7.0, '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': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', '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': '141', 'valuenum': 141.0, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '55.1', 'valuenum': 55.1, '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': '8.5', 'valuenum': 8.5, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, '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': '2.74', 'valuenum': 2.74, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '57.9', 'valuenum': 57.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '8.5', 'valuenum': 8.5, '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': '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '231', 'valuenum': 231.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.75', 'valuenum': 2.75, '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': '57.5', 'valuenum': 57.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '6', 'valuenum': 6.0, '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': '1.8', '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, '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': '31.5', 'valuenum': 31.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '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': '___', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'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': 167.0, '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': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY.'}, {'value': '___', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY ALTERNATE METHODOLOGY. ANION GAP VERIFIED.'}, {'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': '71', 'valuenum': 71.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '248', 'valuenum': 248.0, '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': '2.74', 'valuenum': 2.74, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '58.1', 'valuenum': 58.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.2, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'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': '17', 'valuenum': 17.0, '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': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, '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 1.6, . estimated GFR (eGFR) is likely between 32 and 39 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': 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': '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, '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}, {'value': '___', 'valuenum': 1.44, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'value': '1.86', 'valuenum': 1.86, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, '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': '18.2', 'valuenum': 18.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '71.3', 'valuenum': 71.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '2.97', 'valuenum': 2.97, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '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': '0.11', 'valuenum': 0.11, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.71', 'valuenum': 0.71, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '58.2', 'valuenum': 58.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '54', 'valuenum': 54.0, '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': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 10.3, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 155.0, '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': '261', 'valuenum': 261.0, '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': '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': '5.3', 'valuenum': 5.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, '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': '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': '31.4', 'valuenum': 31.4, '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.5', 'valuenum': 57.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '12', 'valuenum': 12.0, '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': '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': '4.4', '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': '39', 'valuenum': 39.0, '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': '___', 'valuenum': 1.23, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LEVELS SHOULD BE OBTAINED 4-6 HRS AFTER LAST SUBCUTANEOUS DOSE OF LMWH.;THERAPEUTIC RANGES FOR VENOUS THROMBOSIS: 0.6-1.0 U/ML FOR BID DOSING..'}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '9.5', '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': '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': 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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', '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': '39', 'valuenum': 39.0, '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': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '207', 'valuenum': 207.0, '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': '2.83', 'valuenum': 2.83, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '56.5', 'valuenum': 56.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 115.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '74.6', 'valuenum': 74.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.6', 'valuenum': 60.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.5', 'valuenum': 49.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '8.7', 'valuenum': 8.7, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.80', 'valuenum': 2.8, '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': '55.6', 'valuenum': 55.6, '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': '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, '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': '46', 'valuenum': 46.0, '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': '81.4', 'valuenum': 81.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '59.9', 'valuenum': 59.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 123.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '48', 'valuenum': 48.0, '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': '43.4', 'valuenum': 43.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '56.7', 'valuenum': 56.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '15.3', 'valuenum': 15.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '86.9', 'valuenum': 86.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '46.5', 'valuenum': 46.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61.0', 'valuenum': 61.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, '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': '236', 'valuenum': 236.0, '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': '2.92', 'valuenum': 2.92, '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': '56.1', 'valuenum': 56.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '24.1', 'valuenum': 24.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '78.9', 'valuenum': 78.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '1.5', 'valuenum': 1.5, '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 1.5, . estimated GFR (eGFR) is likely between 34 and 42 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': 130.0, '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': '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': '4.5', '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': '48', 'valuenum': 48.0, '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': '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': '83.4', 'valuenum': 83.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '70.6', 'valuenum': 70.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Well apprearing female in no acute distress. Afebrile with \nstable vital signs\nand controlled pain.\no Respiratory: CTAB\no Cardiovascular: RRR\no Gastrointestinal: NABS\no Genitourinary: voiding ___ foley\no Lymph: no LAD\no Musculoskeletal-Extremities: RLE SILT sp/dp/saph/sural. no \ncalf tenderness,\n___ strength in the right lower extremity. Resolved erythema\no Neurologic: in tact with no focal deficits\no Integument: no rashes, incision clean, dry and in tact without \nerythema or\ndrainage\no Psychiatric: pleasant ___ psychosis', 'diagnoses': [{'icd_code': 'I2699', 'desc': 'Other pulmonary embolism without acute cor pulmonale'}, {'icd_code': 'J159', 'desc': 'Unspecified bacterial pneumonia'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'J849', 'desc': 'Interstitial pulmonary disease, unspecified'}, {'icd_code': 'J9611', 'desc': 'Chronic respiratory failure with hypoxia'}, {'icd_code': 'C259', 'desc': 'Malignant neoplasm of pancreas, unspecified'}, {'icd_code': 'E440', 'desc': 'Moderate protein-calorie malnutrition'}, {'icd_code': 'I471', 'desc': 'Supraventricular tachycardia'}, {'icd_code': 'E1122', 'desc': 'Type 2 diabetes mellitus with diabetic chronic kidney disease'}, {'icd_code': 'I272', 'desc': 'Other secondary pulmonary hypertension'}, {'icd_code': 'Z9981', 'desc': 'Dependence on supplemental oxygen'}, {'icd_code': 'E861', 'desc': 'Hypovolemia'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I4510', 'desc': 'Unspecified right bundle-branch block'}, {'icd_code': 'E039', 'desc': 'Hypothyroidism, unspecified'}, {'icd_code': 'Z86711', 'desc': 'Personal history of pulmonary embolism'}, {'icd_code': 'G4730', 'desc': 'Sleep apnea, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'A084', 'desc': 'Viral intestinal infection, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, 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': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'Z6829', 'desc': 'Body mass index [BMI] 29.0-29.9, adult'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}], 'summary': '___ 07:39PM SED RATE-25*\n___ 07:39PM PLT COUNT-242\n___ 07:39PM WBC-7.5 RBC-3.60* HGB-10.8* HCT-32.4* MCV-90 \nMCH-30.1 MCHC-33.5 RDW-14.9\n___ 07:39PM CRP-10.5*\n___ 07:39PM estGFR-Using this\n___ 07:39PM GLUCOSE-139* UREA N-15 CREAT-0.7 SODIUM-137 \nPOTASSIUM-3.5 CHLORIDE-98 TOTAL CO2-26 ANION GAP-___ y/o F s/p Right ___ complicated by cellulitis of \nright distal \nshin w Keflex x 10 days but still an erythematous right lower \nextremity. She was seen ___ \nin clinic by Dr ___ with focal erythema at 3 vicryl suture \nsites. She had an intact incision and was sent to ED from clinic \nfor Arthrocentesis and \nadmission to Ortho service with ID consult and further work-up. \nShe was initially discharged on 10 days of doxycyline but \nreturned on ___ with recurrent cellulitis.\nShe was seen by infectious disease and was started on vancomycin \n1000mg BID. Her tough was taken and she showed clinical \nimprovement. There was no operative treatment of her RLE \ncellulitis. She was discharged in improved condition with ID (2 \nweeks of vancomycin) and ___ clinic follow-up on \nHD#3'}}
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{'final_diagnoses': ['right leg cellulitis'], 'procedures': ['none. administration of antibiotics'], 'visit_summary': 'She was seen by infectious disease and was started on vancomycin \n1000mg BID. Her tough was taken and she showed clinical \nimprovement. There was no operative treatment of her RLE \ncellulitis. She was discharged in improved condition with ID (2 \nweeks of vancomycin) and ___ clinic follow-up on \nHD#3', 'medications_prescribed': ['Amitriptyline 25 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).', 'Divalproex ___ mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO TID (3 times a day).', 'Methadone 5 mg Tablet Sig: One (1) Tablet PO NOON (At Noon).', 'Simvastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Oxybutynin Chloride 5 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', 'Nystatin 100,000 unit Tablet Sig: One (1) Tablet Vaginal HS \n(at bedtime).', 'Lorazepam 1 mg Tablet Sig: One (1) Tablet PO HS (at bedtime).', 'Clonidine 0.1 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly \nTransdermal QSAT (every ___.', 'Methadone 5 mg Tablet Sig: One (1) Tablet PO QAM (once a day \n(in the morning)).', 'Methadone 5 mg Tablet Sig: 1.5 Tablets PO QHS (once a day \n(at bedtime)).', 'Modafinil 100 mg Tablet Sig: One (1) Tablet PO daily ().', 'Atenolol 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Baclofen 10 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).', 'Fentanyl 25 mcg/hr Patch 72 hr Sig: One (1) Patch 72 hr \nTransdermal Q 48 HRS ().', 'Nystatin 500,000 unit Tablet Sig: One (1) Tablet PO Q8H \n(every 8 hours).', 'Heparin, Porcine (PF) 10 unit/mL Syringe Sig: One (1) ML \nIntravenous PRN (as needed) as needed for line flush.', 'Vancomycin in Dextrose 1 gram/200 mL Piggyback Sig: One (1) \n1 gram/200ml piggyback Intravenous Q 12H (Every 12 Hours) for 6 \nweeks.\nDisp:*84 1 gram/200ml piggyback* Refills:*0*', 'Triamterene-Hydrochlorothiazid 37.5-25 mg Capsule Sig: One \n(1) Cap PO BID (2 times a day).']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 36, 'gender': 'M', 'symptoms': 'chronic abd pain', 'medical_history': ['FVL deficiency s/p IVC filter', 'DVT/PE on lovenox x ___ years', 'aortic clot due to atherosclerosis, followed by Dr. ___', 'Dr. ___ s/p negative bronch ___', 'recent chest CT did not confirm TBM', 'hemoptysis - occurs ___ times a day, light colored', 'incisional hernia in RUQ', 'ventral hernia s/p mesh repair', 'complex renal cyst - on CT ___ looks like benign renal cyst 1.8x1.5 cm', 'chronic chest pain got EKG stress test ___ that was neg', 'chronic abd pain - neg CT, no porphyria, colonoscopy neg, colchicine trial neg', 'hematuria, chronic', 'COPD', 'HTN', 'HL', 'lung nodule seen ___ - needs CT in ___ year', 's/p splenectomy', 'diverticulitis', 'adjustment d/o - followed by Dr. ___'], 'family_history': 'mother with blood clots, father with DM, GM with glaucoma', 'present_illness': "___ yo male with FVL deficiency on lovenox, h/o DVT/PE, HTN, HL, \n2 abdominal hernias, chronic chest pain, chronic abd pain, s/p \nsplenectomy here with an exacerbation of his RUQ hernia pain. \nHe states that at baseline he has chronic pain that he can \ncontrol with oxycodone, which he takes 15 mg q4-6 hours. \nYesterday afternoon he developed worsening of his cough with the \nusual concommitant hemoptysis. He was up all night coughing; \nhis inhalers helped his breathing but not the cough. He had run \nout of his guafenesin-codeine. He denies sick contacts or \nfevers, just chills. This morning he woke up with severe \nworsening of his abd pain and came to the emergency at 8AM. He \nthinks it is possible that his cough exacerbated his abd pain \nbut it doesn't always. His abd pain is ___, is in the same \nlocation as always, in the RUQ, worse with tensing of his \nstomach muscles, inspiration, or coughing. It does not radiate. \nHe had some nausea in the ED but not currently. His bowel \nmovements have not changed. There are no characteristics of his \npain currently that differentiate from other episodes of abd \npain exacerbation.", 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Promethazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H: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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q3H: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', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, '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': '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': '98', 'valuenum': 98.0, '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': '3.9', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, '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': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, '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': '26.6', 'valuenum': 26.6, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '204', 'valuenum': 204.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, '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': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Gen obese male in some distress\nVS 97.9 133/97 73 18 96% RA\nHEENT anicteric, mild conj injection\nNeck no JVD\nCV RR no mrg\nPul CTAB\nAbd small palpable mass under what appears to be a laparatomy scar, tenderness to palpation\nExt without edema, no calf tenderness\nNeuro nonfocal fluent speech\nPsych normal affect appropriate', 'diagnoses': [{'icd_code': '82332', 'desc': 'Open fracture of shaft of fibula with tibia'}, {'icd_code': 'E9170', 'desc': 'Striking against or struck accidentally by objects or persons in sports'}], 'summary': '___ 03:43PM K+-3.9\n___ 11:10AM GLUCOSE-109* UREA N-14 CREAT-0.8 SODIUM-137 \nPOTASSIUM-5.3* CHLORIDE-105 TOTAL CO2-24 ANION GAP-13\n___ 11:10AM ALT(SGPT)-20 AST(SGOT)-35 ALK PHOS-41 TOT \nBILI-0.2\n___ 11:10AM LIPASE-32\n___ 11:10AM WBC-7.9 RBC-4.12* HGB-13.5* HCT-40.1 MCV-97 \nMCH-32.8* MCHC-33.7 RDW-15.5\n___ 11:10AM NEUTS-68.2 ___ MONOS-6.5 EOS-1.6 \nBASOS-1.1\n___ 11:10AM PLT COUNT-335\n___ 11:10AM ___ PTT-21.9* ___\n___ yo male presents with acute on chronic abdominal pain which \nappears to be flare of incisional hernia pain, which he has \nchronically. Reasonable etiology is coughing spasm (but did not \ncough during our history/exam). No evid of obstruction or \nstrangulation on CT, and does not have clinical evidence of this \neither. \nHe was continued on his home dose of oxycodone 15 mg po q 4hr \nprn, but he required dilaudid 1 mg IV q 4 hr, which was infused \nover ___ minutes. He continued to lobby for having the \ndilaudid rapidly pushed instead of infused, and requested larger \ndoses. He was maintained on a clear liquid diet until he was \nable to tolerate entirely oral pain control. He was ordered for \na lidoderm patch to the incisional area, which he refused. Note \nthat he is on a narcotics contract he did not receive additional \npain scripts on discharge. He has taken some initiative to get \nin contact with Dr. ___ for possible hernia \nrepair surgery to end this cycle of pain. At this point he seems \nto need a referral for the appt. There was no urgent indication, \nhowever, for an in-house surgery consult. Pain regimen was \nmoved to Oxycontin 30mg BID with Oxycodone 5mg PO q4-6hr prn for \nbreakthrough. He agreed to turn in unused Oxycodone 15mg \ntablets to his pharmacy prior to filling the new scripts. He \nwas given Dr. ___ number. His PCP is emailed the \nabove plan. He may benefit from Pain Clinic evaluation in the \nfuture as needed.\n.\n# DVT/PE/Factor V ___ - continued on lovenox at 110mg SC \ndaily injections, by giving himself injections just above 0.7ml \nmark from his 120mg/0.8ml syringes.\n.\n# chronic precordial CP - EKG unchanged, recent stress test \nlimited but negative.\n.\n# HTN benign - continued HCTZ, amlodipine, ACEI\n.\n# HL - continued statin\n.\n# COPD - continued advair and albuterol, stable\n.\n# hemoptysis and ___ - this has been worked up \nextensively with bronchoscopy. No known cause; has a sub-cm lung \nnodule and is a smoker but no airway lesions. Worsened by the \nfact that he is on anticoagulation. It was stable clinically \nwith scant appearance. He has outpt follow up.\n.\n# aortic clot - felt to be atheroma vs. clot. Has not changed in \nsize while on anticoagulation.\n- continued lovenox\n.\n# s/p splenectomy - no evid of infection, but at high risk for \nsuch.\n.\n# F/U lung CT in ___ year for lung nodule (PCP aware, is in OMR \nproblem list).\n# Renal cyst appears benign by recent CT (PCP aware, is in OMR \nproblem list).'}}
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{'final_diagnoses': ['# Acute on chronic abdominal pain, at incisional hernia', '# chronic hemoptysis and ___', '# Hx DVT/Hx PE/Factor V ___'], 'procedures': ['none'], 'visit_summary': '___ yo male presents with acute on chronic abdominal pain which \nappears to be flare of incisional hernia pain, which he has \nchronically. Reasonable etiology is coughing spasm (but did not \ncough during our history/exam). No evid of obstruction or \nstrangulation on CT, and does not have clinical evidence of this \neither. \nHe was continued on his home dose of oxycodone 15 mg po q 4hr \nprn, but he required dilaudid 1 mg IV q 4 hr, which was infused \nover ___ minutes. He continued to lobby for having the \ndilaudid rapidly pushed instead of infused, and requested larger \ndoses. He was maintained on a clear liquid diet until he was \nable to tolerate entirely oral pain control. He was ordered for \na lidoderm patch to the incisional area, which he refused. Note \nthat he is on a narcotics contract he did not receive additional \npain scripts on discharge. He has taken some initiative to get \nin contact with Dr. ___ for possible hernia \nrepair surgery to end this cycle of pain. At this point he seems \nto need a referral for the appt. There was no urgent indication, \nhowever, for an in-house surgery consult. Pain regimen was \nmoved to Oxycontin 30mg BID with Oxycodone 5mg PO q4-6hr prn for \nbreakthrough. He agreed to turn in unused Oxycodone 15mg \ntablets to his pharmacy prior to filling the new scripts. He \nwas given Dr. ___ number. His PCP is emailed the \nabove plan. He may benefit from Pain Clinic evaluation in the \nfuture as needed.\n.\n# DVT/PE/Factor V ___ - continued on lovenox at 110mg SC \ndaily injections, by giving himself injections just above 0.7ml \nmark from his 120mg/0.8ml syringes.\n.\n# chronic precordial CP - EKG unchanged, recent stress test \nlimited but negative.\n.\n# HTN benign - continued HCTZ, amlodipine, ACEI\n.\n# HL - continued statin\n.\n# COPD - continued advair and albuterol, stable\n.\n# hemoptysis and ___ - this has been worked up \nextensively with bronchoscopy. No known cause; has a sub-cm lung \nnodule and is a smoker but no airway lesions. Worsened by the \nfact that he is on anticoagulation. It was stable clinically \nwith scant appearance. He has outpt follow up.\n.\n# aortic clot - felt to be atheroma vs. clot. Has not changed in \nsize while on anticoagulation.\n- continued lovenox\n.\n# s/p splenectomy - no evid of infection, but at high risk for \nsuch.\n.\n# F/U lung CT in ___ year for lung nodule (PCP aware, is in OMR \nproblem list).\n# Renal cyst appears benign by recent CT (PCP aware, is in OMR \nproblem list).', 'medications_prescribed': ['1. albuterol sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig: \nOne (1) Puff Inhalation Q6H (every 6 hours) as needed for \nBronchospasm. ', '2. trazodone 50 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) \nas needed for Insomnia. ', '3. amlodipine 5 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '4. enoxaparin 120 mg/0.8 mL Syringe Sig: One (1) Subcutaneous \nQ12H (every 12 hours). ', '5. fluticasone-salmeterol 250-50 mcg/dose Disk with Device Sig: \nOne (1) Disk with Device Inhalation BID (2 times a day). ', '6. hydrochlorothiazide 12.5 mg Capsule Sig: One (1) Capsule PO \nDAILY (Daily). ', '7. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '8. simvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '9. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). ', '10. bisacodyl 5 mg Tablet, Delayed Release (E.C.) Sig: Two (2) \nTablet, Delayed Release (E.C.) PO DAILY (Daily) as needed for \nconstipation.\nDisp:*60 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', '11. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID \n(2 times a day).\nDisp:*60 Capsule(s)* Refills:*0*', '12. oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q4H (every 4 \nhours) as needed for abd pain: Do not drive or operated heavy \nmachinery on this medication.\nDisp:*30 Tablet(s)* Refills:*0*', '13. oxycodone 30 mg Tablet Sustained Release 12 hr Sig: One (1) \nTablet Sustained Release 12 hr PO Q12H (every 12 hours): do not \ndrive or operate heavy machinery on this medication.\nDisp:*10 Tablet Sustained Release 12 hr(s)* 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': 'Dyspnea', 'medical_history': ['- Heart failure with preserved EF: ___ echo with 55% EF, \nLVH, moderate 2+ MR. ', '- Mitral regurgitation: ___ echo with 2+ MR ', '- Coronary artery disease, ___ cath: 80% LAD, 80% LCx s/p \nDES, RCA totally occluded. ', '* NSTEMI ___ s/p DES to LCx ', '- Hypertension ', '- Atrial fibrillation, diagnosed ___ ', '- Nocturnal hypoxia on 2 L NC at night ', '- Pulmonary hypertension, echo ___ moderate PASP 35 to 40 \nmmHg ', '- GERD ', '- Hypothyroidism, iatrogenic following radioactive iodine \nablation for thyroid cancer per patient. ', '- Renal cell cancer s/p left partial nephrectomy (___) (Dr. \n___ @ ___ ', '- History of colonic adenoma s/p right hemicolectomy ', '- History of basal cell carcinoma and invasive squamous \ncarcinoma of nose (___) ', '- Stress incontinence ', '- Spinal stenosis ', '- Cervical stenosis ', '- Osteopenia ', '- S/p hysterectomy ', '- S/p appendectomy ', '- S/p ventral hernia repair. ', '- Gout ', '- Vitamin B12 deficiency'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \n\nsudden cardiac death; otherwise non-contributory. Sister had \nbreast cancer, one sister with "bone marrow cancer," Both \nparents had CAD.', 'present_illness': '___ hx of CAD (s/p PCI ___, ___, Afib, last echo ___ with \nLVEF>55%, 2+ MR and ___ presents with SOB. She lives in assisted \nliving and has had worsening SOB at rest since ___. She is on \n2L home O2 at night but on 2L during day since yestrday. Aide \nfound her at 0530 to be short of breath with shallow, rapid \nbreathing, was at 94% 02 sat when EMS arrived at scene, placed \non 4LNC. She reports taking her home medications as prescribed. \nReports some runny nose, but otherwise denies viral prodrome, no \nsore throat, cough, nasal congestion, dysuria or diarrhea. No \nfever, cough, CP, abdominal pain, nausea/vomiting, syncope, \nlight-headedness/dizziness. \n\nIn the ED, initial vitals were 97 78 159/90 22 99% 4L Nasal \nCannula. She was given AM medications - pills whole with \napplesauce. Given 20 IV lasix, and 10 PO torsemide. CXR done \nwhich showed: small bilateral pleural effusions, and moderate \ninterstitial pulmonary edema. Labs notable for Trop at 0.02 x2, \nproBNP 2767, WBC 7.0, H/H 10.0/32.2, Plt 146, BUN/Cr ___. \n \nOn arrival to floor, VS: Wt. 78.3, T 98.1, BP 138/66, HR 68, RR \n18, 98% 6L. Patient is laying in bed, in NAD, conversant. \nDenies cp, sob. \n\nROS: ROS + as per HPI. 10 point review systems otherwise \nnegative.', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Wellbutrin', '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': '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': 'Oxycodone-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 via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 81.0, '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': '2.9', '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': '140', 'valuenum': 140.0, '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': '45.7', 'valuenum': 45.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '33.3', 'valuenum': 33.3, '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': '286', 'valuenum': 286.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.09', 'valuenum': 5.09, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS: Wt. 78.3, T 98.1, BP 138/66, HR 68, RR 18, 98% 6L. \nGeneral: Laying in bed, in NAD. \nHEENT: NC/AT, EOMI, sclera anicteric, MMM \nNeck: Trachea midline, JVD 4 cm above sternal notch\nCV: irregular rhythm, normal s1/s2, no r/m/g appreciated \nLungs: Crackles to mid-lung bilaterally \nAbdomen: Soft, non-distended, NTTP, +BS \nGU: Deferred \nExt: 1+ pitting edema at BLE, 1+ DP pulses \nNeuro: A&Ox3, able to do days of week backwards with ease, \nmoving all extremities, speech fluent\nSkin: No rashes noted, echymoses noted at ___\n\nDISCHARGE PHYSICAL EXAM:\nVS: Wt. 75.1 kg (stand ___, 75.2 kg ( ___ stand); 79.1 kg \n___ - bed), 78.3 kg ___ - bed) \nT 97.7, BP 102-135/50-56, HR 57, RR 20, 98% 2L NC\nTele: aflutter, rates 50-60s throughout night \nGeneral: Laying in bed, in NAD. \nHEENT: NC/AT, EOMI, sclera anicteric, MMM \nNeck: Trachea midline, + hepato-jugular reflex (while laying \nflat)\nCV: irregular rhythm, normal s1/s2, no r/m/g appreciated \nLungs: bilateral crackles ___ the way up, no rhonchi or wheezes \nappreciated \nAbdomen: Soft, non-distended, NTTP, +BS \nGU: Deferred \nExt: no edema at BLE - pruning of skin noted at BLE from \ndecreased fluid, 1+ DP pulses \nNeuro: A&Ox3, moving all extremities, speech fluent\nSkin: No rashes noted, echymoses noted at BUE', 'diagnoses': [{'icd_code': '8052', 'desc': 'Closed fracture of dorsal [thoracic] vertebra without mention of spinal cord injury'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': 'E8498', 'desc': 'Accidents occurring in other specified places'}], 'summary': 'LABS:\n___ 07:48AM BLOOD WBC-5.2 RBC-3.29* Hgb-9.3* Hct-29.7* \nMCV-91 MCH-28.2 MCHC-31.2 RDW-16.2* Plt ___\n___ 06:00AM BLOOD WBC-7.0 RBC-3.56* Hgb-10.0* Hct-32.2* \nMCV-90 MCH-28.0 MCHC-30.9* RDW-16.0* Plt ___\n___ 06:00AM BLOOD Neuts-80.7* Lymphs-11.4* Monos-5.5 \nEos-2.0 Baso-0.5\n___ 07:48AM BLOOD ___ PTT-29.1 ___\n___ 04:35PM BLOOD Glucose-111* UreaN-25* Creat-1.0 Na-147* \nK-3.8 Cl-104 HCO3-37* AnGap-10\n___ 07:48AM BLOOD Glucose-88 UreaN-25* Creat-0.9 Na-148* \nK-3.8 Cl-107 HCO3-34* AnGap-11\n___ 06:00AM BLOOD Glucose-100 UreaN-29* Creat-0.9 Na-145 \nK-4.1 Cl-104 HCO3-31 AnGap-14\n___ 12:15PM BLOOD cTropnT-0.02*\n___ 06:00AM BLOOD cTropnT-0.02*\n___ 06:00AM BLOOD proBNP-2767*\n___ 04:35PM BLOOD Calcium-9.9 Phos-3.2 Mg-2.1\n___ 07:48AM BLOOD Calcium-10.0 Phos-3.3 Mg-2.0\n\nDISCHARGE LABS:\n___ 06:55AM BLOOD WBC-5.4 RBC-3.57* Hgb-10.0* Hct-33.4* \nMCV-94 MCH-28.0 MCHC-29.9* RDW-16.2* Plt ___\n___ 07:05AM BLOOD Glucose-77 UreaN-24* Creat-1.0 Na-144 \nK-3.9 Cl-101 HCO3-34* AnGap-13\n___ 07:05AM BLOOD Calcium-10.4* Phos-2.7 Mg-2.0\n\nIMAGING/STUDIES:\nECG (___): Atrial fibrillation with mean ventricular rate of \n75. Left bundle-branch block with left axis deviation and \nnon-specific repolarization abnormalities. Cannot exclude prior \ninferior wall myocardial infarction. Compared to the previous \ntracing of ___ cardiac rhythm is now atrial fibrillation.\n\nCXR (___): IMPRESSION: Moderately cardiomegaly is worse with \nsmall bilateral pleural effusions, and moderate interstitial \npulmonary edema in the setting of CHF exacerbation. \n\nCXR (___): FINDINGS: Comparison is made to the prior \nradiographs from ___. \nHeart size is enlarged but stable. There is atelectasis at the \nlung bases. There are again seen bilateral pleural effusions, \nleft worse than right and there is prominence of the pulmonary \ninterstitial markings which is slightly improved. There are no \npneumothoraces.\n\nMICRO: None\nASSESSMENT AND PLAN: ___ hx of CAD (s/p PCI ___, ___, Afib, \nlast echo ___ with LVEF>55%, 2+ MR and PAH presents with SOB. \nShe lives in assisted living and has had worsening SOB at rest \nsince ___, likely CHF exacerbation. \n \n# CHF exacerbation: unclear etiology. BNP elevated at 2767. \nPatient with h/o dCHF with LVEF > 55% (echo ___. Patient \nreports some nasal congestion, but otherwise no viral prodrome \nor sign of infection. EKG unchanged from prior, trops negative, \npatient denied any chest pain, ischemic event unlikely. Given \ndCHF, atrial fibrillation may have contributed to decompensation \ngiven loss of atrial kick. Patient was on 6L by NC on \nadmission, with significant crackles on lung exam, elevated JVP \nand 2+ BLE edema. Patient was diuresed with PO torsemide and \nprn IV lasix. Daily I/Os were unable to be monitored as patient \nwas incontinent of urine and refused foley. She was monitored \nclinically for improvement as judged by O2 requirement, lung \nexam and ___ edema. Home torsemide dose was increased to 10 mg \ndaily. Patient improved clinically and was discharged to home. \nHer O2 sat on discharge was 92-94% on room air. Admission \nweight was 78.3 kg (bed weight). Discharge weight was 75.1 kg \n(standing weight). \n \n# CAD: s/p PCI in ___: drug-eluting stent LCX and PTCA LAD. \nPatient was continued on home atorvastatin, metoprolol, imdur, \naspirin and plavix.\n \n# Atrial fibrillation: chads2 of 3. on amiodarone at home. not \nanticoagulated. given age and fall risk, will hold off on \ninitiation of anticoagulation during this hospitalization. \nAmiodarone was discontinued. Did not plan on performing \ncardioversion during this admission given age/comorbidities and \nimprovement with diuresis; also unclear patient would remain in \nsinus even with cardioversion given atrial enlargement\n\n# Anemia: chronic, stable. no sign of active bleeding. CBC was \nmonitored daily.\n\n# Hypothyroidism: TSH normal on ___. Continued on home \nsynthroid dose.\n \n# GERD: continued on home PPI\n\n# Hypernatremia: Resolved. patient became hypernatremic with \ndiuresis, up to 149. Patient was without mental status changes. \n Trended down and resolved with discontinuation of prn IV lasix. \n Serum Na was 144 on day of discharge.'}}
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{'final_diagnoses': ['CHF exacerbation', 'Atrial fibrillation'], 'procedures': ['None'], 'visit_summary': 'ASSESSMENT AND PLAN: ___ hx of CAD (s/p PCI ___, ___, Afib, \nlast echo ___ with LVEF>55%, 2+ MR and PAH presents with SOB. \nShe lives in assisted living and has had worsening SOB at rest \nsince ___, likely CHF exacerbation. \n \n# CHF exacerbation: unclear etiology. BNP elevated at 2767. \nPatient with h/o dCHF with LVEF > 55% (echo ___. Patient \nreports some nasal congestion, but otherwise no viral prodrome \nor sign of infection. EKG unchanged from prior, trops negative, \npatient denied any chest pain, ischemic event unlikely. Given \ndCHF, atrial fibrillation may have contributed to decompensation \ngiven loss of atrial kick. Patient was on 6L by NC on \nadmission, with significant crackles on lung exam, elevated JVP \nand 2+ BLE edema. Patient was diuresed with PO torsemide and \nprn IV lasix. Daily I/Os were unable to be monitored as patient \nwas incontinent of urine and refused foley. She was monitored \nclinically for improvement as judged by O2 requirement, lung \nexam and ___ edema. Home torsemide dose was increased to 10 mg \ndaily. Patient improved clinically and was discharged to home. \nHer O2 sat on discharge was 92-94% on room air. Admission \nweight was 78.3 kg (bed weight). Discharge weight was 75.1 kg \n(standing weight). \n \n# CAD: s/p PCI in ___: drug-eluting stent LCX and PTCA LAD. \nPatient was continued on home atorvastatin, metoprolol, imdur, \naspirin and plavix.\n \n# Atrial fibrillation: chads2 of 3. on amiodarone at home. not \nanticoagulated. given age and fall risk, will hold off on \ninitiation of anticoagulation during this hospitalization. \nAmiodarone was discontinued. Did not plan on performing \ncardioversion during this admission given age/comorbidities and \nimprovement with diuresis; also unclear patient would remain in \nsinus even with cardioversion given atrial enlargement\n\n# Anemia: chronic, stable. no sign of active bleeding. CBC was \nmonitored daily.\n\n# Hypothyroidism: TSH normal on ___. Continued on home \nsynthroid dose.\n \n# GERD: continued on home PPI\n\n# Hypernatremia: Resolved. patient became hypernatremic with \ndiuresis, up to 149. Patient was without mental status changes. \n Trended down and resolved with discontinuation of prn IV lasix. \n Serum Na was 144 on day of discharge.', 'medications_prescribed': ['1. Allopurinol ___ mg PO DAILY ', '2. Aspirin 81 mg PO DAILY ', '3. Atorvastatin 20 mg PO DAILY ', '4. Clopidogrel 75 mg PO DAILY ', '5. Cyanocobalamin 1000 mcg PO DAILY ', '6. Desonide 0.05% Cream 1 Appl TP DAILY ', '7. Docusate Sodium 100 mg PO DAILY ', '8. Gabapentin 300 mg PO BID ', '9. Isosorbide Mononitrate (Extended Release) 15 mg PO DAILY ', '10. Latanoprost 0.005% Ophth. Soln. 1 DROP LEFT EYE HS ', '11. Levothyroxine Sodium 112 mcg PO DAILY ', '12. Lidocaine 5% Patch 1 PTCH TD QAM ', '13. Metoprolol Tartrate 25 mg PO BID ', '14. Nitroglycerin SL 0.3 mg SL PRN chest pain ', '15. Omeprazole 20 mg PO DAILY ', '16. Vitamin D 1000 UNIT PO DAILY ', '17. Centrum Silver \n(\nmultivit-\nmin-\nFA-\nlycopen-lutein;multivitamin-minerals-lutein;mv-min-folic \nacid-lutein) 400-250 mcg oral daily ', '18. FiberCon (calcium polycarbophil) 625 mg oral daily ', '19. Glucosamine Sulf-Chondroitin (glucosamine ___ 2KCl-chondroit) \n500-400 mg oral daily ', '20. Miconazole Powder 2% 1 Appl TP QID ', '21. PrednisoLONE Acetate 1% Ophth. Susp. 1 DROP BOTH EYES BID ', '22. PreserVision AREDS (vitamins A,C,E-zinc-copper) \n___ unit-mg-unit oral uncertain ', '23. triamcinolone acetonide 55 mcg nasal daily ', '24. Simbrinza (brinzolamide-brimonidine) ___ % ophthalmic BID ', '25. Zirgan (ganciclovir) 0.15 % ophthalmic 5x/daily ', '26. Torsemide 10 mg PO DAILY \nRX *torsemide 10 mg 1 tablet(s) by mouth Daily Disp #*30 Tablet \nRefills:*0', '27. Acetaminophen 325 mg PO QDAY:PRN joint pain ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'M', 'symptoms': 'pt presents with c/o SI in context of\nmedication noncompliance', 'medical_history': ['Denies.'], 'family_history': 'Mother with depression', 'present_illness': "___ y/o M with reported h/o depression and paranoia who self\npresents to ED endorses increased suicidal ideation in context \nof\nworsening depression and medication noncompliance. Apparently \nwas\nrecently discharged from ___, where he had similar\npresention of depression with SI. Pt was did not follow up with\ndischarge planning, and claims to have no outpt treaters. \n\nPt admits to ___ yr increasing depression, worse over the last \n___\nweeks. Extremely vague historian but states significant stressor\nin his life are his homelessness and his lack of money. Pt \nclaims\nthat the main reason he was not compliant with his medications\nwas the fact the he could not afford to pay for them. States \nthat\nhe is homeless and lives on the streets. Pt reports \x93 I just\ncan't do this any more, I need help.\x94\n\n(+) neuroveg including poor sleep, decreased appetite, and poor\nconcentration. (+) hopelessness. (+) anhedonia, increasing \nsocial\nisolation x several months. Denies ah/vh but does endorse\nparanoid that in that \x93I think people are out to get me.\x94\nHowever, pt does report that he is trustful of the medical \nstaff.\nWhen asked who exactly might be out to get him, pt reports \x93the\npeople in the street.\x94 Denies manic sxs\n\nPt admits to past suicide attempts x 2 most recently as teen \nwhen\ntried to cut wrist. Pt endorses current SI, with plan to cut\nwrists. Denies HI. Denies current use of substances.", 'medications': [{'medication': 'Senna', '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': 'PO/NG', 'frequency': 'ONCE MR1', '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': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Finasteride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', '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': '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': 'Bethanechol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8.9', 'valuenum': 8.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62.7', 'valuenum': 62.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '300', 'valuenum': 300.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.72', 'valuenum': 3.72, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '60', 'valuenum': 60.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 17.2, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL DIURNAL PATTERN: 7-10AM 6.2-19.4 / 4-8PM 2.3-11.9.'}, {'value': '___', 'valuenum': 60.0, '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': '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': 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': '1.9', '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': '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.7', 'valuenum': 34.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.9', 'valuenum': 38.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE BY INDIRECT IMMUNOFLUORESCENCE.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '30.3', 'valuenum': 30.3, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '259', 'valuenum': 259.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': 'mL', 'ref_range_lower': None, 'ref_range_upper': None, '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': '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': '32.0', 'valuenum': 32.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, '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': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '89', 'valuenum': 89.0, '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': '13.7', 'valuenum': 13.7, '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': 4.6, 'ref_range_upper': 6.2, '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}], 'exams': 'VS: T: 97.6 BP: 180/100 P: 78 RR: 15 O2: 98%\n\nMENTAL STATUS EXAMINATION:\nAppearance/behavior: obese Caucasian male, dressed in hospital\ngown, poorly groomed, appears stated age, cooperative with\ninterview, poor eye contact, no abnormal movements\nSpeech: regular rate, volume, and prosody\nAffect: depressed \nMood: \x93depressed\x94\nThought Process: linear and goal-directed, coherent\nThought Content: (+) SI as per HPI. the patient denies homicidal\nideation, no auditory or visual hallucinations, no evidence of\ndelusions, (+) paranoid ideation, no preoccupations\nInsight/Judgment: poor/poor\n\nCOGNITION:\nOrientation: oriented to ___, ___\nCalculation: 3 quarters in $1.75\nMemory: ___ at 5 min\nLanguage: intact\nAttention/Concentration: ___ backwards correctly', 'diagnoses': [{'icd_code': '71916', 'desc': 'Hemarthrosis, lower leg'}, {'icd_code': 'E9342', 'desc': 'Anticoagulants causing adverse effects in therapeutic use'}, {'icd_code': '45981', 'desc': 'Venous (peripheral) insufficiency, unspecified'}, {'icd_code': '4548', 'desc': 'Varicose veins of lower extremities with other complications'}, {'icd_code': '72751', 'desc': 'Synovial cyst of popliteal space'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '2270', 'desc': 'Benign neoplasm of adrenal gland'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '3694', 'desc': 'Legal blindness, as defined in U.S.A.'}, {'icd_code': '36250', 'desc': 'Macular degeneration (senile), unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '78820', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}], 'summary': "___ 03:10AM URINE HOURS-RANDOM\n___ 03:10AM URINE HOURS-RANDOM\n___ 03:10AM URINE GR HOLD-HOLD\n___ 03:10AM URINE bnzodzpn-NEG barbitrt-NEG opiates-NEG \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 03:10AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 03:10AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.5 \nLEUK-NEG\n___ 01:20AM GLUCOSE-139* UREA N-17 CREAT-0.7 SODIUM-136 \nPOTASSIUM-4.3 CHLORIDE-100 TOTAL CO2-29 ANION GAP-11\n___ 01:20AM estGFR-Using this\n___ 01:20AM ALT(SGPT)-25 AST(SGOT)-25 ALK PHOS-71 TOT \nBILI-0.2\n___ 01:20AM TSH-2.0\n___ 01:20AM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG\n___ 01:20AM WBC-11.4* RBC-4.49* HGB-13.6* HCT-38.9* \nMCV-87 MCH-30.2 MCHC-34.9 RDW-13.3\n___ 01:20AM NEUTS-62.5 ___ MONOS-4.1 EOS-2.7 \nBASOS-0.5\n___ 01:20AM PLT COUNT-346\nPsychotherapy:\nMet with pt and briefly reviewed with pt many of the \ncircumstances leading to his current hospitalization including \npt h/o depression and paranoia, and pt increasing depression, \nworse over the last ___ weeks. Pt continues to endorse that \nsignificant stressors in his life are his hopelessness and his \nlack of money. Pt continues to claim that the main reason he was \nnot compliant with his medications after his last \nhospitalization was the fact the he could not afford to pay for \nthem. His financial situation has left him homeless.\n\nWhile in hospital, pt continues to note better appetite and much \nimproved sleep. Pt denied all suicidality, and expresses desire \nto be able to keep intake referral appointment for new \npsychiatrist schedule for ___ at ___. Pt also able to \ngive phone # for his CM, ___ (___). Pt also \ngive permission to contact his brother who lives in ___ \n(___). Per nursing pt has been taking all \nof medications, eating well on unit. Pt does have to be \necouraged to shower and keep himself clean while on unit. Pt \nable to CFS while on unit. Denies any AH/VH/manic \nsymptoms/paranoia/delusions. \n\nSpoke with ___'s ___ case manager, ___, who confirms \nthat he knows pt very well x ___ yrs, and that pt has never \nattempted suicide in the past, and that pt has been rejected \nfrom multiple shelters over the past 2 weeks due to his poor \nhygiene. He also believes that pt presented not because pt was \nsuicidal, but because is has no where else to go for sleep and \nshelter. He believes pt will be safe for discharge directly to \nhis appointment, and the he will follow up with pt as \noutpatient.\n\nOn discharge, pt reported that he has multiple plans including \nseeking housing, and continuing his participation in his social \ngroup, which often goes out on social outings and dinner \noutings. \n\nMedical:\nThere were no medical problems\n\nPsychopharm:\nContinued pt outpt medication regimen"}}
|
{'final_diagnoses': ['Axis I: Schizoaffective disorder', 'Axis II: Defer', 'Axis III: See Past Medical History', 'AXIS IV: lack of social supports', 'AXIS V: GAF=60'], 'procedures': ['none'], 'visit_summary': "Psychotherapy:\nMet with pt and briefly reviewed with pt many of the \ncircumstances leading to his current hospitalization including \npt h/o depression and paranoia, and pt increasing depression, \nworse over the last ___ weeks. Pt continues to endorse that \nsignificant stressors in his life are his hopelessness and his \nlack of money. Pt continues to claim that the main reason he was \nnot compliant with his medications after his last \nhospitalization was the fact the he could not afford to pay for \nthem. His financial situation has left him homeless.\n\nWhile in hospital, pt continues to note better appetite and much \nimproved sleep. Pt denied all suicidality, and expresses desire \nto be able to keep intake referral appointment for new \npsychiatrist schedule for ___ at ___. Pt also able to \ngive phone # for his CM, ___ (___). Pt also \ngive permission to contact his brother who lives in ___ \n(___). Per nursing pt has been taking all \nof medications, eating well on unit. Pt does have to be \necouraged to shower and keep himself clean while on unit. Pt \nable to CFS while on unit. Denies any AH/VH/manic \nsymptoms/paranoia/delusions. \n\nSpoke with ___'s ___ case manager, ___, who confirms \nthat he knows pt very well x ___ yrs, and that pt has never \nattempted suicide in the past, and that pt has been rejected \nfrom multiple shelters over the past 2 weeks due to his poor \nhygiene. He also believes that pt presented not because pt was \nsuicidal, but because is has no where else to go for sleep and \nshelter. He believes pt will be safe for discharge directly to \nhis appointment, and the he will follow up with pt as \noutpatient.\n\nOn discharge, pt reported that he has multiple plans including \nseeking housing, and continuing his participation in his social \ngroup, which often goes out on social outings and dinner \noutings. \n\nMedical:\nThere were no medical problems\n\nPsychopharm:\nContinued pt outpt medication regimen", 'medications_prescribed': ['1. Risperidone 2 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).\nDisp:*30 Tablet(s)* Refills:*0*', '2. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily).\nDisp:*30 Capsule(s)* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 25, 'gender': 'F', 'symptoms': 'MVC with major blunt chest trauma', 'medical_history': ["___'s", 'Asthma'], 'family_history': 'nc', 'present_illness': 'Pt is ___ yo m admitted ___ s/p MVC transported via Med \nflight. Pt was the driver involved in high speed MVC in which \nhis car reportedly hit and went under tractor trailer which \nresulted in prolonged extrication and then medflighted to ___.', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', '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': '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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 via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', '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}]}, 'clinical_findings': {'labs': [{'value': 'NEG', 'valuenum': None, 'valueuom': '+/-', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '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': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '40', 'valuenum': 40.0, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1.016', 'valuenum': 1.016, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Temp (F): 99.0 Heart Rate: 89 Blood Pressure: 177/93\nResp Rate: 15 O2 Sat(%): 98 Room Air/O2: 15L non rebreather\n\nGENERAL non-rebreather in place\nHEENT trachea midline, subcutaneous emphysema along chest wall \nand neck midline\nRESPIRATORY bilateral wheeze \nCARDIOVASCULAR RRR\nGI Soft NABS ND', 'diagnoses': [{'icd_code': 'S52272A', 'desc': "Monteggia's fracture of left ulna, initial encounter for closed fracture"}, {'icd_code': 'W010XXA', 'desc': 'Fall on same level from slipping, tripping and stumbling without subsequent striking against object, initial encounter'}, {'icd_code': 'Y92480', 'desc': 'Sidewalk as the place of occurrence of the external cause'}], 'summary': "___ CXR\nIMPRESSION:\n\nOsseous fractures involving the middle third of the bilateral \nclavicles, bilateral upper ribs, and right scapula.\n\nSubcutaneous emphysema involving the soft tissues of the neck \nand upper chest. Persistent pneumomediastinum.\n\nNo pneumothorax is identified.\n___ Hand\nFINDINGS: The forearm is obscured by an overlying cast. There \nare displaced fractures involving the distal radius and ulna \nwith one bone width volar displacement and medial angulation of \nthe over-riding distal fragments. There is surrounding soft \ntissue swelling. There are no radiopaque foreign bodies. There \nare no other fractures in the visualized wrist, fingers and \nelbow. There are no degenerative changes.\n\nIMPRESSION:\nDistal radius and ulna shaft fractures as described. \n\n___ CT Torso\nIMPRESSION:\n1. Significant pneumomediastinum with posterior tracheal \nlaceration just above the carina.\n2. Bilateral upper lung contusions, right greater than left.\n3. Bilateral upper rib fractures, clavicle fractures, right \nscapular fracture with extensive chest wall emphysema extending \ninto the neck soft tissues as well as along nerve roots into the \ncentral spinal canal.\n4. No evidence of traumatic injury to the abdomen or pelvis.\n___ CTH\nIMPRESSION:\n1. No evidence of intracranial hemorrhage or skull fracture.\n2. Soft tissue gas as described likely extension from \nsubcutaneous emphysema and pneumomediastinum in the chest. \nPlease refer to report from CT torso for further detail.\n___ CT CSPINE\nIMPRESSION:\n1. Chip fracture involving the right C6 transverse process \n(stable). No fracture line extension into the transverse \nforamen. Remainder of the cervical spine is intact with normal \nalignment.\n2. Extensive soft tissue gas in the chest wall, neck soft \ntissues.\n3. Pneumomediastinum with air dissecting into the retropharynx \nand parapharyngeal space.\n4. Bilateral rib fractures, right first, left first and second. \nBilateral clavicular fractures.\n5. Air outlining the thecal sac which appears to extend in along \nthe nerve roots.\n___ UGI\nLimited exam due to patient's discomfort.There is a small area \nof persistent opacification adjacent to the esophagus, which may \nbe artefactual however a small self-contained leak cannot be \nexcluded. Findings discussed with Dr ___ shortly on the \nday of the study.\nThe patient was admitted to Trauma surgery from the emergency \ndepartment directly to the Trauma ICU. \n.\nInjuries were found to be:\n1) Bilateral clavicle fx and Right scapular fracture\n2) Open radial/ulnar fx- s/p I&D, ORIF right BBFFx w/ ECU Repair \n___ Chip fracture involving the right C6 transverse process \n(stable). \n4) R>L Pulmonary contusions\n5) Bilateral rib fx: No intervention was done for the rib \nfractures\n6) Pneumomediastinum\n7) Evulsed R ___ digit tip - Plastics followed and adaptec \nplaced\n8) ? Right upper molar fracture\n.\n** Regarding the multiple bony fractures: Orthopedics has been \nfollowing along. The team took him to the OR after \nstabilization of the chest injury to perform incision and \ndrainage and open reduction internal fixation of the open \nradial/ulnar fractures with ECU repair. The patient tolerated \nthe procedure well with no complications. Expectant management \nwas done on the remainder of the fractures with the patient only \nrequiring pain control. Physical therapy and occupational \ntherapy were consulted on the patient to assess home ___ rehab \nneeds and both services felt the patient was capable and able \nenough to return home, requiring only home OT\n\n** Regarding the pneumomediastinum: The patient had developed \nevidence of pneumomediastinum, as evidence by CAT scan and chest \nx-ray. After discussion with the patient and the ICU team and \nThoracic Surgery, it was decided the patient would be best \nserved by a flexible bronchoscopy and \nesophagogastroduodenoscopy, to determine if there was any \nevidence of tracheal or esophageal injury. The following day, an \nUGI was performed to rule out esophageal injury and was \nreportedly negative. The patient's diet was advanced, and he \ntolerated advancement of his diet without any complications. \nThe crepitus is resolving.\n\n** Regarding the evulsed R ___ digit tip: Plastic Surgery has \nbeen following and placed adaptec and did not feel any surgical \ncorrection was necessary. Outpatient follow up with Plastics in \nHand Clinic was recommended.\n\n** Regarding the possible right upper molar fracture: a panorex \nwas taken to evaluate for fractures. The read was not performed \nat the time of discharge, so the patient was discharged with the \ncopy of the panorex and instruction to follow up with an Oral \nsurgeon or dentist as an outpatient\n\nThe patient was intubated in the TICU s/p bronchoscopy to \nevaluate for tracheal injury s/p blunt trauma. None were found \nand the patient was extubated without issues. Ortho operated on \nthe patient in the OR as above. On ___ the patient was \ntransfered out of the ICU in stable condition and had pain \ncontrolled on PCA. The patient had an uncomplicated remainder \nof his hospital course.\n\nUpon discharge, the patient was afebrile with all vitals stable, \ntolerating po feeds, ambulating independently, and with pain \ncontrolled on po pain medication."}}
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{'final_diagnoses': ['1) Bilateral clavicle fx and right scapular fx', '2) Open radial/ulnar fx', '3) Chip fracture involving the right C6 transverse process \n(stable).', '4) R>L Pulmonary contusions', '5) Bilateral rib fx', '6) Evulsed R ___ digit tip', '7) ? Right upper molar fx'], 'procedures': ['I&D, ORIF right BBFFx w/ ECU Repair ___', 'Flex bronch, EGD'], 'visit_summary': "The patient was admitted to Trauma surgery from the emergency \ndepartment directly to the Trauma ICU. \n.\nInjuries were found to be:\n1) Bilateral clavicle fx and Right scapular fracture\n2) Open radial/ulnar fx- s/p I&D, ORIF right BBFFx w/ ECU Repair \n___ Chip fracture involving the right C6 transverse process \n(stable). \n4) R>L Pulmonary contusions\n5) Bilateral rib fx: No intervention was done for the rib \nfractures\n6) Pneumomediastinum\n7) Evulsed R ___ digit tip - Plastics followed and adaptec \nplaced\n8) ? Right upper molar fracture\n.\n** Regarding the multiple bony fractures: Orthopedics has been \nfollowing along. The team took him to the OR after \nstabilization of the chest injury to perform incision and \ndrainage and open reduction internal fixation of the open \nradial/ulnar fractures with ECU repair. The patient tolerated \nthe procedure well with no complications. Expectant management \nwas done on the remainder of the fractures with the patient only \nrequiring pain control. Physical therapy and occupational \ntherapy were consulted on the patient to assess home ___ rehab \nneeds and both services felt the patient was capable and able \nenough to return home, requiring only home OT\n\n** Regarding the pneumomediastinum: The patient had developed \nevidence of pneumomediastinum, as evidence by CAT scan and chest \nx-ray. After discussion with the patient and the ICU team and \nThoracic Surgery, it was decided the patient would be best \nserved by a flexible bronchoscopy and \nesophagogastroduodenoscopy, to determine if there was any \nevidence of tracheal or esophageal injury. The following day, an \nUGI was performed to rule out esophageal injury and was \nreportedly negative. The patient's diet was advanced, and he \ntolerated advancement of his diet without any complications. \nThe crepitus is resolving.\n\n** Regarding the evulsed R ___ digit tip: Plastic Surgery has \nbeen following and placed adaptec and did not feel any surgical \ncorrection was necessary. Outpatient follow up with Plastics in \nHand Clinic was recommended.\n\n** Regarding the possible right upper molar fracture: a panorex \nwas taken to evaluate for fractures. The read was not performed \nat the time of discharge, so the patient was discharged with the \ncopy of the panorex and instruction to follow up with an Oral \nsurgeon or dentist as an outpatient\n\nThe patient was intubated in the TICU s/p bronchoscopy to \nevaluate for tracheal injury s/p blunt trauma. None were found \nand the patient was extubated without issues. Ortho operated on \nthe patient in the OR as above. On ___ the patient was \ntransfered out of the ICU in stable condition and had pain \ncontrolled on PCA. The patient had an uncomplicated remainder \nof his hospital course.\n\nUpon discharge, the patient was afebrile with all vitals stable, \ntolerating po feeds, ambulating independently, and with pain \ncontrolled on po pain medication.", 'medications_prescribed': ['1. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed.\nDisp:*60 Tablet(s)* Refills:*0*', '2. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '3. Outpatient Occupational Therapy\nPlease assist with Activities of Daily Living', '4. Albuterol Inhalation']}
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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': 'missed HD x several days', 'medical_history': ['1. ESRD on HD ___', '2. Anemia of chronic kidney disease', '3. Hypertension, likely secondary to renal disease and \nmedication non-adherence', '4. Asthma', '5. History of nephrotic syndrome (___)', '6. History of dysphagia', '7. Mental retardation', '8. History of glucose intolerance', '9. Probable secondary hyperparathyroidism', '10. History of hip and shoulder pain'], 'family_history': 'Mother with ESRD on HD of unclear cause', 'present_illness': 'Mr. ___ is a ___ year old gentleman with ESRD on HD, history of \nnephrotic syndrome, hypertension, dysphagia, hip/shoulder pain, \nmild mental retardation, asthma who presenting after missing HD \nsince last last ___. Patient states that he \nmissed HD because he was having symptoms of cold, with cough, \ncongestion, mild SOB. He also notes intermittent diarrhea for \nseveral months. He arrived to ___ center late today and was told \nto come to ED. Patient states that he feels he is hyperkalemic \nas he has been craving more orange juice. Patient has been to \nthe ED for missing HD in the past as well.\n\nIn the ED, initial VS: 97.6 95 145/92 16 100% RA. ECG showed \npeaked Ts but QRS not widened. Initial blood draw in ED was \nhemolyzed; mildly hemolyzed specimen showed K of 8. Patient was \ngiven 1g calcium gluconate as well as kayexalate 30g, insulin \n10u IM and 1 amp dextrose, albuterol-ipratrop nebs to bring K \ndown. Repeat K+ was 6.0. Nephrology fellow saw patiet in ED. \nPortable CXR looks clear, no infiltrates, effusions or fluid \noverload. Vitals in ED prior to transfer as follows: afebrile HR \n95 BP 152/100 RR 17.\n\nOn the floor, patient feels well overall. States that he \nsometimes has difficulty breathing, but thinks this is secondary \nto congestion. No fevers but endorses chills; he does states \nthat he feels chills mostly when he opens the window and is \nwearing shorts and a tshirt at home. He has mild generalized \nfatigue over the last few days as well as some lightheadedness, \nhaving some associated difficulty with balance when walking. He \nsometimes feels general malaise after missing dialysis. He \nstates that he usually takes his medications but he sometimes \ndoes not because he gets confused about whether he is supposed \nto take them prior to hemodialysis or not; he has been told by \nsome not to take certain meds prior to HD and by others that he \nshould take all meds prior to HD. He reports cough at baseline \nworse when lying down at night.', 'medications': [{'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Digoxin', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Enalapril Maleate', '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': 'Magnesium Oxide', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alprazolam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Spironolactone', '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': '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': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Spironolactone', '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:PRN', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', '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}]}, 'clinical_findings': {'labs': [{'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': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, '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': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, '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': '___', 'valuenum': 67.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEW REFERENCE INTERVAL AS OF ___;UPPER LIMIT (97.5TH %ILE) VARIES WITH ANCESTRY AND GENDER (MALE/FEMALE);WHITES 322/201 BLACKS 801/414 ASIANS 641/313.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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': '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '134', 'valuenum': 134.0, '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': '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': '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': '4.5', 'valuenum': 4.5, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\nVS: 97.6 142/91 94 20 100%RA\nGENERAL: Well-appearing middle-aged ___ gentleman \nin NAD, comfortable, appropriate. alert and oriented, but \nsometimes his speech is difficult to understand.\nHEENT: sclerae injected bilaterally, MMM, OP clear.\nNECK: Supple, no JVD, Right tunneled IJ catheter with no \nsurrounding erythema or signs of infection\nHEART: RRR, no MRG, nl S1-S2.\nLUNGS: CTA bilat, intermittent inspiratory wheeze diffusely, \ngood air movement, resp unlabored.\nABDOMEN: Soft, mildly distended, no tenderness, mildly \nhyperactive bowel sounds, no rebound/guarding.\nEXTREMITIES: WWP, no c/c/e, 2+ peripheral pulses.\nSKIN: No rashes or lesions.\nNEURO: Awake, A&Ox3.\n\nOn Discharge: VSS, exam unchanged from admission except wheezing \nresolved', 'diagnoses': [{'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}], 'summary': '___ 11:30PM GLUCOSE-90 UREA N-98* CREAT-22.6* SODIUM-139 \nPOTASSIUM-7.0* CHLORIDE-107 TOTAL CO2-17* ANION GAP-22*\n___ 11:30PM CALCIUM-9.1 PHOSPHATE-6.0* MAGNESIUM-3.1*\n___ 08:09PM K+-8.6*\n___ 09:40PM K+-6.0*\n___ 08:03PM GLUCOSE-100 UREA N-100* CREAT-22.3*# \nSODIUM-133 POTASSIUM-GREATER TH CHLORIDE-113* TOTAL CO2-15*\n___ 08:03PM WBC-3.5* RBC-4.11*# HGB-11.8*# HCT-36.4*# \nMCV-89 MCH-28.7 MCHC-32.4 RDW-16.8*\n___ 08:03PM NEUTS-73.5* ___ MONOS-3.6 EOS-2.4 \nBASOS-0.6\n___ 08:03PM PLT COUNT-191\n\nMicrobiology: wound culture and blood cx x 1 with coag negative \nstaph\n\nImaging:\nCXR - no fluid overload or infiltrate\n\nLabs on discharge:\n___ 06:17AM BLOOD WBC-2.2* RBC-3.64* Hgb-10.3* Hct-31.1*\nMCV-86 MCH-28.4 MCHC-33.2 RDW-16.4* Plt ___\n___ 06:17AM BLOOD Calcium-8.9 Phos-4.9* Mg-2.1\n\nOther labs:\n___ 08:25AM BLOOD PTH-981*\n___ 05:49AM BLOOD VitB12-629 Folate-18.\nw hx of noncompliance, ESRD on HD, mild mental retardation, \npresenting after missing hemodialysis for several days in \nsetting of URI symptoms.\n.\n# ESRD on HD: Pt presented with non-compliance with dialysis.\nPatient was given insulin and dextrose, albuterol, kayexalate in \nthe ED, as well as calcium gluconate for hyperkalemia, as he was \nseen to have peaked Ts on ECG. Patient has no signs of fluid \noverload on exam. He was seen by the renal team and re-started \non hemodialysis. His home meds were continued and on discharge \ncalcitiol and calcium carbonate were discontinued per renal \nrecommendations. He was started on sevelamer.\n.\n# URI: with no evidence of pneumonia on CXR. He was treated \nwith home albuterol and fluticasone as there was concern that \nhis asthma may be contributing to his symptoms.\n.\n# Bacteremia/Low WBC: thought most likely to be due to \ninfection, however pt without evidence of severe infection and \npositive blood cultures likely a contaminant. Regardless, HD \nline was replaced over a wire and vanco was continued on \ndischarge pending final culture results. It will be dosed with \nHD. Would recommend repeating CBC as an outpatient to ensure \nimprovement of leukopenia.\n.\n# Hypertension: he was continued on metoprolol, diltiazem and \naspirin.\n.\n# Hx of noncompliance: Patient is not in touch frequently with \ncase manager, though he seems to require more support. His \nguardian is his cousin who lives in ___ and cannot \nactively participate in his care. He has also not seen his new \nprimary care physician ___. On discharge, he was offered \nadditional help but refused and social work contacted several \nfriends/family members to help encourage compliance.\n.\n# Hyperlipidema: simvastatin was continued\n.\n# Anemia of Chronic Kidney Disease: he was discharged on home \nepo.\n.\n# Hx Asthma: albuterol and fluticasone were continued'}}
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{'final_diagnoses': ['Hyperkalemia and uremia from missed dialysis sessions', 'Dialysis line infection'], 'procedures': ['Tunneled dialysis line exchange'], 'visit_summary': 'w hx of noncompliance, ESRD on HD, mild mental retardation, \npresenting after missing hemodialysis for several days in \nsetting of URI symptoms.\n.\n# ESRD on HD: Pt presented with non-compliance with dialysis.\nPatient was given insulin and dextrose, albuterol, kayexalate in \nthe ED, as well as calcium gluconate for hyperkalemia, as he was \nseen to have peaked Ts on ECG. Patient has no signs of fluid \noverload on exam. He was seen by the renal team and re-started \non hemodialysis. His home meds were continued and on discharge \ncalcitiol and calcium carbonate were discontinued per renal \nrecommendations. He was started on sevelamer.\n.\n# URI: with no evidence of pneumonia on CXR. He was treated \nwith home albuterol and fluticasone as there was concern that \nhis asthma may be contributing to his symptoms.\n.\n# Bacteremia/Low WBC: thought most likely to be due to \ninfection, however pt without evidence of severe infection and \npositive blood cultures likely a contaminant. Regardless, HD \nline was replaced over a wire and vanco was continued on \ndischarge pending final culture results. It will be dosed with \nHD. Would recommend repeating CBC as an outpatient to ensure \nimprovement of leukopenia.\n.\n# Hypertension: he was continued on metoprolol, diltiazem and \naspirin.\n.\n# Hx of noncompliance: Patient is not in touch frequently with \ncase manager, though he seems to require more support. His \nguardian is his cousin who lives in ___ and cannot \nactively participate in his care. He has also not seen his new \nprimary care physician ___. On discharge, he was offered \nadditional help but refused and social work contacted several \nfriends/family members to help encourage compliance.\n.\n# Hyperlipidema: simvastatin was continued\n.\n# Anemia of Chronic Kidney Disease: he was discharged on home \nepo.\n.\n# Hx Asthma: albuterol and fluticasone were continued', 'medications_prescribed': ['1. albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation Q6H (every 6 hours) as \nneeded for sob/wheeze.', '2. sevelamer carbonate 800 mg Tablet Sig: One (1) Tablet PO TID \nW/MEALS (3 TIMES A DAY WITH MEALS).\nDisp:*90 Tablet(s)* Refills:*2*', '3. fluticasone 110 mcg/Actuation Aerosol Sig: Two (2) Puff \nInhalation BID (2 times a day).', '4. furosemide 40 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '5. metoprolol succinate 25 mg Tablet Extended Release 24 hr Sig: \nThree (3) Tablet Extended Release 24 hr PO DAILY (Daily).\nDisp:*30 Tablet Extended Release 24 hr(s)* Refills:*2*', '6. diltiazem HCl 180 mg Capsule, Extended Release Sig: One (1) \nCapsule, Extended Release PO DAILY (Daily).', '7. epoetin alfa 10,000 unit/mL Solution Sig: One (1) Injection \nevery other week.', '8. aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', '9. simvastatin 40 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '10. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily).', '11. B complex-vitamin C-folic acid 1 mg Capsule Sig: One (1) \nCapsule PO once a day.', '12. vancomycin 1,000 mg Recon Soln Sig: One (1) Intravenous HD \nPROTOCOL (HD Protochol).']}
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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': 'Rectal cancer', 'medical_history': ['Fibromyalgia', 'chronic headaches', 'rectal cancer T4 NO', 'Laser Palatine ablation for sleep apnea'], 'family_history': 'Mother was on dialysis and had stage renal disease, father is \nhealthy and alive', 'present_illness': '___ is a ___ man who presents for follow-up\nof his rectal cancer. The patient was last seen in clinic in\n___ of this year and at that time required thoracentesis \nof\npleural fluid and additional imaging studies. The cytology of\nthoracentesis revealed no malignancy and his most recent PET \nscan\nhas shown no metastatic disease the patient reports his \nbreathing\nhas improved since the thoracentesis was performed he can\nambulate much farther than before his energy level is the same \nas\nit was before he was diagnosed with cancer. The patient reports\nalternating diarrhea and constipation as he does take narcotics\nfor fibromyalgia and experiences diarrhea after taking laxative.\nHe reports blood in the stool recently particularly when with\nconstipation, he notes the blood is mixed in with the stool. He\ndenies any issues with urination. He denies fevers, chills,\nchange in his weight, nausea, or vomiting. He understands he\nwill require surgery and would like to discuss the next steps.', 'medications': [{'medication': 'Lisinopril', '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', 'doses_per_24_hrs': 2.0}, {'medication': 'Eptifibatide', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', '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': 'DAILY: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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', '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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', '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': 'Clopidogrel Bisulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol', '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', 'route': 'PO', 'frequency': 'DAILY', '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}]}, 'clinical_findings': {'labs': [{'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': '___', 'valuenum': 23.9, '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': '75.8', 'valuenum': 75.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'Ratio', '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': '106', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '160', 'valuenum': 160.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '152', 'valuenum': 152.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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 1.1,. Estimated GFR = 69 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': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', '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': '4.4', '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': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': None, 'priority': 'ROUTINE', 'comments': '<0.01. CTROPNT > 0.10 NG/ML SUGGESTS ACUTE MI.'}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.7', 'valuenum': 40.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, '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': '203', 'valuenum': 203.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 20.3, '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': '60.9', 'valuenum': 60.9, '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': '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': '55.1', 'valuenum': 55.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': None, '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': '34.7', 'valuenum': 34.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '211', 'valuenum': 211.0, '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': '4.64', 'valuenum': 4.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, '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': '4.1', '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 14.6, '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': '50.5', 'valuenum': 50.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '128', 'valuenum': 128.0, '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': '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': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.4, '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': '26.8', 'valuenum': 26.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '87', 'valuenum': 87.0, 'valueuom': 'IU/L', 'ref_range_lower': 38.0, 'ref_range_upper': 174.0, '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': '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': '100', 'valuenum': 100.0, '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': '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.3', 'valuenum': 40.3, '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': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '194', 'valuenum': 194.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.47', 'valuenum': 4.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': "AFVSS\n GEN: WN in NAD \n HEENT: NCAT, EOMI, anicteric \n CV: RRR\n PULM: non-labored respirations \n ABD: soft, NT, ND, ostomy dark, brown stool output in bag. JP\nwith thin serosang output, dc'd\n PELVIS: incision, C/I, no erythema \n EXT: WWP, no CCE, no tenderness \n NEURO: A&Ox3, no focal neurologic deficits \n PSYCH: normal judgment/insight, normal memory, normal\nmood/affect", 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '4111', 'desc': 'Intermediate coronary syndrome'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}], 'summary': "___ 07:06AM BLOOD WBC-7.0 RBC-3.07* Hgb-8.7* Hct-28.3*\nMCV-92 MCH-28.3 MCHC-30.7* RDW-19.6* RDWSD-64.5* Plt ___\n___ 07:06AM BLOOD Glucose-84 UreaN-9 Creat-1.0 Na-140 K-4.8 \nCl-101 HCO3-25 AnGap-14\n___ 07:06AM BLOOD Calcium-8.5 Phos-4.0 Mg-2.6\nMr. ___ presented to ___ holding at ___ on ___ \nfor a robotic APR for his rectal cancer. He tolerated the \nprocedure well without complications (Please see operative note \nfor further details). After a brief and uneventful stay in the \nPACU, the patient was transferred to the floor for further \npost-operative management. \n Neuro: Pain was well controlled on oral pain medications and \nhome methadone \n CV: Vital signs were routinely monitored during the patient's \nlength of stay. \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. \n GU: Patient had a Foley catheter that was removed prior to \ndischarge. Urine output was monitored as indicated. At time of \ndischarge, the patient was voiding without difficulty. \n ID: The patient's vital signs were monitored for signs of \ninfection and fever. \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 Wound: The patient was maintained on perineal precautions with \nbacitracin ointment application to the perineal wound BID. His \nJP drain was removed on ___. \n On ___, the patient was discharged to home with services. At \ndischarge, he was tolerating a regular diet, passing flatus and \nstool from his ostomy, voiding, and ambulating independently. He \nwill follow-up in the clinic in ___ weeks. This information was \ncommunicated to the patient directly prior to discharge. \n Include in Brief Hospital Course for Every Patient and check of \nboxes that apply: \n Post-Surgical Complications During Inpatient Admission: \n [ ] Post-Operative Ileus resolving w/o NGT \n [ ] Post-Operative Ileus requiring management with NGT \n [ ] UTI \n [ ] Wound Infection \n [ ] Anastomotic Leak \n [ ] Staple Line Bleed \n [ ] Congestive Heart failure \n [ ] ARF \n [ ] Acute Urinary retention, failure to void after Foley D/C'd \n\n [ ] Acute Urinary Retention requiring discharge with Foley \nCatheter \n [ ] DVT \n [ ] Pneumonia \n [ ] Abscess \n [x] None \n Social Issues Causing a Delay in Discharge: \n [ ] Delay in organization of ___ services \n [ ] Difficulty finding appropriate rehab hospital disposition. \n\n [ ] Lack of insurance coverage for ___ services \n [ ] Lack of insurance coverage for prescribed medications. \n [ ] Family not agreeable to discharge plan. \n [ ] Patient knowledge deficit related to ileostomy delaying \ndispo \n [x] No social factors contributing in delay of discharge."}}
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{'final_diagnoses': ['T3N1a rectal cancer'], 'procedures': ['Robotic-assisted ___'], 'visit_summary': "Mr. ___ presented to ___ holding at ___ on ___ \nfor a robotic APR for his rectal cancer. He tolerated the \nprocedure well without complications (Please see operative note \nfor further details). After a brief and uneventful stay in the \nPACU, the patient was transferred to the floor for further \npost-operative management. \n Neuro: Pain was well controlled on oral pain medications and \nhome methadone \n CV: Vital signs were routinely monitored during the patient's \nlength of stay. \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. \n GU: Patient had a Foley catheter that was removed prior to \ndischarge. Urine output was monitored as indicated. At time of \ndischarge, the patient was voiding without difficulty. \n ID: The patient's vital signs were monitored for signs of \ninfection and fever. \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 Wound: The patient was maintained on perineal precautions with \nbacitracin ointment application to the perineal wound BID. His \nJP drain was removed on ___. \n On ___, the patient was discharged to home with services. At \ndischarge, he was tolerating a regular diet, passing flatus and \nstool from his ostomy, voiding, and ambulating independently. He \nwill follow-up in the clinic in ___ weeks. This information was \ncommunicated to the patient directly prior to discharge. \n Include in Brief Hospital Course for Every Patient and check of \nboxes that apply: \n Post-Surgical Complications During Inpatient Admission: \n [ ] Post-Operative Ileus resolving w/o NGT \n [ ] Post-Operative Ileus requiring management with NGT \n [ ] UTI \n [ ] Wound Infection \n [ ] Anastomotic Leak \n [ ] Staple Line Bleed \n [ ] Congestive Heart failure \n [ ] ARF \n [ ] Acute Urinary retention, failure to void after Foley D/C'd \n\n [ ] Acute Urinary Retention requiring discharge with Foley \nCatheter \n [ ] DVT \n [ ] Pneumonia \n [ ] Abscess \n [x] None \n Social Issues Causing a Delay in Discharge: \n [ ] Delay in organization of ___ services \n [ ] Difficulty finding appropriate rehab hospital disposition. \n\n [ ] Lack of insurance coverage for ___ services \n [ ] Lack of insurance coverage for prescribed medications. \n [ ] Family not agreeable to discharge plan. \n [ ] Patient knowledge deficit related to ileostomy delaying \ndispo \n [x] No social factors contributing in delay of discharge.", 'medications_prescribed': ['1. Acetaminophen 1000 mg PO TID', '2. Bacitracin Ointment 1 Appl TP TID', '3. Enoxaparin Sodium 40 mg SC QD \nRX *enoxaparin 40 mg/0.4 mL 40 mg sc once a day Disp #*22 \nSyringe Refills:*0', '4. OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain - \nModerate \nRX *oxycodone 5 mg 1 tablet(s) by mouth q4h prn Disp #*40 Tablet \nRefills:*0', '5. Polyethylene Glycol 17 g PO EVERY OTHER DAY', '6. Amitriptyline 150 mg PO QHS', '7. Methadone 10 mg PO BID']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'AMS, Sepsis', 'medical_history': ['CAD: s/p CABG ___ (LIMA to the LAD, SVG to D1, SVG to OM2 and SVG to RCA)', 'biventricular heart failure: EF 15%', 'Atrial fibrillation CHADS2 ___ s/p AVJ ablation and AICD placement', 'Ventricular Tachycardia, history of both polymorphic and monomorphic VTs. Could not upgrade to BiV because of inability to pass wire', 'HTN', 'Diabetes II', 'CKD Stage III ~1.5-2.0, on dialysis as outpatient', 'BPH', 'SDH s/p left craniotomy for ___ evacuation on ___', 'Depression/Anxiety', 'Hypothyroidism', 'Gout', 'Nephrolithiasis', 'Primary polydipsia'], 'family_history': 'Per chart:\nBrother CAD/PVD - Early; Cancer - Prostate \nFather ___ - Type II \nMother ___ \nSister Cancer - Breast', 'present_illness': "___ year old man with medical history of severe advanced sCHF (LVEF 15%), CAD s/p MI and CABG in ___, VT s/p ___ ICD, permanent A-fib s/p AVJ ablation after failure of rate control, ESRD on HD, who was found to have AMS and agitation last night at his nursing home. EMS was called and patient was found to be hypotensive. He was taken to ___, where he was agitated, febrile and hypotensive (SBPs ___, hypoxic to ___ on RA. CT head at ___ showed pneumocephalus which was felt to be stable and likely postoperative from prior ___ evacuation and CT A/P showed ascending colitis. EKG was unchanged from prior. Exam was notable for cold and clamped extremities per report. He was started on zosyn and levophed and got 500cc IVF at the OSH and transferred to ___ for further management. \n\nOf note, he was discharged from the cardiology service on ___. \n\nDuring prior admission patient required Lasix 200 mg IV bolus and Lasix drip at 30 cc/hr, as well as spironolactone 100 mg daily for diuresis. He was discharged at 86.0 kg on bumex 5 mg PO bid and metolazone 5 mg qod. There was concern during that \n\nhospitalization for him tampering with Lasix drip. His anatomy/ epicardium have been determined unsuitable for BiV pacing.\n\nIn the ED, initial vitals: 98.6 90 99/44 17 80% Nasal Cannula. Exam per report was remarkable for being clamped down peripherally, cold, 1+ pulses, hand with levophed appeared mottled. Belly soft, non-surgical. Only alert to self, moaning, crackles on exam and with evidence of volume overload. Heme positive maroon stool. Labs notable for wbx 27.8, 11% bands, H/H ___, platelets 242. Chemistries notable for Na 126 (baseline anywhere from 121-130), K 4.6, Cl 88, HCO3 23, BUN 57, Cr 2.1, on HD. Troponin 0.12 (last admission 0.08). Pro-BNP 6614 (compared to prior ___. ALT 226, AST 282 (recent baseline ___, AP 84, Tbili 1, PTT 36.7, INR 2. UA was grossly negative. VBG 7.44/35, HCO3 25. Lactate in ED 3.6->2.6. Blood and urine cx's were sent. CXR with mild to moderate pulmonary edema and small right pleural effusion. On bedside US, CVP is 50, IVC plump. \n\nHe was given 1 g vancomycin, flagyl, and continued on norepinephrine gtt in setting of shock, and also given 5mg IV Haldol for agitation. He was difficult access, R IJ was placed. Cardiology was consulted and recommened admission to MICU for management of shock. Renal made aware. \n\nOn arrival to the MICU, initial vitals were Temp 98.8, HR 91, BP 104/79 on 2.5 levophed, MAP 82, O2 sat 96% NRB. Patient opened eyes to name, could answer some questions and follow commands, but not able to engage in a conversation.", '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': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION PE:\n\nVitals: Temp 98.8, HR 91, BP 104/79 \nGENERAL: lethargic, but following commands, chronically ill-appearing man, oriented only to person\nHEENT: Sclera anicteric, MMM, oropharynx clear \nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, rhonchi \nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, gallops \nABD: soft, non-tender, non-distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema \nSKIN: \nNEURO: PERRL, limited by cooperation, moving all extremities, no facial asymmetries. \n\nDISCHARGE PE:\n\nDeceased', 'diagnoses': [{'icd_code': '2102', 'desc': 'Benign neoplasm of major salivary glands'}, {'icd_code': '71596', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, lower leg'}, {'icd_code': '6953', 'desc': 'Rosacea'}], 'summary': "___ 07:19AM BLOOD WBC-27.8*# RBC-4.61 Hgb-13.0* Hct-39.6* \nMCV-86 MCH-28.2 MCHC-32.8 RDW-16.9* RDWSD-51.8* Plt ___\n___ 07:19AM BLOOD Neuts-83* Bands-11* Lymphs-4* Monos-2* \nEos-0 Baso-0 ___ Myelos-0 AbsNeut-26.13* \nAbsLymp-1.11* AbsMono-0.56 AbsEos-0.00* AbsBaso-0.00*\n___ 07:19AM BLOOD Hypochr-NORMAL Anisocy-1+ Poiklo-2+ \nMacrocy-NORMAL Microcy-NORMAL Polychr-OCCASIONAL Spheroc-1+ \nOvalocy-OCCASIONAL Burr-2+\n___ 07:19AM BLOOD ___ PTT-36.7* ___\n___ 07:19AM BLOOD Glucose-228* UreaN-57* Creat-2.1* Na-126* \nK-4.6 Cl-88* HCO3-23 AnGap-20\n___ 07:19AM BLOOD ALT-226* AST-282* AlkPhos-84 TotBili-1.0\n___ 07:19AM BLOOD Albumin-2.3* Calcium-8.0* Phos-4.6*# \nMg-1.8\n___ 09:17AM BLOOD ___ Temp-36.4 Rates-/24 O2 Flow-12 \npO2-38* pCO2-35 pH-7.44 calTCO2-25 Base XS-0 Intubat-NOT INTUBA \nComment-NON-REBREA\n___ 07:23AM BLOOD Lactate-3.6*\n___ 09:17AM BLOOD O2 Sat-64\n\nDISCHARGE LABS: Deceased\n\nMICRO:\n\n STAPH AUREUS COAG +. \n Consultations with ID are recommended for all blood \ncultures\n positive for Staphylococcus aureus, yeast or other \nfungi. \n PRELIMINARY SENSITIVITY. \n These preliminary susceptibility results are offered to \nhelp guide\n treatment; interpret with caution as final \nsusceptibilities may\n change. Check for final susceptibility results in 24 \nhours. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n STAPH AUREUS COAG +\n | \nOXACILLIN------------- S\n\nSPUTUM: >25 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\nURINE: NG\n\nIMAGING:\n\nCXR ___: Mild pulmonary edema. Moderate right and trace left \npleural effusions.\n___ year old man with complex medical history including advanced sCHF (EF 15%) from ischemic heart disease, permanent atrial fibrillation, ESRD on HD, presenting with septic shock felt to be secondary to colitis and infected HD line. \n\nPatient was admitted to the intensive care unit for care. He was treated with broad spectrum antibiotics (IV flagyl, PO Vanco, IV Vancomycin, Cefepime). He also required significant pressor support and was maintained on norepinephrine, phenylepherine and dobutamine. There was initial concern for severe complicated c. difficile colitis given CT findings, however ACS surgery team was consulted and did not feel that he had an acute abdomen and the patient was without loose stool for the duration of his ICU stay; stool studies were negative and c. difficile unable to be run as patient had solid stool. Empiric for colitis was continued given CT findings, however abdominal exam remained benign.\n\nBlood cultures returned with MRSA, and patient's tunneled HD line was removed given concern for source of infection. A TTE was without evidence of endocarditis or pacer lead infection. The patient was also initially treated with IV diuresis given his severe sCHF, however eventually developed overwhelming sepsis and BPs unable to tolerate further IV diuresis. Renal also consulted this admission, however did not feel that patient was a candidate for CVVH as he had not tolerated outpatient HD and CVVH would not address the primary problems underlying his shock. Cardiology also followed the patient during his admission. In the end, felt that patient was a mixed cardiogenic and septic shock picture. \n\nAfter treatment for 2 days with high dose pressors and antibiotics, patient continued to remain critically ill with little improvement and his CVo2 and lactate continued to worsen. Patient's mental status remained poor, with a non-focal neurologic exam. \n\nFamily meeting was held with the patient's brother, daughter and MICU team. Family discussed conversation held with Mr. ___ several months ago in which he said that if he appeared to at any point be suffering in the hospital, he would not want further aggressive care, and focus would be on comfort. The family felt that he did not appear to be improving and only appeared to be suffering so the decision was made to make the patient comfort-focused care. The patient's AICD was deactivated and the patients care was transitioned to comfort measures only. He died peacefully overnight."}}
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{'final_diagnoses': ['deceased'], 'procedures': ['CVL ___'], 'visit_summary': "___ year old man with complex medical history including advanced sCHF (EF 15%) from ischemic heart disease, permanent atrial fibrillation, ESRD on HD, presenting with septic shock felt to be secondary to colitis and infected HD line. \n\nPatient was admitted to the intensive care unit for care. He was treated with broad spectrum antibiotics (IV flagyl, PO Vanco, IV Vancomycin, Cefepime). He also required significant pressor support and was maintained on norepinephrine, phenylepherine and dobutamine. There was initial concern for severe complicated c. difficile colitis given CT findings, however ACS surgery team was consulted and did not feel that he had an acute abdomen and the patient was without loose stool for the duration of his ICU stay; stool studies were negative and c. difficile unable to be run as patient had solid stool. Empiric for colitis was continued given CT findings, however abdominal exam remained benign.\n\nBlood cultures returned with MRSA, and patient's tunneled HD line was removed given concern for source of infection. A TTE was without evidence of endocarditis or pacer lead infection. The patient was also initially treated with IV diuresis given his severe sCHF, however eventually developed overwhelming sepsis and BPs unable to tolerate further IV diuresis. Renal also consulted this admission, however did not feel that patient was a candidate for CVVH as he had not tolerated outpatient HD and CVVH would not address the primary problems underlying his shock. Cardiology also followed the patient during his admission. In the end, felt that patient was a mixed cardiogenic and septic shock picture. \n\nAfter treatment for 2 days with high dose pressors and antibiotics, patient continued to remain critically ill with little improvement and his CVo2 and lactate continued to worsen. Patient's mental status remained poor, with a non-focal neurologic exam. \n\nFamily meeting was held with the patient's brother, daughter and MICU team. Family discussed conversation held with Mr. ___ several months ago in which he said that if he appeared to at any point be suffering in the hospital, he would not want further aggressive care, and focus would be on comfort. The family felt that he did not appear to be improving and only appeared to be suffering so the decision was made to make the patient comfort-focused care. The patient's AICD was deactivated and the patients care was transitioned to comfort measures only. He died peacefully overnight.", 'medications_prescribed': ['deceased']}
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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': '___', 'medical_history': ['Unknown'], 'family_history': 'Unknown', 'present_illness': "Mrs. ___ is a very unfortunate ___ yo woman with unknown\npast medical history who presents with a massive SAH. She was\napparently in her USOH until this evening when she was at a\nrestaurant, complained of headache and said that she wanted to \ngo\nto the bathroom. When she didn't come out, she was found down in\nthe bathroom.", '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', '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': 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 via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID: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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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}]}, 'clinical_findings': {'labs': [{'value': '2.59', 'valuenum': 2.59, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, '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': '48.1', 'valuenum': 48.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '16.2', 'valuenum': 16.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.5', 'valuenum': 51.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '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': '84', 'valuenum': 84.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '304', 'valuenum': 304.0, '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': '5.71', 'valuenum': 5.71, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.10', 'valuenum': 0.1, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.53', 'valuenum': 0.53, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.76', 'valuenum': 1.76, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.4', 'valuenum': 39.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '1.3', 'valuenum': 1.3, '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': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, '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': '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': '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': '___', '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': '33', 'valuenum': 33.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Upon arriving here, she was seemingly moving all four \nextremities\nand was oriented to name. She then vomited, prompting her to be\nintubated. Head CT showed thick SAH with possible left Acomm\naneurysm, with significant IVH and hydro, casting of the ___ ventricle and obscuration of the basal cisterns.\n\nWhen I saw her, 5 minutes off of propofol, she was extensor\nposturing.', 'diagnoses': [{'icd_code': 'M5106', 'desc': 'Intervertebral disc disorders with myelopathy, lumbar region'}, {'icd_code': 'G834', 'desc': 'Cauda equina syndrome'}, {'icd_code': 'R200', 'desc': 'Anesthesia of skin'}, {'icd_code': 'K599', 'desc': 'Functional intestinal disorder, unspecified'}], 'summary': "CT Head:\nIMPRESSION: Hemorrhage distending entire ventricular system and \nalso\nsubarachnoid hemorrhage in the cisterns, along bifrontoparietal \nsulci and\ninterhemispheric fissures, with cerebral edema and evolving \nhydrocephalus. \n13-mm left frontal relatively focal hematoma suggestive of \naneurysm rupture,\nas confirmed on subsequent CTA, with a source aneurysm arising \nfrom the left\nsupraclinoid ICA. \n\nCTA Head:\nIMPRESSION:\n1. 10 x 8 mm aneurysm, arising dorsally from the left supraclinoid carotid\nartery surrounding by hematoma, likely indicating recent rupture.\n\n2. The major vessels in the circle of ___ are patent, including the\nbasilar artery. The patient is status post interval placement of bilateral\nfrontal approach intraventricular shunt catheters, with tips terminating in\nthe lateral ventricles, intraventricular and diffuse subarachnoid hemorrhage,\nnot significantly changed since the preceding head CT.\nMrs. ___ is a very unfortunate ___ yo woman with unknown\npast medical history who presents with a massive SAH. She was\napparently in her USOH until this evening when she was at a\nrestaurant, complained of headache and said that she wanted to \ngo\nto the bathroom. When she didn't come out, she was found down in\nthe bathroom. \n\nUpon arriving here, she was seemingly moving all four \nextremities\nand was oriented to name. She then vomited, prompting her to be\nintubated. Head CT showed thick SAH with possible left Acomm\naneurysm, with significant IVH and hydro, casting of the ___ ventricle and obscuration of the basal cisterns. \n\nWhen I saw her, 5 minutes off of propofol, she was extensor\nposturing. Dr. ___ came to patient's bedside and\nplaced 2 EVDs (one on each side), one of which is at 10 and the\nother of which is currently open. With placement of the EVD, it\nwas noted that 200cc of fresh blood came out. A CTA was \nperformed\nright after this and showed a clear left Acomm vs. A2 aneurysm.\n\nSubsequent to the CTA Dr. ___ the patient and\nfound her to have fixed and dilated pupils. Dr. ___ felt\nthat angiography would be too risky given her active herniation. \n\n\nAt this time, the patient has a dismal prognosis. As a result, we\nwill pursue end-of-life discussions with the family and elicit\ntheir wishes.\n\nPatient pronounced at 4:19 a.m. Proximate cause of death was\ncardiopulmonary arrest. Main cause of death was transtentorial\ncerebral herniation secondary to subarrachnoid hemorrhage.\n\nExamination shows fixed and dilated pupils. No corneals, no gag,\nno Doll's. No pulse, no breath sounds, no heart sounds."}}
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{'final_diagnoses': ['SAH', 'Hydrocephalus', 'Aneurysm', 'Cerebral edema'], 'procedures': ['Bilateral EVD Placement'], 'visit_summary': "Mrs. ___ is a very unfortunate ___ yo woman with unknown\npast medical history who presents with a massive SAH. She was\napparently in her USOH until this evening when she was at a\nrestaurant, complained of headache and said that she wanted to \ngo\nto the bathroom. When she didn't come out, she was found down in\nthe bathroom. \n\nUpon arriving here, she was seemingly moving all four \nextremities\nand was oriented to name. She then vomited, prompting her to be\nintubated. Head CT showed thick SAH with possible left Acomm\naneurysm, with significant IVH and hydro, casting of the ___ ventricle and obscuration of the basal cisterns. \n\nWhen I saw her, 5 minutes off of propofol, she was extensor\nposturing. Dr. ___ came to patient's bedside and\nplaced 2 EVDs (one on each side), one of which is at 10 and the\nother of which is currently open. With placement of the EVD, it\nwas noted that 200cc of fresh blood came out. A CTA was \nperformed\nright after this and showed a clear left Acomm vs. A2 aneurysm.\n\nSubsequent to the CTA Dr. ___ the patient and\nfound her to have fixed and dilated pupils. Dr. ___ felt\nthat angiography would be too risky given her active herniation. \n\n\nAt this time, the patient has a dismal prognosis. As a result, we\nwill pursue end-of-life discussions with the family and elicit\ntheir wishes.\n\nPatient pronounced at 4:19 a.m. Proximate cause of death was\ncardiopulmonary arrest. Main cause of death was transtentorial\ncerebral herniation secondary to subarrachnoid hemorrhage.\n\nExamination shows fixed and dilated pupils. No corneals, no gag,\nno Doll's. No pulse, no breath sounds, no heart sounds.", 'medications_prescribed': ['Expired']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 84, 'gender': 'F', 'symptoms': 'initiation of dialysis', 'medical_history': ['Chronic alcoholic pancreatitis', 'Chronic kidney disease', 'Hepatitis C', 'Gout', 'Hypertension'], 'family_history': 'Father with hypertension on hemodialysis. Maternal aunt with \ndiabetes on dialysis. Brother with coronary artery disease.', 'present_illness': 'Mr. ___ is a delightful ___ ___ \ngentleman with a past medical history of chronic hepatitis C \ninfection, longstanding hypertension, and chronic pancreatitis, \nwho returns who is being admitted to initiate hemodialysis for \nhis stage V chronic kidney disease. The patient denies symptoms \nreferable to uremia such as anorexia, nausea, vomiting, weight \nloss, confusion, or pruritus, except for a altered taste \nsensation- he has a metallic taste in his mouth. He is sleeping \nvery well. He states his appetite is outstanding. With regard to \nhis urine output, he states that it is completely normal and he \nnotices increased urine output on the 3 days a week he takes the \nlasix. The remainder of the review of systems is entirely \nnegative across all systems surveyed.\n.\nOn the floor, he arrives just after HD that was performed \nwithout complication. He has no complaints', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 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': 'Fluoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Neomycin-Polymyxin-Bacitracin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'ValACYclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Clotrimazole 1% Vaginal Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'VG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'ValACYclovir', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'Discontinued', 'route': 'IV', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', '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': 'Tolterodine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 1%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 0.4, '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 0.9,. 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': '580', 'valuenum': 580.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', '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': '17', 'valuenum': 17.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '229', 'valuenum': 229.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '203', 'valuenum': 203.0, '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': '3.1', '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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': '29.8', 'valuenum': 29.8, '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': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, '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': '270', 'valuenum': 270.0, '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': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, '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': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'RARE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'LG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 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': '25', 'valuenum': 25.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, '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': '1.022', 'valuenum': 1.022, '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': 'OCC', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0-2', 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.7', 'valuenum': 9.7, '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': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '249', 'valuenum': 249.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.13', 'valuenum': 3.13, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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, 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32.0, 'valueuom': 'mg/dL', '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': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, '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': '___', 'valuenum': 76.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': None, 'priority': 'STAT', 'comments': 'LDL(CALC) INVALID IF TRIG>400 OR NON-FASTING SAMPLE.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '25.5', 'valuenum': 25.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '18', 'valuenum': 18.0, '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': '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, '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': '153', 'valuenum': 153.0, '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': '10.5', 'valuenum': 10.5, '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 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'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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '45', 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'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': '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': 118.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', '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': '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '3.7', 'valuenum': 3.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.8', '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': '5.9', 'valuenum': 5.9, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89.5', 'valuenum': 89.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': '16.8', 'valuenum': 16.8, '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': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', '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': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '8.6', 'valuenum': 8.6, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, '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': '29.4', 'valuenum': 29.4, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '303', 'valuenum': 303.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.94', 'valuenum': 2.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '330', 'valuenum': 330.0, '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': '2.77', 'valuenum': 2.77, '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': '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', '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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.9', 'valuenum': 29.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, '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': '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': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '434', 'valuenum': 434.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.46', 'valuenum': 3.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': 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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': 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': '1.023', 'valuenum': 1.023, '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': '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}, {'value': '30.3', 'valuenum': 30.3, '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': '28.3', 'valuenum': 28.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '435', 'valuenum': 435.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.38', 'valuenum': 3.38, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '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': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', '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': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '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': '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': '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', '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': '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': '131', 'valuenum': 131.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.63', 'valuenum': 0.63, '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': '345', 'valuenum': 345.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, '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': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '1+.'}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'TOXIC GRANULATION.'}, {'value': '496', 'valuenum': 496.0, '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': '3.25', 'valuenum': 3.25, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '494', 'valuenum': 494.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 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': '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': '___', 'valuenum': 84.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\nVitals: 97.9 145/79 65 17 98% on RA\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 , normal S1 + S2, flow murmur radiating from \nfistula\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\nfistula on left upper extremity\nNeuro: pleasant, appropriate, non-focal \n\nOn Discharge:\nVitals: 98.5 147/76 63 18 95% on RA\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, normal S1 + S2, flow murmur radiating from \nfistula\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\nfistula on left upper extremity, PPD is negative, no raised \narea.', 'diagnoses': [{'icd_code': '82021', 'desc': 'Closed fracture of intertrochanteric section of neck of femur'}, {'icd_code': '42843', 'desc': 'Acute on chronic combined systolic and diastolic heart failure'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '4168', 'desc': 'Other chronic pulmonary heart diseases'}, {'icd_code': '0417', 'desc': 'Pseudomonas infection in conditions classified elsewhere and of unspecified site'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '27650', 'desc': 'Volume depletion, unspecified'}, {'icd_code': '0539', 'desc': 'Herpes zoster without mention of complication'}, {'icd_code': '78830', 'desc': 'Urinary incontinence, unspecified'}, {'icd_code': '59651', 'desc': 'Hypertonicity of bladder'}, {'icd_code': '71595', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, pelvic region and thigh'}, {'icd_code': 'E8889'}, {'icd_code': '2809', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': '78009', 'desc': 'Other alteration of consciousness'}, {'icd_code': '6981', 'desc': 'Pruritus of genital organs'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '38021', 'desc': 'Cholesteatoma of external ear'}, {'icd_code': '3804', 'desc': 'Impacted cerumen'}, {'icd_code': '38420', 'desc': 'Perforation of tympanic membrane, unspecified'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}], 'summary': 'On Admission:\n\n___ 12:45PM BLOOD WBC-3.7* RBC-3.51* Hgb-9.8* Hct-30.3* \nMCV-86 MCH-28.0 MCHC-32.4 RDW-15.3 Plt ___\n___ 12:45PM BLOOD Glucose-154* UreaN-67* Creat-10.2*# \nNa-144 K-4.0 Cl-109* HCO3-22 AnGap-17\n___ 12:45PM BLOOD Calcium-7.9* Phos-5.5* Mg-2.1\n\nOn Discharge:\n\n___ 06:15AM BLOOD WBC-3.9* RBC-3.50* Hgb-9.8* Hct-30.3* \nMCV-87 MCH-28.1 MCHC-32.4 RDW-14.8 Plt ___\n___ 06:15AM BLOOD Glucose-96 UreaN-46* Creat-7.9* Na-141 \nK-4.1 Cl-102 HCO3-28 AnGap-15\n___ 06:15AM BLOOD Calcium-8.6 Phos-4.9* Mg-1.9\n\nIron Studies and Hepatitis Screen:\n\n___ 06:22AM BLOOD Iron-83\n___ 06:22AM BLOOD calTIBC-256* Ferritn-682* TRF-197*\n___ 12:45PM BLOOD HBsAg-NEGATIVE HBsAb-NEGATIVE \nHBcAb-NEGATIVE\n___ 12:45PM BLOOD HCV Ab-POSITIVE*\n___ year-old male with history of Stage V CKD, hypertension, \nchronic pancreatitis, and Hep C who is being evaluated for renal \ntransplant, admitted to initial hemodialysis.\n\n# end-stage renal disease: The patient presented with \nhyperphosphatemia, anemia, and unrelenting climbing of his \ncreatinine. He was asymptomatic. His lasix and calcitriol was \nstopped with initiation of dialysis. He was given vitamin D \nwith dialysis and was started on nephrocaps. A PPD was placed \nand was negative after 48 hours. He will continue ___ HD after \ndischarge. \n.\n# hypertension, stage II- The patient was continued on his home \ndose of amlodipine.\n.\n# history of chronic hepatitis C- Serology was hep C positive as \nexpected. He has not been treated.\n.\n# chronic pancreatitis- no currently on medications for this. \nstopped alcohol in ___ after first bout, his last bout was ___ \nyears ago. \n.\n# anemia- likely secondary to end-stage renal disease. Iron \nstudies revealed no evidence of iron deficiency.'}}
|
{'final_diagnoses': ['end-stage renal disease'], 'procedures': ['none'], 'visit_summary': '___ year-old male with history of Stage V CKD, hypertension, \nchronic pancreatitis, and Hep C who is being evaluated for renal \ntransplant, admitted to initial hemodialysis.\n\n# end-stage renal disease: The patient presented with \nhyperphosphatemia, anemia, and unrelenting climbing of his \ncreatinine. He was asymptomatic. His lasix and calcitriol was \nstopped with initiation of dialysis. He was given vitamin D \nwith dialysis and was started on nephrocaps. A PPD was placed \nand was negative after 48 hours. He will continue ___ HD after \ndischarge. \n.\n# hypertension, stage II- The patient was continued on his home \ndose of amlodipine.\n.\n# history of chronic hepatitis C- Serology was hep C positive as \nexpected. He has not been treated.\n.\n# chronic pancreatitis- no currently on medications for this. \nstopped alcohol in ___ after first bout, his last bout was ___ \nyears ago. \n.\n# anemia- likely secondary to end-stage renal disease. Iron \nstudies revealed no evidence of iron deficiency.', 'medications_prescribed': ['1. Amlodipine 10 mg PO DAILY', '2. Calcium Carbonate 500 mg PO BID', '3. Nephrocaps 1 CAP PO DAILY \nRX *B complex-vitamin C-folic acid [Nephrocaps] 1 mg 1 \ncapsule(s) by mouth daily Disp #*30 Capsule Refills:*0', '4. Viagra *NF* (sildenafil) ___ ORAL PRN sexual activity \nuse as directed']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 32, 'gender': 'F', 'symptoms': 'Shortness of breath', 'medical_history': ['CAD s/p MI ___', 'Atrial fibrillation, not on Coumadin since ___', 'h/o stroke ___ left PCA and right superor MCA infarcts', 'diastolic CHF, EF 55-60% in ___', 'Hypertension', 'Hypercholesterolemia', 'Pulmonary hypertension', 'Asthma', 'Allergic rhinitis', 'GERD'], 'family_history': 'There is family history of hypertension and asthma.', 'present_illness': '___ p/w one hour of sob that improved with O2 from EMS. No fever \nor CP. ___ swelling worse x1 month. Pt states that she has \nchronic sinusitis ___ allergic rhinitis. She noticed worsening \nsinus congestion and cough over the past 2 weeks. Pt states that \nshe eats food at the assisted living facility, but feels that \nshe ate "very salty food" there on day prior to admission. ___ \nstates that she had soup that was "pure salt." Pt denies eating \noutside food. Pt denies having asthma flare, saying that this \ndifficulty breathing was different than her last asthma \nexacerbation, which was in ___. Pt denies fevers, shaking, \nchills, chest pain, n/v, diarrhea. Pt complains of chronic \nindigestion, which she feels is relieved by MOM. Pt complains \nthat it is worse at night, but denies that it has been worse \nrecently. Pt states that up until time of admission, she was at \nher baseline ambulation and sleep habits, which include 4 pillow \northopnea and 2 block walking limit before getting out of \nbreath. ', 'medications': [{'medication': 'Naproxen', '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', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': '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 (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '33.5', 'valuenum': 33.5, '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': '30.8', 'valuenum': 30.8, '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': '93', 'valuenum': 93.0, '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': 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': '3.60', 'valuenum': 3.6, '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': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '97.4 124/60 60 20 96% RA. Pt ins 600 vs 1522 out over last \n16hrs. Pt is comfortable, ambulating, breathing comfortably.\nHEENT: NCAT, PERRL OP WNL\nNeck: +JVD to 2cm below ear w/ flicker\nChest: Distant breath sounds, small scattered wheezes. No \ncrackles, but decreased BS at bases b/l. 1:2 I:E, RR at ___.\nHeart: 3+ late ejection murmur at apex radiating to neck. \nIrregularly irregular rhythm at 60bpm, no s3/s4. \nGI: soft, nontender. obese abdomen. no palpable organomegally. + \nBS X 4quadrants.\nExt: Warm, well perfused. 2+ pitting edema ___ distance to knee\nNeuro: ___ strength all extremities flex/extend. intact to \ntouch. Normal gait.\nSkin: No rash\nAccess: R peripheral IV in place', 'diagnoses': [{'icd_code': 'D1771', 'desc': 'Benign lipomatous neoplasm of kidney'}, {'icd_code': 'G43909', 'desc': 'Migraine, unspecified, not intractable, without status migrainosus'}], 'summary': "___ 06:30AM BLOOD WBC-10.0 RBC-3.84* Hgb-11.6* Hct-35.6* \nMCV-93 MCH-30.1 MCHC-32.5 RDW-14.1 Plt ___\n___ 04:05AM BLOOD WBC-9.8 RBC-3.97* Hgb-11.8* Hct-35.4* \nMCV-89# MCH-29.7 MCHC-33.3 RDW-14.0 Plt ___\n___ 04:05AM BLOOD Neuts-73.2* Lymphs-17.0* Monos-7.2 \nEos-2.2 Baso-0.4\n___ 06:30AM BLOOD Plt ___\n___ 04:55AM BLOOD ___ PTT-29.3 ___\n___ 04:05AM BLOOD Plt ___\n___ 06:30AM BLOOD Glucose-114* UreaN-47* Creat-1.1 Na-139 \nK-4.3 Cl-96 HCO3-37* AnGap-10\n___ 03:45PM BLOOD Glucose-120* UreaN-49* Creat-1.2* Na-140 \nK-3.8 Cl-94* HCO3-37* AnGap-13\n___ 04:05AM BLOOD Glucose-123* UreaN-47* Creat-1.2* Na-140 \nK-4.2 Cl-96 HCO3-34* AnGap-14\n___ 03:45PM BLOOD CK(CPK)-66\n___ 03:45PM BLOOD CK-MB-3 cTropnT-<0.01\n___ 04:05AM BLOOD cTropnT-<0.01\n___ 04:05AM BLOOD proBNP-827*\n___ 06:30AM BLOOD Calcium-8.7 Phos-3.4 Mg-2.8*\n___ 03:45PM BLOOD Calcium-9.1 Phos-4.7*# Mg-2.\n___ year old female with A fib on coumadin, CAD s/p MI, strokes, \nasthma who presents with SOB. CHF and RAD are likely both \ncontributing factors and should be managed concurrently. \n. \n# Dyspnea - Differential included asthma exacerbation, CHF, PE, \nPNA, and ACS. \nPt was treated for CHF and asthma. PE was inconsistent with pt's \nclinical presentation, PNA was not supported by physical exam or \nCXR, and ACS was ruled out with 2 sets of negative cardiac \nenzymes.\n \n# CHF \n-Pt baseline weight is 168lbs. Pt arrived at baseline weight, \nand CHF was managed clinically.\n-Pt received 40mg IV lasix 30min after 5mg metolazone IV as \nneeded for diuresis on HD1. Pt was transitioned to home dose of \n80mg Lasix PO following metolazone on HD2. Pt was diuresed to \nnet loss 1250ml on day 1. Clinical improvement was noted day 2, \nthough patient's urine output was lost due to pt using toilet \nand discarding outs. With diuresis, pt's creatinine improved \nfrom 1.2 to 1.1 on day of discharge. Pt was kept on low salt \n<2mg/day, and was counseled on the importance of maintaining a \nlow salt diet. At time of D/C, pt satting 95% on RA.\n\n# RAD\n-Pt placed on albuterol/atrovent Q4hrs, and was more comfortable \nbreating following nebs. It is likely that patient's RAD was \nexacerbated by her CHF. No oral steroids were given during pt's \nstay. If pt continues to require albuterol or atrovent as an \noutpatient, she could benefit from inhaled corticosteroids. We \ndid not place her on these this hospital stay. At time of \ndischarge, pt's lungs were clear, with no wheezes.\n \n# CAD - Patient denied chest pain . \nPt received aspirin, metoprolol succinate 50mg daily. Repeat \ncardiac biomarkers to finish evaluation for ACS were negative.Pt \nreceived simvastatin 40mg/day and Aspirin 81mg QD\n.\n#. Atrial fibrillation: Her rate was well controlled on her beta \n\nblocker therapy. Coumadin was initially held because her INR \nwas supratherapeutic but can be restarted on discharge. \n\n# Hypertension - Stable, continue lisinopril 20mg daily and \nmetoprolol 50mg daily as above \n\n#. Anxiety/depression - continued on sertraline and ativan. \n.\nCode Status: FULL CODE, discussed with patient on admission"}}
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{'final_diagnoses': ['acute on chronic diastolic congestive heart failure'], 'procedures': ['none'], 'visit_summary': "___ year old female with A fib on coumadin, CAD s/p MI, strokes, \nasthma who presents with SOB. CHF and RAD are likely both \ncontributing factors and should be managed concurrently. \n. \n# Dyspnea - Differential included asthma exacerbation, CHF, PE, \nPNA, and ACS. \nPt was treated for CHF and asthma. PE was inconsistent with pt's \nclinical presentation, PNA was not supported by physical exam or \nCXR, and ACS was ruled out with 2 sets of negative cardiac \nenzymes.\n \n# CHF \n-Pt baseline weight is 168lbs. Pt arrived at baseline weight, \nand CHF was managed clinically.\n-Pt received 40mg IV lasix 30min after 5mg metolazone IV as \nneeded for diuresis on HD1. Pt was transitioned to home dose of \n80mg Lasix PO following metolazone on HD2. Pt was diuresed to \nnet loss 1250ml on day 1. Clinical improvement was noted day 2, \nthough patient's urine output was lost due to pt using toilet \nand discarding outs. With diuresis, pt's creatinine improved \nfrom 1.2 to 1.1 on day of discharge. Pt was kept on low salt \n<2mg/day, and was counseled on the importance of maintaining a \nlow salt diet. At time of D/C, pt satting 95% on RA.\n\n# RAD\n-Pt placed on albuterol/atrovent Q4hrs, and was more comfortable \nbreating following nebs. It is likely that patient's RAD was \nexacerbated by her CHF. No oral steroids were given during pt's \nstay. If pt continues to require albuterol or atrovent as an \noutpatient, she could benefit from inhaled corticosteroids. We \ndid not place her on these this hospital stay. At time of \ndischarge, pt's lungs were clear, with no wheezes.\n \n# CAD - Patient denied chest pain . \nPt received aspirin, metoprolol succinate 50mg daily. Repeat \ncardiac biomarkers to finish evaluation for ACS were negative.Pt \nreceived simvastatin 40mg/day and Aspirin 81mg QD\n.\n#. Atrial fibrillation: Her rate was well controlled on her beta \n\nblocker therapy. Coumadin was initially held because her INR \nwas supratherapeutic but can be restarted on discharge. \n\n# Hypertension - Stable, continue lisinopril 20mg daily and \nmetoprolol 50mg daily as above \n\n#. Anxiety/depression - continued on sertraline and ativan. \n.\nCode Status: FULL CODE, discussed with patient on admission", 'medications_prescribed': ['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.', 'oxycodone 5 mg Tablet Sig: One (1) Tablet PO Q8H (every 8 \nhours) as needed for prn breakthrough pain.', 'warfarin 2 mg Tablet Sig: One (1) Tablet PO DAYS \n(___).', 'lorazepam 0.5 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime) as needed for anxiety.', 'lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'sertraline 25 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'cholecalciferol (vitamin D3) 400 unit Tablet Sig: Two (2) \nTablet PO DAILY (Daily).', 'fluticasone 50 mcg/Actuation Spray, Suspension Sig: One (1) \nSpray Nasal BID (2 times a day).', 'meclizine 12.5 mg Tablet Sig: Two (2) Tablet PO Q8H (every 8 \nhours) as needed for dizziness.', 'fexofenadine 60 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day).', 'Toprol XL 50 mg Tablet Extended Release 24 hr Sig: One (1) \nTablet Extended Release 24 hr PO once a day.', 'aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'furosemide 80 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'magnesium hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO Q12H (every 12 hours) as needed for constipation or gas \npains.', 'metolazone 2.5 mg Tablet Sig: One (1) Tablet PO once a day: \n30 min prior to lasix.', 'simvastatin 40 mg Tablet Sig: One (1) Tablet PO once a day.', 'Diphenhist 25 mg Capsule Sig: One (1) Capsule PO at bedtime \nas needed.', 'loratadine 10 mg Tablet Sig: One (1) Tablet PO once a day.', 'azelastine 137 mcg Aerosol, Spray Sig: One (1) spray Nasal \nonce a day.', 'albuterol sulfate 2.5 mg /3 mL (0.083 %) Solution for \nNebulization Sig: One (1) Inhalation every four (4) hours as \nneeded for wheezing, sob.', 'ipratropium bromide 0.02 % Solution Sig: One (1) Inhalation \nevery six (6) hours as needed for SOB.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'Acute appendicitis', 'medical_history': ['None'], 'family_history': 'Noncontributory', 'present_illness': 'The patient presented to the ED with right lower quadrant pain. \nA CT was performed and the findings were consistent with \nappendicitis. The patient was resuscitated and brought to the \noperating room.', 'medications': [{'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', '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': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aquaphor', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cephalexin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '0.7', 'valuenum': 0.7, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, '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': '8.7', 'valuenum': 8.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, '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': '10.1', 'valuenum': 10.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79.3', 'valuenum': 79.3, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '267', 'valuenum': 267.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, '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': '___', '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': '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': '137', 'valuenum': 137.0, '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': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '5', 'valuenum': 5.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '16', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.5', 'valuenum': 35.5, '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': '18', 'valuenum': 18.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60', 'valuenum': 60.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'NAD', 'diagnoses': [{'icd_code': '6822', 'desc': 'Cellulitis and abscess of trunk'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '1844', 'desc': 'Malignant neoplasm of vulva, unspecified site'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '28850', 'desc': 'Leukocytopenia, unspecified'}, {'icd_code': 'E9331', 'desc': 'Antineoplastic and immunosuppressive drugs causing adverse effects in therapeutic use'}, {'icd_code': 'V1005', 'desc': 'Personal history of malignant neoplasm of large intestine'}, {'icd_code': 'V153'}, {'icd_code': 'V161'}], 'summary': '___ 04:30AM BLOOD WBC-16.1* RBC-5.16 Hgb-15.4 Hct-43.5 \nMCV-84 MCH-29.9 MCHC-35.5* RDW-13.4 Plt ___\n___ 01:53PM BLOOD WBC-16.3* RBC-4.61 Hgb-13.9* Hct-38.7* \nMCV-84 MCH-30.1 MCHC-35.9* RDW-13.5 Plt ___\n___ 05:40PM BLOOD WBC-11.4* RBC-3.89* Hgb-11.5* Hct-34.2* \nMCV-88 MCH-29.5 MCHC-33.5 RDW-15.4 Plt ___\n___ 08:48PM BLOOD WBC-11.0 RBC-3.53* Hgb-10.5* Hct-29.9* \nMCV-85 MCH-29.6 MCHC-35.0 RDW-13.2 Plt ___\n___ 06:05AM BLOOD WBC-9.1 RBC-3.39* Hgb-9.9* Hct-29.6* \nMCV-88 MCH-29.2 MCHC-33.4 RDW-13.4 Plt ___\n___ 05:25AM BLOOD WBC-9.2 RBC-3.19* Hgb-9.4* Hct-26.9* \nMCV-84 MCH-29.6 MCHC-35.1* RDW-13.7 Plt ___\n___ 09:15PM BLOOD WBC-7.2 RBC-3.09* Hgb-9.1* Hct-26.1* \nMCV-85 MCH-29.6 MCHC-35.0 RDW-13.3 Plt ___\n___ 06:55AM BLOOD WBC-6.9 RBC-3.07* Hgb-9.1* Hct-26.2* \nMCV-85 MCH-29.7 MCHC-34.9 RDW-13.7 Plt ___\n___ 05:40PM BLOOD ___ PTT-26.1 ___\n___ 04:30AM BLOOD Glucose-105 UreaN-17 Creat-1.2 Na-139 \nK-5.4* Cl-104 HCO3-20* AnGap-20\n___ 01:53PM BLOOD Glucose-110* UreaN-12 Creat-1.2 Na-140 \nK-4.2 Cl-104 HCO3-23 AnGap-17\n___ 05:40PM BLOOD Glucose-107* UreaN-12 Creat-1.1 Na-136 \nK-3.4 Cl-98 HCO3-28 AnGap-13\n___ 06:05AM BLOOD Glucose-88 UreaN-6 Creat-0.9 Na-136 K-3.8 \nCl-100 HCO3-27 AnGap-13\n___ 05:25AM BLOOD Glucose-108* UreaN-4* Creat-0.8 Na-132* \nK-3.8 Cl-95* HCO3-27 AnGap-14\n___ 09:15PM BLOOD Glucose-99 UreaN-4* Creat-0.8 Na-133 \nK-3.5 Cl-95* HCO3-30 AnGap-12\n___:55AM BLOOD Glucose-79 UreaN-4* Creat-0.8 Na-138 \nK-4.0 Cl-98 HCO3-28 AnGap-16\n___ 09:00AM BLOOD Glucose-151* UreaN-8 Creat-0.7 Na-132* \nK-4.6 Cl-94* HCO3-26 AnGap-17\n___ 04:30AM BLOOD ALT-12 AST-33 TotBili-0.7\n\n___ CT ___: Findings consistent with acute \nappendicitis, with appendix distended to 12 mm and containing \nmultiple appendicoliths. No evidence of perforation. \n\n___ ECG: Artifact is present. Sinus rhythm. There is an \nearly transition which is non-specific. No previous tracing \navailable for comparison \n\n___ KUB: Findings are worrisome for small bowel \nobstruction.\nPatient admitted for acute appendicitis. Went to the operating \nroom and underwent a laparoscopic appendectomy. Postoperative \ncourse was uneventful and patient was discharged home. He came \nback with CC; of bleeding at his laparoscopic site. He went back \nto the operating room where they found A 1-cm dehiscence of the \nsupraumbilical port site with a small evisceration of tongue of \nomentum due to disruption of a single suture. Also, Slight \noozing from the mesoappendix which was oversewn.\nNo other bleeding sites identified. \n\nPostoperative course was complicated by ileus identified \nMultiple air-fluid levels in dilated small bowel loops measuring \nup to 4.8 cm in diameter.\n\nPatient was progressed slowly to a regular diet.\n\nWe will discharge him to home today with follow up in 3 weeks.'}}
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{'final_diagnoses': ['Acute Appendicitis.', 'Intra-abdominal hemorrhage.', 'Wound dehiscence suprapubic port site.'], 'procedures': ['Laparoscopic appendectomy.', 'Exploratory laparotomy.', 'Evacuation of clot.', 'Oversewing of staple line.', 'Closure of the midline wound.'], 'visit_summary': 'Patient admitted for acute appendicitis. Went to the operating \nroom and underwent a laparoscopic appendectomy. Postoperative \ncourse was uneventful and patient was discharged home. He came \nback with CC; of bleeding at his laparoscopic site. He went back \nto the operating room where they found A 1-cm dehiscence of the \nsupraumbilical port site with a small evisceration of tongue of \nomentum due to disruption of a single suture. Also, Slight \noozing from the mesoappendix which was oversewn.\nNo other bleeding sites identified. \n\nPostoperative course was complicated by ileus identified \nMultiple air-fluid levels in dilated small bowel loops measuring \nup to 4.8 cm in diameter.\n\nPatient was progressed slowly to a regular diet.\n\nWe will discharge him to home today with follow up in 3 weeks.', 'medications_prescribed': ['Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ6H (every 6 hours) as needed.\nDisp:*40 Tablet(s)* Refills:*0*', 'Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day.\nDisp:*60 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': 58, 'gender': 'M', 'symptoms': '"can\'t catch my breath after walking 20 feet or even button my \npants!"', 'medical_history': ['-- Hypertension', '-- Hyperlipidemia', '-- BPH; s/p turp x2', '-- Gout', '-- Impaired glucose tolerance', '-- Interstitial lung disease with diminished DLCO (thought ___ \nto pulmonary fibrosis and emphysema as per Pulmonary). B/L \npleural thickening and honeycombing on CT. pt needs ___, \noccasionally 4L, of continuous supp O2 at baseline, pt is able \nto ambulate independently w/o walker, cane, or assistance.', '-- End-stage Cor pulmonale', '-- Left ventricular diastolic dysfunction/heart failure', '-- Obesity', '-- Diabetes mellitus 2, diet controlled', '-- hiatal hernia', '-- sleep apnea', '-- R sided renal lesion', '-- CKD - baseline creatinine is 1.6-1.7', '-- Abdominal aortic aneurysm.', '-- Constipation.', '-- Hypothyroidism'], 'family_history': 'Non-Contributory', 'present_illness': '___ M w/ COPD with interstitial lung disease, pulm HTN, severe \ncor pulmonale, and chronic renal disease who p/w worsening SOB, \nincreasing abdominal girth, and 20 lb wt gain for 2 weeks. \n\nPt reports feeling exhausted and "terrible." He is becoming \nshort of breath after walking ___ feet from the bathroom to \nthe living room, having stop and catch his breath, which is \nunusual for him. At the same time, he was noted to have \nincreasing weight--a gain of 20 lbs over 2 wks (198 -> 218 lbs). \n Accordingly, he then developed "belly pain" and began having \ntrouble buttoning his pants over his growing abd. \nBecause of these increasing symptoms, he was brought to the ED \nfor further evaluation. \n\nOf note, the pt has had a precipitous decline in his functional \nstatus since ___ primarily due to symptoms of end-stage cor \npulmonale from his severe pulm disease. In ___, pt developed \nsimilar symptoms of SOB, abd distension, and wt gain and was \nhospitalized at ___ for a total of 12 days.', 'medications': [{'medication': 'Diphenoxylate-Atropine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Hydrocerin', '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': '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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Citalopram', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Maalox/Diphenhydramine/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Naproxen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'INV-Pembrolizumab', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'DINNER', 'doses_per_24_hrs': 1.0}, {'medication': 'Aldesleukin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Cephalexin', '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': 'Expired', 'route': 'SC', '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': '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': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Naproxen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Aldesleukin', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'DOPamine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', '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': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY: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': 'LUNCH', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', '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': '/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': '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': '8.0', 'valuenum': 8.0, '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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, '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': 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': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '34.8', 'valuenum': 34.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '657', 'valuenum': 657.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '32', 'valuenum': 32.0, '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': '0.2', 'valuenum': 0.2, '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': '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': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 201.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '5.7', 'valuenum': 5.7, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 140.0, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.66', 'valuenum': 0.66, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, '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': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.5', 'valuenum': 7.5, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '76.5', 'valuenum': 76.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', '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': '13.8', 'valuenum': 13.8, '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': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.35', 'valuenum': 0.35, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '___', '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 329.0, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.3, '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': 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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '568', 'valuenum': 568.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '23', 'valuenum': 23.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 189.0, '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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '0.07', 'valuenum': 0.07, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '31.8', 'valuenum': 31.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '90.6', 'valuenum': 90.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 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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': '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': '2.1', 'valuenum': 2.1, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 217.0, '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': '1.8', 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'70', 'valuenum': 70.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '784', 'valuenum': 784.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '81', 'valuenum': 81.0, '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': 'abnormal', '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': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 986.0, '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'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': '2.0', 'valuenum': 2.0, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '4.7', 'valuenum': 4.7, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '14', 'valuenum': 14.0, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HOLD.'}, {'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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '___', 'valuenum': 824.0, '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'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': 217.0, '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': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '12', 'valuenum': 12.0, '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': '1.59', 'valuenum': 1.59, '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': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.5', 'valuenum': 23.5, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, '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': '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '61.3', 'valuenum': 61.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.10', 'valuenum': 0.1, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.84', 'valuenum': 0.84, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.14', 'valuenum': 4.14, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '50.2', 'valuenum': 50.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '855', 'valuenum': 855.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '27', 'valuenum': 27.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 636.0, '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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'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': '2.1', 'valuenum': 2.1, 'valueuom': 'g/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 189.0, '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': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', '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': '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': '___', '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 250.0, '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.6, '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '___', '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 261.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '2.2', 'valuenum': 2.2, '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '11', 'valuenum': 11.0, '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}], 'exams': 'Tm 98.3, Tc 96.3, HR 88 (50-80s), BP 100/67 (90-110s/40-60s), RR \n20, 02 96% 4L (92-100%)\nAdmission wt 99.3kg, I/O: Length of stay in MICU -5.5L\nConstitutional: Pleasant elderly man sitting up in chair waiting \nfor transfer.\nHEENT: NC/AT. PERRL. Oral pharynx benign.\nCV: Regular rate, irregular rhythm. Loud P2. No M/R/G.\nPULM: B/l crackles up to mid lung fields. No wheezes.\nABD: Severely distended, protuberant abd w/ significant fluid \nwave. Soft yet slightly taut. NT. +BS\nEXTREM: Mild clubbing present throughout b/l finger nails. Mild \nR hand tremor at rest. B/l ___ 1+ pitting edema.\nSKIN: 2 scabs -- 1.5cm x 0.5cm and 0.5cm x 0.5cm at R inner leg. \n1 broken blister w/ dried blood at L shin. L inner leg dried \nbroken blister. Dry, scaly skin w/ hyperpigmentation below \nmid-leg b/l.\nNEURO: Alert and oriented x 3. CN II-XII intact. Motor strength \nfull (___) throughout b/l UE and ___. Mild R hand tremor at rest. \nOnly b/l biceps reflexes elicited, unable to elicit patellar, \nankle, or triceps reflexes. Downgoing toes b/l. Proprioception \nintact at b/l toes. Narrow-based gait.', 'diagnoses': [{'icd_code': 'C7889', 'desc': 'Secondary malignant neoplasm of other digestive organs'}, {'icd_code': 'C7951', 'desc': 'Secondary malignant neoplasm of bone'}, {'icd_code': 'C7931', 'desc': 'Secondary malignant neoplasm of brain'}, {'icd_code': 'C7800', 'desc': 'Secondary malignant neoplasm of unspecified lung'}, {'icd_code': 'C787', 'desc': 'Secondary malignant neoplasm of liver and intrahepatic bile duct'}, {'icd_code': 'Z85820', 'desc': 'Personal history of malignant melanoma of skin'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'Z794', 'desc': 'Long term (current) use of insulin'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'D6959', 'desc': 'Other secondary thrombocytopenia'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}, {'icd_code': 'E0965', 'desc': 'Drug or chemical induced diabetes mellitus with hyperglycemia'}], 'summary': "**********LABORATORY RESULTS**********\n___ 03:10PM BLOOD WBC-7.4 RBC-4.50* Hgb-11.8* Hct-37.6* \nMCV-84 MCH-Plt ___\n___ 07:10AM BLOOD WBC-5.8 RBC-3.75* Hgb-10.1* Hct-31.3* \nMCV-84 MCH-27.0 MCHC-32.2 RDW-21.1* Plt ___\n\n___ 03:10PM BLOOD ___ PTT-26.7 ___\n\n___ 03:10PM BLOOD Glucose-145* UreaN-44* Creat-2.0* Na-134 \nK-4.7 ___ 07:10AM BLOOD Glucose-100 UreaN-36* Creat-1.8* \nNa-136 K-4.1 Cl-94* HCO3-30 \n\n___ 03:10PM BLOOD ___\n\n___ 07:26PM BLOOD Digoxin-0.6*\n___ 03:13PM BLOOD Lactate-3.1*\n___ 07:46PM BLOOD Lactate-2.7*\n\n___ 4:11 pm PERITONEAL FLUID. GRAM STAIN (Final ___: \n1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR LEUKOCYTES. NO \nMICROORGANISMS SEEN. \nFLUID CULTURE (Final ___: NO GROWTH. \nANAEROBIC CULTURE (Final ___: NO GROWTH. \n\n___ 3:10 pm BLOOD CULTURE VENIPUNCTURE #1. \nBlood Culture, Routine (Final ___: NO GROWTH. \n___ 3:25 pm BLOOD CULTURE VENIPUNCTURE #2.\nBlood Culture, Routine (Final ___: NO GROWTH. \n\n___ 11:38 am URINE Source: Catheter. \n URINE CULTURE (Final ___: \n ENTEROCOCCUS SP.. >100,000 ORGANISMS/ML..\n _______________________________________________________\n ENTEROCOCCUS SP.\n | \nAMPICILLIN------------ <=2 S\nNITROFURANTOIN-------- 64 I\nTETRACYCLINE---------- =>16 R\nVANCOMYCIN------------ <=1 S\n\nEchocardiography ___ at 2:01:13 ___\nThe right atrium is markedly dilated. No atrial septal defect is \nseen by 2D or color Doppler. The estimated right atrial pressure \nis ___. Normal left ventricular systolic function. The \nright ventricular cavity is dilated with severe global free wall \nhypokinesis. There is abnormal septal motion/position consistent \nwith right ventricular pressure/volume overload. There is no \nmass/thrombus in the right ventricle. There are three aortic \nvalve leaflets. The aortic valve leaflets are moderately \nthickened. Trace aortic regurgitation is seen. The mitral valve \nleaflets are mildly thickened. There is no mitral valve \nprolapse. There is trivial mitral regurgitation. The left \nventricular inflow pattern suggests impaired relaxation. The \ntricuspid valve leaflets are mildly thickened. The tricuspid \nvalve leaflets fail to fully coapt. Severe [4+] tricuspid \nregurgitation is seen. There is severe pulmonary artery systolic \nhypertension. The pulmonic valve leaflets are thickened. \nSignificant pulmonic regurgitation is seen. There is no \npericardial effusion.\nIMPRESSION: Severe right ventricular dilation and hypokinesis \nwith severe tricuspid regurgitation. Right ventricular \npressure/volume overload. Severe pulmonary hypertension. No \nevidence of intracardiac shunt.\n\nSINGLE AP UPRIGHT RADIOGRAPH OF THE CHEST: There is a right \nlower lobe opacity in comparison with multiple prior studies, \nlikely represents epicardial fat exaggerated by lordotic \ntechnique and patient rotation. With the exception of this, \nthere are no focal consolidations. There is no pulmonary edema. \nThere is no pleural effusion or pneumothorax. Heart size is \nenlarged, stable. IMPRESSION: No acute cardiopulmonary process.\n\nStudy Date of ___ 9:00 AM\nRIGHT UPPER QUADRANT ULTRASOUND: The liver echotexture is \nnormal. There is\nno focal liver lesion or intrahepatic biliary ductal dilatation. \nThe main\nportal vein is patent with the appropriate direction of flow, \nthough flow is noted to be pulsatile. The heparic veins are also \ndilated.\n \nThe gallbladder is normal without evidence of stones. The common \nduct is not dilated, measuring 2 mm. The pancreas is not \nvisualized. The spleen is normal in size, measuring 8.5 cm. A \nmoderate to large amount of ascites is seen in all quadrants.\n \nIMPRESSION: Probable passive hepatic congestion related to \nright-sided heart failure, particularly in light of relatively \npulsatile blood flow in the portal vein. Normal liver \nechotexture and spleen size. Large amount of\nascites.\nMr. ___ is a ___ year-old male with COPD/interstitial lung \ndisease, pulmonary hypertension, severe cor pulmonale, and \nchronic kidney disease who presented with exacerbation of cor \npulmonale, worsening SOB and 20 lb wt gain.\n\nIn the ED, pt experienced hematemesis x 2. O2 sat of ___ on 4L \nNC and then 94-96% on NRB. Pt was placed on Bipap ___ and \nreceived 40 mg IV Lasix x 2. Lactate was 3.1 on admission, BNP \n10809, Trop slightly above baseline of 0.02 to 0.04. Pt was \ninitially admitted to Medicine ward for further treatment of his \nR-sided HF. On arrival to the medical ward, the patient was \nhypoxic w/ O2 sats in low ___, BP 131/86, dyspneic at RR 44, \ntachy w/ HR of 92, as well as vomited 50cc of bloody contents \nupon arrival to the floor. He transferred to the MICU for \nfurther monitoring and management. \n\nIn the MICU, pt was gently diuresed w/ IV Lasix. A 4L \nparacentesis was performed. He became hypotensive (BP into the \n___ systolic) following the paracentesis. For this, he \nreceived total of 75g albumin over 2 days. Once patient's vitals \nstabilized, he was transferred to the floor for further \nmanagement.\n\nOn the General Medicine floor, the following issues were managed \nas described below. \n## Pulmonary fibrosis: \nPt has severe interstitial pulmonary disease refractory to \ntreatment. It has led to severe pulmonary hypertension and \nend-stage cor-pulmonale. He requires Given prior side effects \nof hypotension, tachycardia, and dizziness with a trial of \nsildenafil in the past (___), no sildenafil was attempted \nduring this hospital stay. Patient was maintained on prn \ninhalers and continued on oxygen regimen increased from home \ndose of 4L. Patient was also placed on CPAP overnight. \nContinued outpatient pulmonary follow-up with Dr. ___ will \nbe needed. \n\n## Cor pulmonale: \nChronic. Echo shows severe right ventricular dilation and \nhypokenesis w/ severe tricuspid regurgitation, as well as right \nventricular pressure/volume overload. This is thought to be \nsecondary to severe pulmonary fibrosis/pulmonary hypertension. \nThere is no evidence of intracardiac shunt on echo.\nHis right ventricular failure has led to hepatic congestion -> \nascites -> b/l ___ edema. He was treated with aggressive \ndiuresis as well as paracentesis x2. Net total weight/fluid \nloss at the end of the hospital stay was approximately 20 lbs. \nDischarge weight 87kg (day prior had been 92kg, before 2L \nparacentesis).\nPatient was discharged with Lasix 80 mg PO BID with increased \noxygen requirement at 5L NC satting between 90-94%. He goal 02 \nsat is >93%. \n\n## Hypotension: \nPt is relatively hypotensive at baseline with SBP typically \n90-110. However, following his first paracentesis of 4L his BP \ndid drop into the ___. He remained asymptomatic despite \nthis drop in blood pressure. His blood pressure responded to \nalbumin. Of note, he underwent a ___ therapeutic paracentesis \nof 2L and his blood pressure tolerated the lower volume tap. \n\n## Chylous ascites: The fluid was chylous in nature w/ high \n___. The cause of ascites secondary to hepatic congestion \nrelated to RH failure. \nAbdomen remained significantly protuberant with dramatic fluid \nwave on exam despite paracentesis. Patient received therapeutic \nparacentesis x 2. \n\n## Hematemesis: \nPatient had episode of hematemesis on admission, though no \nsubsequent episodes. He was evaluated by the GI service. EGD \nwas discussed but the patient preferred to hold on the procedure \nsince there was no recurrence of following admission. His HCT \nremained relatively stable in the low to mid-30s. Given no \nfurther evidence of bleend and the patient's request to decrease \nthe number of pills taken daily, Protonix was discontinued \nduring the latter half of the hospitalization. \n\n## LV diastolic HF: Echo showed 55% LV systolic function. \n\n## Insomnia: \nPatient initially complained of insomnia, which was treated with \nhome dose of 10 mg PO Ambien.\n\n## Hypothyroidism: \nClinically stable with complaints of cold intolerance but no \nother symptoms or signs of hypothyroidism. Patient was \nmaintained on home dose of levothyroxine.\n\n## CODE: DNR/DNI"}}
|
{'final_diagnoses': ['primary: pulmonary fibrosis, pulmonary hypertension, cor \npulmonale, hypotension', 'secondary: hypothyroidism, hematemesis, hepatic congestion, left \nventricular diastolic heart failure, possible urinary tract \ninfection, chylous ascites, insomnia'], 'procedures': ['Paracentesis x2'], 'visit_summary': "Mr. ___ is a ___ year-old male with COPD/interstitial lung \ndisease, pulmonary hypertension, severe cor pulmonale, and \nchronic kidney disease who presented with exacerbation of cor \npulmonale, worsening SOB and 20 lb wt gain.\n\nIn the ED, pt experienced hematemesis x 2. O2 sat of ___ on 4L \nNC and then 94-96% on NRB. Pt was placed on Bipap ___ and \nreceived 40 mg IV Lasix x 2. Lactate was 3.1 on admission, BNP \n10809, Trop slightly above baseline of 0.02 to 0.04. Pt was \ninitially admitted to Medicine ward for further treatment of his \nR-sided HF. On arrival to the medical ward, the patient was \nhypoxic w/ O2 sats in low ___, BP 131/86, dyspneic at RR 44, \ntachy w/ HR of 92, as well as vomited 50cc of bloody contents \nupon arrival to the floor. He transferred to the MICU for \nfurther monitoring and management. \n\nIn the MICU, pt was gently diuresed w/ IV Lasix. A 4L \nparacentesis was performed. He became hypotensive (BP into the \n___ systolic) following the paracentesis. For this, he \nreceived total of 75g albumin over 2 days. Once patient's vitals \nstabilized, he was transferred to the floor for further \nmanagement.\n\nOn the General Medicine floor, the following issues were managed \nas described below. \n## Pulmonary fibrosis: \nPt has severe interstitial pulmonary disease refractory to \ntreatment. It has led to severe pulmonary hypertension and \nend-stage cor-pulmonale. He requires Given prior side effects \nof hypotension, tachycardia, and dizziness with a trial of \nsildenafil in the past (___), no sildenafil was attempted \nduring this hospital stay. Patient was maintained on prn \ninhalers and continued on oxygen regimen increased from home \ndose of 4L. Patient was also placed on CPAP overnight. \nContinued outpatient pulmonary follow-up with Dr. ___ will \nbe needed. \n\n## Cor pulmonale: \nChronic. Echo shows severe right ventricular dilation and \nhypokenesis w/ severe tricuspid regurgitation, as well as right \nventricular pressure/volume overload. This is thought to be \nsecondary to severe pulmonary fibrosis/pulmonary hypertension. \nThere is no evidence of intracardiac shunt on echo.\nHis right ventricular failure has led to hepatic congestion -> \nascites -> b/l ___ edema. He was treated with aggressive \ndiuresis as well as paracentesis x2. Net total weight/fluid \nloss at the end of the hospital stay was approximately 20 lbs. \nDischarge weight 87kg (day prior had been 92kg, before 2L \nparacentesis).\nPatient was discharged with Lasix 80 mg PO BID with increased \noxygen requirement at 5L NC satting between 90-94%. He goal 02 \nsat is >93%. \n\n## Hypotension: \nPt is relatively hypotensive at baseline with SBP typically \n90-110. However, following his first paracentesis of 4L his BP \ndid drop into the ___. He remained asymptomatic despite \nthis drop in blood pressure. His blood pressure responded to \nalbumin. Of note, he underwent a ___ therapeutic paracentesis \nof 2L and his blood pressure tolerated the lower volume tap. \n\n## Chylous ascites: The fluid was chylous in nature w/ high \n___. The cause of ascites secondary to hepatic congestion \nrelated to RH failure. \nAbdomen remained significantly protuberant with dramatic fluid \nwave on exam despite paracentesis. Patient received therapeutic \nparacentesis x 2. \n\n## Hematemesis: \nPatient had episode of hematemesis on admission, though no \nsubsequent episodes. He was evaluated by the GI service. EGD \nwas discussed but the patient preferred to hold on the procedure \nsince there was no recurrence of following admission. His HCT \nremained relatively stable in the low to mid-30s. Given no \nfurther evidence of bleend and the patient's request to decrease \nthe number of pills taken daily, Protonix was discontinued \nduring the latter half of the hospitalization. \n\n## LV diastolic HF: Echo showed 55% LV systolic function. \n\n## Insomnia: \nPatient initially complained of insomnia, which was treated with \nhome dose of 10 mg PO Ambien.\n\n## Hypothyroidism: \nClinically stable with complaints of cold intolerance but no \nother symptoms or signs of hypothyroidism. Patient was \nmaintained on home dose of levothyroxine.\n\n## CODE: DNR/DNI", 'medications_prescribed': ['1. Oximeter\nPlease provide a pulse oximeter for use at home. Goal oxygen \nsaturations >95%.\n2. Allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*0*\n3. Fluoxetine 10 mg Capsule Sig: One (1) Capsule PO DAILY \n(Daily).\nDisp:*30 Capsule(s)* Refills:*0*\n4. Levothyroxine 50 mcg Tablet Sig: 0.25 Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*0*\n5. Zolpidem 5 mg Tablet Sig: One (1) Tablet PO HS (at bedtime) \nas needed for insomnia.\nDisp:*30 Tablet(s)* Refills:*0*\n6. Ipratropium-Albuterol ___ mcg/Actuation Aerosol Sig: ___ \nPuffs Inhalation Q6H (every 6 hours). \n7. Potassium Chloride 20 mEq Tab Sust.Rel. Particle/Crystal Sig: \nOne (1) Tab Sust.Rel. Particle/Crystal PO once a day.\nDisp:*30 Tab Sust.Rel. Particle/Crystal(s)* Refills:*0*\n8. Lasix 80 mg Tablet Sig: One (1) Tablet PO twice a day.\nDisp:*60 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': 72, 'gender': 'M', 'symptoms': 'Endometrial hyperplasia', 'medical_history': ['Her past medical history is notable for diabetic nephropathy', 'congestive heart failure', 'morbid obesity', 'asthma', 'shoulder pain \nfollowing a left humerus fracture in ___', 'anemia', 'depression', 'diverticulitis', 'carpal tunnel syndrome', 'migraine headaches', 'osteoarthritis', 'panic attacks', 'type 2 diabetes and sleep apnea.'], 'family_history': 'No family hx of gyn cancer. Hx of DM and father with thyroid \ncancer.', 'present_illness': 'Ms. ___ is a ___ who initially presented to gyn onc \nservice in ___ as an inpatient consultation when she \nwas admitted with multifocal pneumonia and anemia secondary to \nmenorrhagia. During that exam, she was found to have a \ntubo-ovarian abscess, which was treated with IV antibiotics and \ndrainage. She underwent an endometrial biopsy on ___, \nwhich showed a low-grade endometrial neoplasm involving a polyp. \n The differential diagnosis was a low-grade endometrial \ncarcinoma versus complex mucinous metaplasia and an endometrial \npolyp. She then underwent a D&C, where curettings showed a \ncomplex papillary proliferation of the endometrium with \ncytologic atypia. Close followup was suggested. Given her \ncomorbidities and past surgical history, the decision was made \nto treat conservatively. She had a Mirena IUD placed in ___. This significantly improved her menorrhagia. Her last \nsampling was ___ where she underwent an exam under \nanesthesia, dilation and curettage, polypectomy removal and \ninsertion of Mirena IUD and operative hysteroscopy. Findings at \nthat time revealed a 2 cm fundal polyp as well as two smaller \npolyps off the posterior wall. The endometrium was otherwise \nsmooth. Pathology from that procedure revealed an endometrial \npolyp with focal gland crowding as well as a submucosal \nleiomyoma. She then underwent a gastric sleeve with Dr. ___ \n___ in ___. At her gyn onc follow-up on \n___ she had lost 60 pounds and her blood pressure has \nnormalized. She remained anxious regarding her history of \nhyperplasia and was interested in definitive surgical \nmanagement. She presented to ___ on ___ for planned \nsurgery.', 'medications': [{'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Metoprolol Tartrate', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': '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 via patient discharge', '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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued 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', 'frequency': 'Q8H', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Hemorrhoidal Suppository', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', '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': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 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': 'Senna', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate (CVICU Reversal Protocol)', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H: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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine (CVICU Reversal Protocol)', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', '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': 'Q2H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, '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': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '98', 'valuenum': 98.0, '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': '13.5', 'valuenum': 13.5, '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': '1.3', 'valuenum': 1.3, '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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '442', 'valuenum': 442.0, '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': '25', 'valuenum': 25.0, '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': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '42', 'valuenum': 42.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.36', 'valuenum': 7.36, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '265', 'valuenum': 265.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.11', 'valuenum': 1.11, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '28', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '176', 'valuenum': 176.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '154', 'valuenum': 154.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, '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': '1.50', 'valuenum': 1.5, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, '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': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '81.4', 'valuenum': 81.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.87', 'valuenum': 2.87, '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': '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': '0.09', 'valuenum': 0.09, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.24', 'valuenum': 0.24, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.64', 'valuenum': 8.64, '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '47.0', 'valuenum': 47.0, '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': '23', 'valuenum': 23.0, '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': '1.00', 'valuenum': 1.0, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '171', 'valuenum': 171.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.2', 'valuenum': 9.2, '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': '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': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '293', 'valuenum': 293.0, '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': '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': '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': '8.2', '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': 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'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': '34.2', 'valuenum': 34.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, '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': '19.2', 'valuenum': 19.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '1.2', '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': '34.9', 'valuenum': 34.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, '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': '38', 'valuenum': 38.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.37', 'valuenum': 7.37, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '288', 'valuenum': 288.0, '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': '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': '-3', 'valuenum': -3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '7.34', 'valuenum': 7.34, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', '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': '177', 'valuenum': 177.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', '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': '11', 'valuenum': 11.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.4', 'valuenum': 30.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, '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': '195', 'valuenum': 195.0, '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': '3.09', 'valuenum': 3.09, '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': '46.7', 'valuenum': 46.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '1.03', 'valuenum': 1.03, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '180', 'valuenum': 180.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-1', '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': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '88', 'valuenum': 88.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '117', 'valuenum': 117.0, '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': '15', 'valuenum': 15.0, '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '37', 'valuenum': 37.0, '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, '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': '316', 'valuenum': 316.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.1', 'valuenum': 26.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, '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': '9.1', 'valuenum': 9.1, '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': '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, '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': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, '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': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '164', 'valuenum': 164.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.81', 'valuenum': 2.81, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, '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': 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': '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': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, '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': '33.3', 'valuenum': 33.3, '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': '166', 'valuenum': 166.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.58', 'valuenum': 2.58, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49.8', 'valuenum': 49.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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 = >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': 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', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.5', 'valuenum': 21.5, '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': '31.2', 'valuenum': 31.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '201', 'valuenum': 201.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.37', 'valuenum': 2.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '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': 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': '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': '2.1', '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': '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': '12', 'valuenum': 12.0, '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': '21.9', 'valuenum': 21.9, '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': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, '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': '266', 'valuenum': 266.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.39', 'valuenum': 2.39, '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': '50.8', 'valuenum': 50.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, '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': '353', 'valuenum': 353.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.55', 'valuenum': 2.55, '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': '51.4', 'valuenum': 51.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'On day of discharge:\nAfebrile, vitals stable\nCV: regular rate and rhythm\nPulm: clear to auscultation bilaterally\nAbd: soft, appropriately tender, nondistended, incision \nclean/dry/intact, no rebound/guarding\n___: nontender, nonedematous', 'diagnoses': [{'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'I447', 'desc': 'Left bundle-branch block, unspecified'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'M353', 'desc': 'Polymyalgia rheumatica'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'R339', 'desc': 'Retention of urine, unspecified'}, {'icd_code': 'I952', 'desc': 'Hypotension due to drugs'}, {'icd_code': 'T41295A', 'desc': 'Adverse effect of other general anesthetics, initial encounter'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': '___ 07:00AM BLOOD WBC-6.5 RBC-4.20 Hgb-12.2 Hct-36.8 MCV-88 \nMCH-29.0 MCHC-33.2 RDW-13.2 RDWSD-42.2 Plt ___\n___ 09:15AM BLOOD WBC-8.2 RBC-4.10 Hgb-12.1 Hct-35.8 MCV-87 \nMCH-29.5 MCHC-33.8 RDW-13.1 RDWSD-41.6 Plt ___\n___ 09:15AM BLOOD Neuts-65.2 ___ Monos-7.8 Eos-0.4* \nBaso-0.2 Im ___ AbsNeut-5.35 AbsLymp-2.15 AbsMono-0.64 \nAbsEos-0.03* AbsBaso-0.02\n___ 07:00AM BLOOD Plt ___\n___ 09:15AM BLOOD Plt ___\n___ 07:00AM BLOOD Glucose-100 UreaN-13 Creat-0.5 Na-140 \nK-3.6 Cl-102 HCO3-30 AnGap-12\n___ 09:15AM BLOOD Glucose-108* UreaN-13 Creat-0.6 Na-139 \nK-3.8 Cl-102 HCO3-31 AnGap-10\n___ 07:00AM BLOOD Calcium-8.8 Phos-3.7 Mg-1.5*\n___ 09:15AM BLOOD Calcium-8.6 Phos-3.1 Mg-1.4*\n___ 12:15PM URINE Color-Yellow Appear-Clear Sp ___\n___ 12:15PM URINE Blood-MOD Nitrite-NEG Protein-TR \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.5 Leuks-SM \n\n___ 12:15 pm URINE Source: ___. \n\n URINE CULTURE (Pending):\nMs. ___ was admitted to the gynecologic oncology service \nafter undergoing robot-assisted total laparoscopic hysterectomy, \nbilateral salpingo-oophorectomy, lysis of adhesions, and \ncystoscopy for endometrial intraepithelial neoplasm. Please see \nthe operative report for full details. Her post-operative \ncourse is detailed as follows. \n\n*) Routine post-op: Immediately postoperatively, her pain was \ncontrolled with IV Dilaudid. Her diet was advanced without \ndifficulty and she was transitioned to Acetaminophen, Ibuprofen, \nand Tramadol. On post-operative day #1, her urine output was \nadequate so her Foley catheter was removed and she voided \nspontaneously. Her JP drain had 168cc output on post-operative \nday #1, and diminishing output on post-operative day #2. \n\n*) Tubo-ovarian abscess: Because residual tubo-ovarian abscess \nwas noted intra-operatively, she was given IV Ancef and Flagyl \nfor 24 hours post-operatively. \n\n*) T2DM: On post-operative day #0, Ms. ___ had a fingerstick \nblood glucose level of 241, thus she was placed on a gentle \ninsulin sliding scale. Her blood glucose levels normalized to \n120s-130s during the remainder of her hospitalization. \n\n*) Chest pain, resolved: On post-operative day #1, Ms. ___ \ncomplained of chest "heaviness," but denied palpitations, \nshortness of breath, calf pain. At that time her vital signs \nwere stable and her physical exam was benign. An EKG revealed \nnormal sinus rhythm. Her vital signs and symptoms were monitored \nthroughout the remainder of this admission, and her chest \nsymptoms completely resolved by post-operative day #2. \n\nBy post-operative day #2, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. Her JP drain was removed and \nshe was then discharged home in stable condition with outpatient \nfollow-up scheduled.'}}
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{'final_diagnoses': ['Endometrial Intraepithelial Neoplasm'], 'procedures': ['Robot assisted total laparoscopic hysterectomy', 'bilateral salpingo-oophorectomy', 'lysis of adhesions', 'cystoscopy'], 'visit_summary': 'Ms. ___ was admitted to the gynecologic oncology service \nafter undergoing robot-assisted total laparoscopic hysterectomy, \nbilateral salpingo-oophorectomy, lysis of adhesions, and \ncystoscopy for endometrial intraepithelial neoplasm. Please see \nthe operative report for full details. Her post-operative \ncourse is detailed as follows. \n\n*) Routine post-op: Immediately postoperatively, her pain was \ncontrolled with IV Dilaudid. Her diet was advanced without \ndifficulty and she was transitioned to Acetaminophen, Ibuprofen, \nand Tramadol. On post-operative day #1, her urine output was \nadequate so her Foley catheter was removed and she voided \nspontaneously. Her JP drain had 168cc output on post-operative \nday #1, and diminishing output on post-operative day #2. \n\n*) Tubo-ovarian abscess: Because residual tubo-ovarian abscess \nwas noted intra-operatively, she was given IV Ancef and Flagyl \nfor 24 hours post-operatively. \n\n*) T2DM: On post-operative day #0, Ms. ___ had a fingerstick \nblood glucose level of 241, thus she was placed on a gentle \ninsulin sliding scale. Her blood glucose levels normalized to \n120s-130s during the remainder of her hospitalization. \n\n*) Chest pain, resolved: On post-operative day #1, Ms. ___ \ncomplained of chest "heaviness," but denied palpitations, \nshortness of breath, calf pain. At that time her vital signs \nwere stable and her physical exam was benign. An EKG revealed \nnormal sinus rhythm. Her vital signs and symptoms were monitored \nthroughout the remainder of this admission, and her chest \nsymptoms completely resolved by post-operative day #2. \n\nBy post-operative day #2, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. Her JP drain was removed and \nshe was then discharged home in stable condition with outpatient \nfollow-up scheduled.', 'medications_prescribed': ['Acetaminophen ___ mg PO Q6H:PRN Pain - Mild \nRX *acetaminophen 500 mg ___ tablet(s) by mouth every 6 hours \nDisp #*50 Tablet Refills:*1', 'TraMADol 50 mg PO Q4H:PRN Pain - Moderate \ndo not drink alcohol or operate vehicles when taking tramadol \nRX *tramadol 50 mg 1 tablet(s) by mouth every 4 hours Disp #*30 \nTablet Refills:*0', 'Albuterol Inhaler 2 PUFF IH Q6H:PRN shortness of breath', 'Cyanocobalamin 1000 mcg PO DAILY', 'Hydrochlorothiazide 12.5 mg PO DAILY', 'Multivitamins 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': 69, 'gender': 'F', 'symptoms': 'Back pain', 'medical_history': ['# CAD with s/p BMS to posterior descending artery ___, prior \nstents to LAD, RCA, circumflex', '# systolic heart failure (most recent EF 30%)', '# IDDM on insulin', '# EtOH abuse with hx of withdrawal, DTs', '# C diff colitis past admission', '# BPH'], 'family_history': 'Father with CHF and diabetes, mother with MI', 'present_illness': "___ year old with a ___ CAD s/p recent NSTEMI and BMS, systolic \nheart failure with EF ___, IDDM, and past EtOH abuse \ntransferred from ___ with epidural abscess, \ndiscitis, osteomyelitis. Initially admitted to ___ \n___ complaining of back pain, nausea and vomiting. Blood \nculture positive for E. coli in ___ bottles ___ positive for \nstrep viridans, which was thought to be a contaminent), \noriginally treated with vanc/zosyn. found to have discitis \n(L3-L4) on CT and MRI. Also initially with DKA vs ETOH \nketoacidosis. He was discharged to rehab on ___ on \nceftriaxone after blood culture grew pan-sensitive E. Coli. \nCourse complicated by ETOH withdrawal/DTs, pulmonary edema and C \ndiff colitis. TTE with no evidence of vegetation. \nHe then presented to ___ from rehab ___ with acute \nshortness of breath and hypoxia. Labs significant for Na 130, \nESR 81, normal WBC. found to have an NSTEMI ___. He was \ninitially managed medically with heparin, aspirin, and plavix. \nCardiac cath ___ couldn't completed due to encephelopathy and \ninability to cooperate. Repeat cath was done ___ showed \npatent stents in proximal RCA, mid LAD and circ. PDA with 95% \nstenosis, second diag with 95% stenosis, with BMS placed in \nproximal PDA. Found to have EF XX%, furosemide dose uptitrated \nto 60mg IV daily. \nIn terms of his back pain, MRI of lumbar spine on ___ showed \nL3-L5 discitis and osteomyelitis with epidural collection behind \nL4 vertebral body causing severe central canal stenosis. NSG \nevaluated ___, felt that he would benefit from L3-L4 and L4-L5 \ndiskectomy with evacuation of epidural abscess. ___ repeat \nMRI showed progressive discitis and osteo, with endplate \ndestruction at L3-L4 and L4-L5. Epidural collection extended \nfrom L3-L5, also with edema and enhancement within paraspinal \nmuscles. Patient has also had left groin pain, with hip x-ray \nnormal. \nCourse also complicated by waxing and waning encephalopathy, for \nwhich he received PRN olanzapine. He became intermittently \nagitated, pulling IVs and refusing meds. He was evaluated by \nneurology and had relatively unremakable MRI brain. He was \nstarted on Megace for malnutrition. He was also seen by \npsychiatry. \n___ for worsening discitis, epidural abscess, osteo and \npoor surgical candidacy due to recent MI. \nOn arrival, patient without significant complaints, other than \nintermittent back pain which is improved by lying flat. Denied \ndyspnea, orthopnea, chest pain. Attempted to get repeat MRI of \nspine, however, patient became quite agitated at MRI and was \nunable to have study done.\nReview of Systems: \n(+) per HPI \n(-) fever, chills, night sweats, headache, vision changes, \nrhinorrhea, congestion, sore throat, cough, shortness of breath, \nchest pain, abdominal pain, nausea, vomiting, diarrhea, \nconstipation, BRBPR, melena, hematochezia, dysuria, hematuria.", 'medications': [{'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', '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': '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'MetFORMIN (Glucophage)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', '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': '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': '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': 'NIFEdipine CR', '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 via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', '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': 'NIFEdipine CR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '60.5', 'valuenum': 60.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '30', 'valuenum': 30.0, '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': 10.3, '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': 0.4, 'ref_range_upper': 1.1, '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': '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': '3.7', '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': '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': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, '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': '26.3', 'valuenum': 26.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, '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': '15.5', 'valuenum': 15.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.44', 'valuenum': 4.44, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '59.7', 'valuenum': 59.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '71.9', 'valuenum': 71.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', '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': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', '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': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '265', 'valuenum': 265.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.6', 'valuenum': 15.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.27', 'valuenum': 4.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, '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': '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 198.0, '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ON ADMISSION: \nVitals - T: 98.2 BP: 80/57 HR: 86 RR: 18 02 sat: 100%/RA \n___: NAD, cachectic \nHEENT: AT/NC, EOMI, PERRL, anicteric sclera, thrush in mouth \nNECK: nontender supple neck, JVP 7cm \nCARDIAC: RRR, S1/S2, no murmurs, gallops, or rubs \nLUNG: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nABDOMEN: nondistended, +BS, nontender in all quadrants, no \nrebound/guarding, no hepatosplenomegaly \nEXTREMITIES: finger injury on R hand \nPULSES: 2+ DP pulses bilaterally \nNEURO: CN II-XII intact. alert, oriented x 2 (hospital (but not \nwhich one), ___. significant hip flexor and hamstring \nweakness on L compared to R, strength and sensation otherwise \nsymmetric, rectal tone normal \nSKIN: warm and well perfused \n\nON DISCHARGE:\nVitals- 98.1, 104/58, 81, 18, 100% on RA\n___- Elderly appearing gentleman, lying in bed, alert, \noriented x3, no acute distress \nHEENT- Sclera anicteric, MMM, \nLungs- Clear to auscultation anteriorly \nCV- Regular rate and rhythm, normal S1 + S2, SEM II/VI \nAbdomen- soft, non-tender, non-distended, bowel sounds present\nGU- foley in place\nExt- warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nNeuro- A and O x 3. sensation intact, LLE ___ hip flexor, LLE \n___orsiflexion and plantarflexion ___ \nbilaterally. Unchanged from prior. ', 'diagnoses': [{'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '25042', 'desc': 'Diabetes with renal manifestations, type II or unspecified type, uncontrolled'}, {'icd_code': '25052', 'desc': 'Diabetes with ophthalmic manifestations, type II or unspecified type, uncontrolled'}, {'icd_code': '3572', 'desc': 'Polyneuropathy in diabetes'}, {'icd_code': '36202', 'desc': 'Proliferative diabetic retinopathy'}, {'icd_code': '72273', 'desc': 'Intervertebral disc disorder with myelopathy, lumbar region'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': '25062', 'desc': 'Diabetes with neurological manifestations, type II or unspecified type, uncontrolled'}, {'icd_code': '36207', 'desc': 'Diabetic macular edema'}, {'icd_code': '78702', 'desc': 'Nausea alone'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '71531', 'desc': 'Osteoarthrosis, localized, not specified whether primary or secondary, shoulder region'}, {'icd_code': '2410', 'desc': 'Nontoxic uninodular goiter'}, {'icd_code': '3670', 'desc': 'Hypermetropia'}, {'icd_code': '58381', 'desc': 'Nephritis and nephropathy, not specified as acute or chronic, in diseases classified elsewhere'}, {'icd_code': '78900', 'desc': 'Abdominal pain, unspecified site'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '3674', 'desc': 'Presbyopia'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'V4561', 'desc': 'Cataract extraction status'}], 'summary': 'ADMISSION LABS:\n___ 07:20AM BLOOD WBC-7.7 RBC-3.68* Hgb-10.7* Hct-34.1* \nMCV-93 MCH-29.2 MCHC-31.5 RDW-14.4 Plt ___\n___ 07:20AM BLOOD Neuts-65.9 ___ Monos-6.3 Eos-4.8* \nBaso-0.4\n___ 07:20AM BLOOD ESR-99*\n___ 07:20AM BLOOD Glucose-119* UreaN-52* Creat-1.0 Na-135 \nK-4.4 Cl-105 HCO3-20* AnGap-14\n___ 07:20AM BLOOD Calcium-8.4 Phos-4.4 Mg-2.4\n___ 07:20AM BLOOD CRP-50.7*\n___ 05:19AM BLOOD HIV Ab-NEGATIVE\n___ 05:19AM BLOOD EDTA ___\nBlood Cx:\n___ 7:20 am BLOOD CULTURE\n\n **FINAL REPORT ___\n\n Blood Culture, Routine (Final ___: NO GROWTH. \n\nOSH Blood Cx:\n___ ___ complaining of back pain, nausea and \nvomiting. Blood culture positive for E. coli in ___ bottles ___ \npositive for strep viridans, which was thought to be a \ncontaminent), originally treated with vanc/zosyn. Found to be \nsensitive to ceftriaxone. \n\nIMAGING:\nMRI results: \n1. Diskitis and osteomyelitis at L2-3. Questionable early \ndiskitis and osteomyelitis at L3-4. \n2. Anterior epidural phlegmon or abscess from L2 through L4, \nincompletely evaluated in the absence of intravenous contrast, \nwhich in combination with degenerative changes results in severe \nspinal canal narrowing at L3 and L4, with crowding of the nerve \nroots within the thecal sac. The collection also compresses the \ntraversing L4 nerve root in the subarticular zone at L3-4. \n3. Small prevertebral phlegmon or abscess at L2-3, incompletely \nevaluated in the absence of intravenous contrast, more extensive \non the left than right, which abuts the posterior aortic wall. \nEdema in bilateral psoas muscles from L2 through L5, more \nextensive on the left than right, with questionable micro \nabscess pockets in the left psoas muscle at L2-3 level, \nincompletely evaluated in the absence of intravenous contrast. \n4. Edema in the C3-4 disc without loss of height, which is \nprobably \ndegenerative, given the presence ___ type 2 discogenic \nmarrow changes, rather than edema, in the adjacent endplates. \nHowever, short-interval followup cervical spine MRI with \ncontrast is suggested to exclude developing infection. \n5. Multilevel cervical degenerative disease with mild to \nmoderate spinal canal stenosis and severe narrowing of multiple \nneural foramina, as detailed above. \n6. No significant abnormalities in the thoracic spine. \n\nDISCHARGE LABS:\n___ 05:25AM BLOOD WBC-5.9 RBC-3.36* Hgb-9.9* Hct-30.5* \nMCV-91 MCH-29.6 MCHC-32.6 RDW-15.4 Plt ___\n___ 05:25AM BLOOD Glucose-127* UreaN-16 Creat-0.5 Na-134 \nK-4.2 Cl-103 HCO3-22 AnGap-13\n___ 05:25AM BLOOD Calcium-8.8 Phos-3.0 Mg-2.0\n___ 05:25AM BLOOD CRP-31.0*\n___ M with hx of CAD s/p recent NSTEMI/BMS, IDDM, sCHF \ntransferred with worsening lumbar discitis, osteomyelitis and \nepidural abscess, now with RUE and LLE weakness. He has a L2-L4 \nepidural abscess that per neurosurgery is stable and as such he \nwill undergo 30 days of plavix and follow up for surgery after a \nplavix washout. \n\n# Epidural abscess, osteomyelitis, discitis: Epidural abscess \nfrom L2-L4. Discussed with neurosurgery who felt that nerves in \nthat area were preserved with plantar and dorsiflexion ___ \nstrength and sensation intact. He had weakness of the psoas \nmuscle on the left side that was thought to be due to micro \nabscesses. As he has a high bleeding risk and the risk would \nneed to stop plavix, the decision was made to continue \nCeftriaxone (likely cause of abscess is e coli that is CTX \nsensitive) at 2gram IV Q24 and complete the 30 days of plavix as \nnoted below. He will then stop plavix on ___ and follow up \nwith neurosurgery with MRI on the same day. He will need \npremedication for the MRI (pain and anxiety). At that point \nsurgery will be considered. He should stay on his aspirin. He \nshould neuro evaluation to ensure that he does not develop \nimpingement at the L2-4 region that would be noted by weakness \nof dorsi or plantar flexion. He will follow up with ID and have \nweekly labs(ESR, CRP, CBC, CHEM 10) and fax results to \n___. He should continue to work with physical therapy. \n\n# CAD: NSTEMI on ___ s/p BMS ___ at OSH, 4 prior stents. \nPlavix due through ___ at least and indefinite aspirin. He had \nan echo that showed an EF of 25%. He did not require any \ndiuretics during his hospitalization at ___ but did require \nintermittent dosing with 60mg IV lasix at the OSH prior to \ntransfer. He will continue on metoprolol, atorvastatin and \nlisinopril. Continue plavix until ___ aqn then start the \nwashout. Will do surgery on ASA 81mg so please do not stop this \nmedication. \n\n# sCHF with EF of 25%: Secondary to ischemia. Significant \ndecrease in EF following NSTEMI form 50-55% to 25%. Euvolemic \nduring hospitalization and required 2.5L on admission. He did \nnot require any diuretics during his hospitalization at ___ \nbut did require intermittent dosing with 60mg IV lasix at the \nOSH prior to transfer. He will continue on metoprolol, \natorvastatin and lisinopril.\n\n# Metabolic encephalopathy: Resolved with interment confusion \nduring this hospitalization. Patient has had waxing and waning \ndelirium throughout his previous hospitalization. Has hx of ETOH \nabuse and per report had a history of DTs. No evidence of \nabnormality or seizure on head MRI at ___. He did not \nrequire any PRNs. \n \n# Type 2 DM: Continued lantus + sliding scale \n \n# Nutrition: Albumin 2.7 on admission to ___, appetite \nquite poor. Improved to 3.3 during hospitalization at ___. \nContinued Megace while in hospital with improvement. '}}
|
{'final_diagnoses': ['Epidural Abscess in L2-L4 with osteomyelitis and discitis', 'NSTEMI with BMS to PDA on ___'], 'procedures': ['None'], 'visit_summary': '___ M with hx of CAD s/p recent NSTEMI/BMS, IDDM, sCHF \ntransferred with worsening lumbar discitis, osteomyelitis and \nepidural abscess, now with RUE and LLE weakness. He has a L2-L4 \nepidural abscess that per neurosurgery is stable and as such he \nwill undergo 30 days of plavix and follow up for surgery after a \nplavix washout. \n\n# Epidural abscess, osteomyelitis, discitis: Epidural abscess \nfrom L2-L4. Discussed with neurosurgery who felt that nerves in \nthat area were preserved with plantar and dorsiflexion ___ \nstrength and sensation intact. He had weakness of the psoas \nmuscle on the left side that was thought to be due to micro \nabscesses. As he has a high bleeding risk and the risk would \nneed to stop plavix, the decision was made to continue \nCeftriaxone (likely cause of abscess is e coli that is CTX \nsensitive) at 2gram IV Q24 and complete the 30 days of plavix as \nnoted below. He will then stop plavix on ___ and follow up \nwith neurosurgery with MRI on the same day. He will need \npremedication for the MRI (pain and anxiety). At that point \nsurgery will be considered. He should stay on his aspirin. He \nshould neuro evaluation to ensure that he does not develop \nimpingement at the L2-4 region that would be noted by weakness \nof dorsi or plantar flexion. He will follow up with ID and have \nweekly labs(ESR, CRP, CBC, CHEM 10) and fax results to \n___. He should continue to work with physical therapy. \n\n# CAD: NSTEMI on ___ s/p BMS ___ at OSH, 4 prior stents. \nPlavix due through ___ at least and indefinite aspirin. He had \nan echo that showed an EF of 25%. He did not require any \ndiuretics during his hospitalization at ___ but did require \nintermittent dosing with 60mg IV lasix at the OSH prior to \ntransfer. He will continue on metoprolol, atorvastatin and \nlisinopril. Continue plavix until ___ aqn then start the \nwashout. Will do surgery on ASA 81mg so please do not stop this \nmedication. \n\n# sCHF with EF of 25%: Secondary to ischemia. Significant \ndecrease in EF following NSTEMI form 50-55% to 25%. Euvolemic \nduring hospitalization and required 2.5L on admission. He did \nnot require any diuretics during his hospitalization at ___ \nbut did require intermittent dosing with 60mg IV lasix at the \nOSH prior to transfer. He will continue on metoprolol, \natorvastatin and lisinopril.\n\n# Metabolic encephalopathy: Resolved with interment confusion \nduring this hospitalization. Patient has had waxing and waning \ndelirium throughout his previous hospitalization. Has hx of ETOH \nabuse and per report had a history of DTs. No evidence of \nabnormality or seizure on head MRI at ___. He did not \nrequire any PRNs. \n \n# Type 2 DM: Continued lantus + sliding scale \n \n# Nutrition: Albumin 2.7 on admission to ___, appetite \nquite poor. Improved to 3.3 during hospitalization at ___. \nContinued Megace while in hospital with improvement. ', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H', '2. Aspirin 81 mg PO DAILY', '3. Atorvastatin 80 mg PO DAILY', '4. CeftriaXONE 2 gm IV Q24H', '5. Clopidogrel 75 mg PO DAILY\nContinue medication until ___. Then stop pending your \nappointment with the neurosurgeons. ', '6. FoLIC Acid 1 mg PO DAILY', '7. Glargine 15 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', '8. Ipratropium-Albuterol Neb 1 NEB NEB Q6H:PRN SOB/Wheeze', '9. Lidocaine 5% Patch 1 PTCH TD QAM', '10. Multivitamins 1 TAB PO DAILY', '11. Ondansetron 4 mg IV Q8H:PRN nausea', '12. Pantoprazole 40 mg PO Q24H', '13. Thiamine 100 mg PO DAILY', '14. Calcium Carbonate 500 mg PO QID:PRN heartburn', '15. Heparin 5000 UNIT SC TID', '16. Heparin Flush (10 units/ml) 2 mL IV DAILY and PRN, line \nflush', '17. Lisinopril 2.5 mg PO DAILY', '18. OxycoDONE (Immediate Release) 5 mg PO Q4H:PRN pain \nRX *oxycodone 5 mg 1 tablet(s) by mouth Every 4 hours Disp #*30 \nTablet Refills:*0', '19. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line \nflush', '20. Sodium Chloride 0.9% Flush 10 mL IV DAILY and PRN, line \nflush', '21. TraZODone 50 mg PO HS:PRN insomnia \nRX *trazodone 50 mg 1 tablet(s) by mouth Nightly Disp #*10 \nTablet Refills:*0', '22. Ascorbic Acid ___ mg PO BID', '23. lactobacillus acidophilus 1 billion cell oral BID', '24. Megestrol Acetate 400 mg PO DAILY \nRX *megestrol 400 mg/10 mL (40 mg/mL) 10 ml by mouth Daily \nRefills:*0', '25. Metoprolol Succinate XL 50 mg PO DAILY', '26. Nitroglycerin SL 0.3 mg SL PRN chest pain', '27. Vitamin D 50,000 UNIT PO 1X/WEEK (MO)']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'F', 'symptoms': 'CC: bifrontal contusions s/p head strike', 'medical_history': ['hx IVDA'], 'family_history': 'Family Hx: NC', 'present_illness': 'HPI: ___ M hx IVDA who was found unresponsive by EMS with head\nlaceration. Pt endorses assault but denies recollection of full\nevents. OSH head CT showed bifrontal contusions with traumatic\nSAH and pt was sent to ___ for further evaluation. C/o headache,\nnausea and vomiting.\n\nROS: no CP, SOB', 'medications': [{'medication': 'Betamethasone Valerate 0.1% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'NIFEdipine CR', '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': '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': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'PredniSONE', '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': 'Sodium Chloride', '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Quetiapine Fumarate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen-Caff-Butalbital', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'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': 'Senna', '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': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clonazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phenytoin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': '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}]}, 'clinical_findings': {'labs': [{'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': '7', 'valuenum': 7.0, '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': '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': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.024', 'valuenum': 1.024, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, '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': '<1.'}, {'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': '16', 'valuenum': 16.0, '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': 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': 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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<1.'}, {'value': '1.009', 'valuenum': 1.009, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '1', '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': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': 'U/mL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE.'}, {'value': '25.5', 'valuenum': 25.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '22', 'valuenum': 22.0, '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': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '19', 'valuenum': 19.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '121', 'valuenum': 121.0, 'valueuom': 'mg/dL', 'ref_range_lower': 90.0, 'ref_range_upper': 180.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 10.0, 'ref_range_upper': 40.0, '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': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, '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': 'NotDone. CK-MB NOT PERFORMED, TOTAL CK < 100.'}, {'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': '97', 'valuenum': 97.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '182', 'valuenum': 182.0, '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': '24.8', 'valuenum': 24.8, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 338.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 149.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '39.6', 'valuenum': 39.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.9', 'valuenum': 27.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '460', 'valuenum': 460.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '4.64', 'valuenum': 4.64, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '___', 'valuenum': 5.9, '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': 6.7, 'valueuom': 'GPL', 'ref_range_lower': 0.0, 'ref_range_upper': 15.0, 'flag': None, 'priority': 'STAT', 'comments': '0-15 GPL: NEGATIVE;15-20 GPL: INDETERMINATE; >20 GPL: POSITIVE.'}, {'value': '___', 'valuenum': 7.5, 'valueuom': 'MPL', 'ref_range_lower': 0.0, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': '0-12.5 MPL: NEGATIVE;12.5-20 MPL: INDETERMINATE; >20 MPL: POSITIVE.'}], 'exams': 'PHYSICAL EXAM:\nO: HR: 41 BP: 138/56 RR: 16 O2Sat: 99% \nGen: WD/WN, comfortable, NAD.\nHEENT: occipital head laceration\nNeck: Supple. C-Collar in place\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: somewhat lethargic but easily arousable, alert,\ncooperative with exam, normal affect.\nOrientation: Oriented to person, place, and date but difficulty\nwith day.\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, 5 to 4\nmm bilaterally. 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 bilaterally.\n\nToes downgoing bilaterally\n\nCoordination: normal on finger-nose-finger\n\nOn Discharge:\nIntact', 'diagnoses': [{'icd_code': '7812', 'desc': 'Abnormality of gait'}, {'icd_code': '2536', 'desc': 'Other disorders of neurohypophysis'}, {'icd_code': 'E9361', 'desc': 'Hydantoin derivatives causing adverse effects in therapeutic use'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '7100', 'desc': 'Systemic lupus erythematosus'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '4928', 'desc': 'Other emphysema'}, {'icd_code': '34590', 'desc': 'Epilepsy, unspecified, without mention of intractable epilepsy'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '5790', 'desc': 'Celiac disease'}, {'icd_code': '3004', 'desc': 'Dysthymic disorder'}], 'summary': "___ 11:00AM CK(CPK)-122\n___ 11:00AM CK-MB-2 cTropnT-<0.01\n___ 03:00AM URINE bnzodzpn-NEG barbitrt-NEG opiates-POS \ncocaine-NEG amphetmn-NEG mthdone-NEG\n___ 03:00AM URINE COLOR-Yellow APPEAR-Clear SP ___\n___ 03:00AM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-40 BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 11:30PM GLUCOSE-116* UREA N-12 CREAT-0.7 SODIUM-136 \nPOTASSIUM-4.3 CHLORIDE-97 TOTAL CO2-24 ANION GAP-19\n___ 11:30PM CALCIUM-10.0 PHOSPHATE-3.8 MAGNESIUM-1.8\n___ 11:30PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n___ 11:30PM WBC-16.4* RBC-4.79 HGB-14.7 HCT-43.4 MCV-91 \nMCH-30.7 MCHC-33.9 RDW-12.8\n___ 11:30PM NEUTS-91.9* LYMPHS-4.1* MONOS-3.9 EOS-0 \nBASOS-0.1\n___ 11:30PM PLT COUNT-281\n___ 11:30PM ___ PTT-29.3 ___\n___ yo ___, found down, possible assault, with bifrontal \ncontusions on head CT, head laceration. Pt was admitted to the \nneurosurgery service on ___ for observation. Repeat head CT on \n___ was stable. \nPt was persistently bradycardic in ___ this was worked up with \nEKG (sinus bradycardia with junctional escape rhythm), TTE \n(negative), cardiac enzymes (negative). Cardiology consult was \nobtained and they felt there was no need for further cardiac \nworkup. \nPt's leukocytosis to 16K on admission (no fever), was worked up \nw/CXR (no acute process), U/A (wnl), blood cx (no growth to \ndate). On was mobilized and on ___ was deemed fit for discharge \nto home without services. He was given instructions for \nfollow-up and prescripitons for required medications."}}
|
{'final_diagnoses': ['Cerebral contusion'], 'procedures': ['None'], 'visit_summary': "___ yo ___, found down, possible assault, with bifrontal \ncontusions on head CT, head laceration. Pt was admitted to the \nneurosurgery service on ___ for observation. Repeat head CT on \n___ was stable. \nPt was persistently bradycardic in ___ this was worked up with \nEKG (sinus bradycardia with junctional escape rhythm), TTE \n(negative), cardiac enzymes (negative). Cardiology consult was \nobtained and they felt there was no need for further cardiac \nworkup. \nPt's leukocytosis to 16K on admission (no fever), was worked up \nw/CXR (no acute process), U/A (wnl), blood cx (no growth to \ndate). On was mobilized and on ___ was deemed fit for discharge \nto home without services. He was given instructions for \nfollow-up and prescripitons for required medications.", 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H:PRN pain', 'Docusate Sodium 100 mg PO BID', 'Oxycodone-Acetaminophen (5mg-325mg) ___ TAB PO Q4H:PRN pain \nDo not take more than 4grams of acetaminophen in a day']}
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Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 77, 'gender': 'M', 'symptoms': 'code stroke', 'medical_history': ['CARDIAC RISK FACTORS', '- Hypertension', '- Dyslipidemia', '- Pre-diabetes: A1c 6.0', '- CKD III', 'CARDIAC HISTORY', '- Coronaries: 60% mRCA', '- Pump: Unknown', '- Rhythm: NSR', 'OTHER PAST MEDICAL HISTORY', '- Hypothyroidism', '- Osteopenia', '- Pituitary Adenoma'], 'family_history': 'Sister bypass surgery in her late ___\nNo family history of SCD, heart disease, arrhythmias. History of \nrenal failure in family.', 'present_illness': 'Neurology at bedside after Code Stroke activation within: 5 mins\nTime/Date the patient was last known well: 5 ___ yesterday\n\nI was present during the CT scanning and reviewed the images\nwithin 20 minutes of their completion.\n\n___ Stroke Scale Score: 6\n\nt-PA administered: \n[] Yes - Time given: __\n[X] No - Reason t-PA was not given or considered: outside window\n\nThrombectomy performed: \n[] Yes \n[X] No - Reason not performed or considered: no LVO\n\nNIHSS performed within 6 hours of presentation at: 12:05 ___ \n___\nNIHSS Total: 6\n1a. Level of Consciousness: 0\n1b. LOC Question: 0\n1c. LOC Commands: 0 \n2. Best gaze: 0\n3. Visual fields: 0\n4. Facial palsy: 3 (upper/lower L facial palsy)\n5a. Motor arm, left: 0\n5b. Motor arm, right: 0\n6a. Motor leg, left: 1\n6b. Motor leg, right: 1\n7. Limb Ataxia: 0\n8. Sensory: 0\n9. Language: 1 (mild-moderate WFD)\n10. Dysarthria: 0\n11. Extinction and Neglect: 0\n\nREASON FOR CONSULTATION: CODE STROKE\n \nHPI: \nMs. ___ is a ___ w/ hx HTN, CAD, prior Bell\'s\npalsy, hypothyroidism, & pituitary macroadenoma s/p resection of\nwho presents w/ acute onset difficulty speaking and L facial\ndroop. Found to have WFD & borderline decreased sensation on L\nface/body. \n\nNoted R upper lip numbness like "shot of novacaine" when went to\nput on chapstick yesterday evening at 6 ___, denies noting L\nfacial droop in mirror at that time. Spoke to son ___ at 8:30 \nAM\nthis morning, who notes patient was drowsy although did not\nappear to be having WFD. Awoke at 9:30 AM and had cup of tea. \nWas\nable to speak normally until this morning (although did not \nspeak\nto anyone). Between 10 AM & 10:30 AM spoke w/ ___, noticed\nthat she was having word finding difficulty and looked in mirror\nand saw her face was different. Called urgent care who informed\nher to call ___. Since calling 911, has noticed L sided \nface/body\nnumbness. \n\nHad screening colonoscopy on ___. Stayed in bed ___ as\nshe thought she was coming down w/ cold d/t rhinorrhea, watery\neyes, congestion, and dry lips. Had cardiac cath ___ w/\nnonobstructive CAD, no PCI. At follow-up w/ cards in ___\nand reports having carotid U/S. Takes daily ASA 81mg, last ___ AM.', 'medications': [{'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', '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', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H: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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Alprazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', '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', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', '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': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Methocarbamol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H: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': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Torsemide', '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', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', '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': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Torsemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '19.8', 'valuenum': 19.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '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': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.4', 'valuenum': 36.4, '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': '152', 'valuenum': 152.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.70', 'valuenum': 3.7, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD. DISCARD GREATER THAN 8 HOURS OLD.'}, {'value': '10', 'valuenum': 10.0, '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.4', 'valuenum': 18.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '145', 'valuenum': 145.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, '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': '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': '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, 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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': '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': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', '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': '35', 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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': '149', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, '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': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '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': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.2', 'valuenum': 23.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1152.0, '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': '12', 'valuenum': 12.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 201.0, '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': '___', 'valuenum': 5.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY REPLICATE ANALYSIS.'}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '20', 'valuenum': 20.0, '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': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, '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': '198', 'valuenum': 198.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.75', 'valuenum': 3.75, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '50', 'valuenum': 50.0, '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': '7.34', 'valuenum': 7.34, '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': '37.1', 'valuenum': 37.1, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '500', 'valuenum': 500.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '14/4.', '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': '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': '8.3', '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': '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 = 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 70+ is 75 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 190.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '___', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES MG..'}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, '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': '35.4', 'valuenum': 35.4, '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': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, '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': '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': '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': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'HEMOLYZED, GROSSLY. INTERPRET RESULTS WITH CAUTION. SUGGEST SAMPLE REDRAW.'}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, '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': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '153', 'valuenum': 153.0, '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': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 759.0, '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': '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', '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': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', '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': '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': 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': '2.2', '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': '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': '22', 'valuenum': 22.0, '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': 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': '31.9', 'valuenum': 31.9, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.85', 'valuenum': 2.85, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.1', 'valuenum': 23.1, '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': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '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': 440.0, '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': '2.49', 'valuenum': 2.49, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.5', 'valuenum': 16.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, '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': '23.2', 'valuenum': 23.2, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, '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': '8.1', 'valuenum': 8.1, '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': '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': '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', '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': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.5', 'valuenum': 9.5, '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': '35.2', 'valuenum': 35.2, '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': '244', 'valuenum': 244.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, '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': 6.2, '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}], 'exams': 'Vitals: Temp 98.4F HR 60 BP 147/87 RR 18 SpO2 100% on RA\n\nGeneral: Awake, cooperative, NAD.\nHEENT: NC/AT, no scleral icterus noted, MMM, no lesions noted in\noropharynx.\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity.\nPulmonary: Normal work of breathing.\nCardiac: RRR, warm, well-perfused.\nAbdomen: Soft, non-distended.\nExtremities: No ___ edema.\nSkin: No rashes or lesions noted.\n \nNeurologic:\n-Mental Status: Alert, oriented x name, date, place, & \nsituation.\nKnows current & prior president. Able to relate history without\ndifficulty. Attentive, able to name ___ backward without\ndifficulty. Language is fluent with intact repetition and\ncomprehension. There were no paraphasic errors. Able to name \nboth\nhigh and low frequency objects. Occasional speech delay w/ WFD. \n\nAble to read without difficulty. No dysarthria. Able to follow\nboth midline and appendicular commands. Able to register 3\nobjects and recall ___ at 5 minutes (additional ___ w/ category\nclues). There was no evidence of apraxia or neglect.\n\n-Cranial Nerves:\nII, III, IV, VI: PERRL 3 to 2mm and brisk. EOMI without\nnystagmus. Normal saccades. VFF to confrontation. \nV: Facial sensation decreased on right w/ light touch (90%\ncompared to left).\nVII: L facial droop\nVIII: Decreased hearing to finger rub on left, Weber w/ \nvibration\nnoted > L ear, ___ air>bone bilaterally.\nIX, X: Palate elevates symmetrically.\nXI: ___ strength in trapezii bilaterally.\nXII: Tongue protrudes in midline with good excursions. Strength\nfull with tongue-in-cheek testing.\n\n-Motor: Normal bulk and tone throughout. No pronator drift. No\nadventitious movements, such as tremor or asterixis noted.\n [Delt][Bic][Tri][ECR][FEx][IO][IP][Quad][Ham][TA][Gas]\nL 5 5 4+ 5 5- 5 5 5 5 5- 5 \nR 5 5 5 5 5 5 5 5 5 5 5 \n\n-Sensory: Decreased sensation to light touch, pinprick, and\ntemperature on left arm/leg/face (90% compared to right). No\nchange in vibration or proprioception throughout. No extinction\nto DSS. Romberg absent. \n\n-Reflexes:\n [Bic] [Tri] [___] [Pat] [Ach]\nL 2 2 2 2 1\nR 2 2 2 2 1 \nPlantar response was flexor bilaterally.\n\n-Coordination: No intention tremor. Normal finger-tap\nbilaterally. No dysmetria on FNF or HKS bilaterally.\n\n-Gait: Good initiation. Narrow-based, normal arm swing, narrowed\nstride. Unable to perform tandem walk.', 'diagnoses': [{'icd_code': '82009', 'desc': 'Other closed transcervical fracture of neck of femur'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': 'V8542', 'desc': 'Body Mass Index 45.0-49.9, adult'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '99643', 'desc': 'Broken prosthetic joint implant'}, {'icd_code': '27801', 'desc': 'Morbid obesity'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'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': '71950', 'desc': 'Stiffness of joint, not elsewhere classified, site unspecified'}, {'icd_code': '2720', 'desc': 'Pure hypercholesterolemia'}, {'icd_code': 'V4364'}, {'icd_code': 'V4365', 'desc': 'Knee joint replacement'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': 'V5861', 'desc': 'Long-term (current) use of anticoagulants'}, {'icd_code': 'E8843', 'desc': 'Accidental fall from wheelchair'}, {'icd_code': 'E8490', 'desc': 'Home accidents'}, {'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'}], 'summary': "Admission Labs\n\n___ 11:59AM BLOOD WBC-5.3 RBC-3.78* Hgb-11.1* Hct-33.9* \nMCV-90 MCH-29.4 MCHC-32.7 RDW-13.2 RDWSD-43.3 Plt ___\n___ 11:59AM BLOOD Neuts-28.1* Lymphs-54.6* Monos-12.2 \nEos-4.9 Baso-0.2 AbsNeut-1.48* AbsLymp-2.87 AbsMono-0.64 \nAbsEos-0.26 AbsBaso-0.01\n___ 11:59AM BLOOD ___ PTT-31.9 ___\n___ 11:59AM BLOOD Plt ___\n___ 06:51AM BLOOD Glucose-95 UreaN-16 Creat-1.0 Na-144 \nK-3.7 Cl-102 HCO3-26 AnGap-16\n___ 11:59AM BLOOD ALT-21 AST-33 AlkPhos-73 TotBili-0.9\n___ 11:59AM BLOOD cTropnT-<0.01\n___ 06:51AM BLOOD TotProt-6.8 Calcium-9.9 Phos-4.6* Mg-2.1\n___ 11:59AM BLOOD VitB12-987*\n___ 11:59AM BLOOD RheuFac-<10 ___ CRP-8.4*\n___ 11:59AM BLOOD Lyme Ab-NEG\n\nPERTINENT STUDIES\n\n___ 08:02PM CEREBROSPINAL FLUID (CSF) TNC-2 RBC-3 Polys-0 \n___ ___ 08:02PM CEREBROSPINAL FLUID (CSF) TotProt-55* \nGlucose-60 LD(LDH)-17\n___ 11:59AM BLOOD Lyme Ab-NEG\n___ 11:59AM BLOOD PEP-NO SPECIFI\n\nIMAGING\nRadiology Report MRI ___ & BRAIN, WITH CONTRAST Study Date of \n___ 8:38 ___\n\nIMPRESSION: \n \n \n1. No evidence of IAC or cerebellopontine angle mass. \n2. Questionable thin small abnormal enhancement along distal \nintracanalicular \nsegment of left facial nerve which may reflect underlying \ninflammatory \nprocess. No definite abnormal enhancement along the foramen \novale. \n3. Partially imaged prominent bilateral level 2 lymph nodes may \nbe reactive to \nrecent infection. \n4. No brainstem lesion or acute abnormality in the brain. \nScattered \nnonspecific white matter signal changes likely reflecting \nchronic \nmicroangiopathy. \n5. Postsurgical changes from previous transsphenoidal pituitary \nmacro adenoma \nresection. \n\nRadiology Report CTA HEAD AND CTA NECK Study Date of ___ \n12:01 ___\n\nIMPRESSION: \n \n \n1. Head CT: No acute intracranial pathology. \n2. Head CTA: Calcified atherosclerotic plaque at the bilateral \ncarotid siphons \nresulting in mild stenosis of the bilateral cavernous segments \nand \nmild-to-moderate stenosis of the right supraclinoid ICA with \ndistal patency. \nOtherwise, the vessels of the ___ appear normal in \ncourse and \ncaliber, without evidence for significant stenosis or aneurysm. \n3. Neck CTA: Trace plaque formation at the left carotid \nbifurcation without \nevidence for internal carotid artery stenosis on either side by \nNASCET \ncriteria. No evidence of dissection.\nTransitional Issues:\n[] Ongoing eye care (drops, tape eye at night)\n[] f/u rheum/lyme/labs\n[] Repeat MRI brain w/ and w/o in ___ months if facial palsy not \nresolving\n\n___ year old lady from ___ with history of CAD, HTN, HLD, \npituitary adenoma s/p resection and radiation, prior left sided \nBell's who presented with left facial droop. She had acute onset \nright upper lip numbness the day prior to admission with \nsubsequent bilateral mouth numbness, left facial droop noted and \npotentially worsened on the day of admission morning. \n\nShe was afebrile without meningismus, fluent speech with \nstuttering primarily with labial words. Otherwise normal \nlanguage. Left LMN facial palsy with full eye closure requiring \nencouragement. Not overcome with emotional laughter. Decreased \npin left patchy areas V3 and right V2. The sensory changes \nresolved and she was left with ___ grade IV weakness. \nShe have MRI brain w/o contrast with slight ___ nerve \nenhancement. CSF was with WBC 2, RBC 3, protein 55. Presentation \nentirely c/w a LMN ___ palsy but patchy sensory involvement of \nlip is odd. Sometimes patient's with Bell's can report this. \nReassuringly CSF was without abnormal WBC. Cytology was sent. \nRhematologic and infectious work-up sent and should be followed \nup as outpatient. Should she develop other cranial neuropathies, \nor should her symptoms progress, further consideration of \nalternative diagnoses should be considered."}}
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{'final_diagnoses': ['facial nerve palsy'], 'procedures': ['lumbar puncture'], 'visit_summary': "Transitional Issues:\n[] Ongoing eye care (drops, tape eye at night)\n[] f/u rheum/lyme/labs\n[] Repeat MRI brain w/ and w/o in ___ months if facial palsy not \nresolving\n\n___ year old lady from ___ with history of CAD, HTN, HLD, \npituitary adenoma s/p resection and radiation, prior left sided \nBell's who presented with left facial droop. She had acute onset \nright upper lip numbness the day prior to admission with \nsubsequent bilateral mouth numbness, left facial droop noted and \npotentially worsened on the day of admission morning. \n\nShe was afebrile without meningismus, fluent speech with \nstuttering primarily with labial words. Otherwise normal \nlanguage. Left LMN facial palsy with full eye closure requiring \nencouragement. Not overcome with emotional laughter. Decreased \npin left patchy areas V3 and right V2. The sensory changes \nresolved and she was left with ___ grade IV weakness. \nShe have MRI brain w/o contrast with slight ___ nerve \nenhancement. CSF was with WBC 2, RBC 3, protein 55. Presentation \nentirely c/w a LMN ___ palsy but patchy sensory involvement of \nlip is odd. Sometimes patient's with Bell's can report this. \nReassuringly CSF was without abnormal WBC. Cytology was sent. \nRhematologic and infectious work-up sent and should be followed \nup as outpatient. Should she develop other cranial neuropathies, \nor should her symptoms progress, further consideration of \nalternative diagnoses should be considered.", 'medications_prescribed': ['Artificial Tears GEL 1% ___ DROP LEFT EYE Q2H \nRX *carboxymethylcellulose sodium [Artificial Tears (cmc)] 1 % 2 \ndrops left eye q2h Refills:*2', 'PredniSONE 60 mg PO DAILY Duration: 7 Days \nRX *prednisone 10 mg 6 tablets by mouth once a day Disp #*36 \nTablet Refills:*0', 'ValACYclovir 1000 mg PO TID Duration: 7 Days \nRX *valacyclovir 1,000 mg 1 tablet(s) by mouth three times a day \nDisp #*6 Tablet Refills:*0', 'Aspirin 81 mg PO DAILY', 'Atorvastatin 40 mg PO QPM', 'Hydrochlorothiazide 25 mg PO DAILY', 'Levothyroxine Sodium 50 mcg PO DAILY', 'Metoprolol Succinate XL 25 mg PO DAILY', 'Multivitamins 1 TAB PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 53, 'gender': 'F', 'symptoms': 'Fatigue, abdominal pain', 'medical_history': ['1)Hypertension', '2)Hypercholesterolemia', '3)Diabetes Mellitus Type 2--states borderline, not on meds', '4)Diastolic Congestive Heart Failure (TTE ___ with EF > 55%)', '5)Multinodular goiter', '6)s/p Thyroid Cyst removal', '7)Osteoarthritis -- intermittently on prednisone for it', '8)GERD and Gastritis with positive H. Pylori ___ LBP', '10)Glaucoma', '11)Bilateral TKR', '12)Gout - polyarticular, recently started on colchicine', '13)Depression', '14)Anxiety', '15)Diverticulosis', '16)S/P C Sections', '17)hx of trochanteric bursitis', '18)Appendectomy ___', '19) CAD', '20)asthma', '21)cataract surgery (left completed, right to be done)'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death. Son has been diagnosed w anginal symptoms \nand HTN. Mother and father both died of CVA.', 'present_illness': '___ y/o female who presents with ___ w/ pEF, CAD, COPD, DM, OA \nwho presents w/ one week history of intermittent diarrhea and \nabdominal pain s/p fall at home. ___ night, patient fell \nwhile getting into bed, landed on her bottom. She denies LOC, \nhitting head. She lives alone and is unable to get up on her \nown after falls, so she utilized lifealert to call an ambulance \nand paramedics took her to hospital upon her request. She \nreports abdominal pain is primarily per-umbilical with radiation \ninto her right side. Reports nausea, intermittent loose, \nnon-bloody stools. She denies vomiting or fevers. \n\nPt reports occasional dysuria without hematuria, and a rash \nunderneath R breast. She has a productive cough at baseline with \nthick white sputum and denies increase in sputum production, \nchange in sputum color or consistency. She denies SOB, \npalpitations, chest pain. \n\nIn the ED, initial vital signs were: T 97.4 P 70 BP 159/109 R 16 \nO2 sat. 100 on RA\nExam notable for epigastric abdominal tenderness. \nLabs were notable for BUN 52, Cr 1.4, Glucose 116, WBC count \n10.9. \nPatient was given 1000mg IV Acetaminophen, 1g IV Ceftriaxone, \n500mg IV Azithromycin, and LR IVF. \n\nOn Transfer Vitals were: 98.0 77 176/69 18 100% on RA', 'medications': [{'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', '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': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', '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}, {'medication': 'Hydrochlorothiazide', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY16', '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': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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 via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', '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', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', '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': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Oxide', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Oxycodone SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '25.2', 'valuenum': 25.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 62.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '257', 'valuenum': 257.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.3', 'valuenum': 18.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '160', 'valuenum': 160.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.8', 'valuenum': 22.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 113.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '___', 'valuenum': 150.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '19.3', 'valuenum': 19.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 107.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '104', 'valuenum': 104.0, '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': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '63', 'valuenum': 63.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, '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': '9.1', 'valuenum': 9.1, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '113', 'valuenum': 113.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '<20*.'}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '459', 'valuenum': 459.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '319', 'valuenum': 319.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '353', 'valuenum': 353.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 84.0, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.4', 'valuenum': 6.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.2', 'valuenum': 26.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '227', 'valuenum': 227.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.5', 'valuenum': 18.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '.8', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.5, 'ref_range_upper': 1.5, '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': '___', 'valuenum': 107.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '98.1', 'valuenum': 98.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': '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': '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': '97', 'valuenum': 97.0, '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': '4.1', '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': '9', 'valuenum': 9.0, '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': '17.8', 'valuenum': 17.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '93.8', 'valuenum': 93.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '6.2', 'valuenum': 6.2, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '225', 'valuenum': 225.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18.6', 'valuenum': 18.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.63', 'valuenum': 3.63, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.9', 'valuenum': 5.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.9', 'valuenum': 25.9, 'valueuom': '%', 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'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '19.6', 'valuenum': 19.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '66', 'valuenum': 66.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, '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': '26.9', 'valuenum': 26.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, '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': '8.6', 'valuenum': 8.6, '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': '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': '106', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.4', 'valuenum': 26.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.6', 'valuenum': 26.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.2', 'valuenum': 19.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '26.2', 'valuenum': 26.2, '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': 4.2, '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': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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': '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': '4.6', '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': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 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': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '70.6', 'valuenum': 70.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION: \nVitals: T 98.5 P 85 BP 155/60 RR 20 O2 sat. 98 on RA\nGeneral : well appearing, AO x 3, NAD\nHEENT: MMM, oropharynx clear, EOMI\nLymph: Supple, JVP not elevated, no LAD \nCV: RRR no m/r/g\nLungs: CTAB no wheezes, rhales, or rhonchi\nAbdomen: soft, nondistended, RLQ tenderness. no \nrebound/guarding\nGU: Foley in place and draining\nExt: warm, well perfused, 2+ pulses, 1+ edema in lower \nextremities. No cyanosis or clubbing. Left ___ - ___ toes with \nresolving ecchymosis\nNeuro: CN II-XII intact, strength ___ in bilateral lower \nextremities, ___ in right upper extremity, ___ in left upper \nextremity secondary to pain with left shoulder movement. \nSensation intact to light touch in bilatearl upper and lower \nextremities.\nSkin: moist, erythematous rash in right inframammary fold with \ndenuded epithelium on inferior right breast. \n\nDISCHARGE: \nVitals: T 98.4 P 60-70s BP 155-160/60s RR 18 O2 sat. 100% on RA\nGeneral: well appearing, AO x 3, NAD\nHEENT: MMM, EOMI\nCV: RRR no m/r/g\nLungs: CTAB no wheezes, rhales, or rhonchi\nAbdomen: soft, nondistended, non-tender to palpation of \nabdomen. BSx4. No rebound/guarding.\nMSK: Significant tenderness to palpation of left lateral hip, \npain with passive movement of left leg, limited ability to \nactively move left leg secondary to pain \nExt: warm, well perfused, 2+ pulses, 1+ edema in lower \nextremities. 1+ edema in bilateral hands. No cyanosis or \nclubbing. Left ___ - ___ toes with resolving ecchymosis\nNeuro: CN II-XII grossly intact. Moves all extremities \nSkin: moist, erythematous rash in right inframammary fold with \ndenuded epithelium on inferior right breast.', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '44329', 'desc': 'Dissection of other artery'}, {'icd_code': '9982', 'desc': 'Accidental puncture or laceration during a procedure, not elsewhere classified'}, {'icd_code': '99672', 'desc': 'Other complications due to other cardiac device, implant, and graft'}, {'icd_code': '9972', 'desc': 'Peripheral vascular complications, not elsewhere classified'}, {'icd_code': '44422', 'desc': 'Arterial embolism and thrombosis of lower extremity'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': '2930', 'desc': 'Delirium due to conditions classified elsewhere'}, {'icd_code': '39891', 'desc': 'Rheumatic heart failure (congestive)'}, {'icd_code': 'E8782', 'desc': 'Surgical operation with anastomosis, bypass, or graft, with natural or artificial tissues used as implant causing abnormal patient reaction, or later complication, without mention of misadventure at time of operation'}, {'icd_code': 'E8790', 'desc': 'Cardiac catheterization as the cause of abnormal reaction of patient, or of later complication, without mention of misadventure at time of procedure'}, {'icd_code': '44021', 'desc': 'Atherosclerosis of native arteries of the extremities with intermittent claudication'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': 'V433'}, {'icd_code': 'V4581', 'desc': 'Aortocoronary bypass status'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': 'V4364'}], 'summary': "ON ADMISSION: \n___ 01:00PM BLOOD WBC-10.9* RBC-3.21* Hgb-10.9* Hct-32.9* \nMCV-103* MCH-34.0* MCHC-33.1 RDW-14.9 RDWSD-56.1* Plt ___\n___ 01:00PM BLOOD Neuts-78.3* Lymphs-14.4* Monos-6.6 \nEos-0.3* Baso-0.2 Im ___ AbsNeut-8.54* AbsLymp-1.57 \nAbsMono-0.72 AbsEos-0.03* AbsBaso-0.02\n___ 05:10AM BLOOD Glucose-116* UreaN-52* Creat-1.4* Na-138 \nK-3.5 Cl-100 HCO3-23 AnGap-19\n___ 04:35PM BLOOD Glucose-137* UreaN-62* Creat-2.2* Na-134 \nK-4.0 Cl-99 HCO3-25 AnGap-14\n\nCT Abdomen & Pelvis W/ Contrast\n1. No acute CT findings to explain the patient's pain.\n2. 2.8 cm right lower pole renal lesion appears unchanged from \n___ may represent a hemorrhagic cyst. This can be \nevaluated with a nonemergent MR as clinically indicated.\n3. Left adrenal adenoma.\n\nCT Head W/O Contrast\n1. No acute intracranial process\n\nCXR\n1. No evidence of pneumothorax after right IJ central venous \ncatheter insertion. \n2. Left basilar opacity may represent atelectasis, pneumonia not \nexcluded in the appropriate clinical setting. \n\nMICROBIOLOGY:\nBCx: pending\nUCx: no growth\n\nON DISCHARGE:\n\n___ 05:08AM BLOOD WBC-7.8 RBC-2.72* Hgb-9.0* Hct-27.8* \nMCV-102* MCH-33.1* MCHC-32.4 RDW-14.9 RDWSD-55.7* Plt ___\n___ 05:08AM BLOOD Glucose-109* UreaN-60* Creat-1.9* Na-136 \nK-4.0 Cl-101 HCO3-25 AnGap-14\n___ 05:08AM BLOOD Calcium-9.6 Phos-4.5 Mg-2.___\n___ y/o female who presents with dCHF w/ pEF, DM, OA who \npresents w/ one week history of intermittent diarrhea/abdominal \npain and recent fall at home.\n\n___ on CKD: Baseline Cr of 1.5-2.0, on admission at baseline w/ \nCr of 1.4. Elevation to 2.2 on ___, with Cr of 1.9 on \ndischarge. Likely post-contrast injury (CT on ___ w/ \ncontrast) w/ decreased PO intake, now trending downward. Lasix \nand lisinopril held on ___ given concern for decreased renal \nperfusion with 500 mL NS bolus given. Lasix resumed on discharge \nat 40 mg qD and home lisinopril of 20 mg qD. Repeat Cr on \n___, to be performed by ___ services\n\n# Concern for PNA: CXR in ED concerning for possible left \nbasilar pneumonia, however, clinical picture was not suggestive \nof an active pneumonia (afebrile, VSS, no change in cough, no \nSOB, mild leukocytosis to 10.0) so pt was not treated with \nantibiotics.\n\n# Abd pain: CT abd/pelvis without clear evidence of cause of \npain. Likely secondary to recent viral gastroenteritis (1 week \nhistory of nausea/diarrhea, now resolved). \n\n#Osteoarthritis: significant pain to palpation of left lateral \nhip (CT abd/pelvis without evidence of fracture in setting of \nrecent falls, 1 prior to admission, another 2 weeks prior to \nadmission). Pain improved with Bengay. Managing conservatively \nwith home pain medications. ___ evaluated and pt ok to return \nhome w/ home ___. \n\n#Anemia: Baseline Hgb of 10.5, today with lower Hgb of 9.0. \nChronic microcytic anemia, likely secondary to anemia of chronic \ndisease/CKD No acute source of blood loss.\n\nChronic Issues: \n\n# HTN: Continue home amlodipine, metoprolol. Discharged on \nlasix at 40 qD \n\n# Hypercholesterolemia: continue home atorvastatin \n \n# Diabetes Mellitus Type 2: diet controlled \n\n# dCHF: TTE ___ with EF > 55%, normal stress test in ___. \nContinue home furosemide at 40 mg qD\n\n#OA: chronic; continue home: salsalate, acetaminophen, oxycodone"}}
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{'final_diagnoses': ['___ on CKD', 'Viral gastroenteritis', 'Osteoarthritis', 'Anemia', 'CKD', 'HTN', 'DM II', 'dCHF'], 'procedures': ['None.'], 'visit_summary': '___ y/o female who presents with dCHF w/ pEF, DM, OA who \npresents w/ one week history of intermittent diarrhea/abdominal \npain and recent fall at home.\n\n___ on CKD: Baseline Cr of 1.5-2.0, on admission at baseline w/ \nCr of 1.4. Elevation to 2.2 on ___, with Cr of 1.9 on \ndischarge. Likely post-contrast injury (CT on ___ w/ \ncontrast) w/ decreased PO intake, now trending downward. Lasix \nand lisinopril held on ___ given concern for decreased renal \nperfusion with 500 mL NS bolus given. Lasix resumed on discharge \nat 40 mg qD and home lisinopril of 20 mg qD. Repeat Cr on \n___, to be performed by ___ services\n\n# Concern for PNA: CXR in ED concerning for possible left \nbasilar pneumonia, however, clinical picture was not suggestive \nof an active pneumonia (afebrile, VSS, no change in cough, no \nSOB, mild leukocytosis to 10.0) so pt was not treated with \nantibiotics.\n\n# Abd pain: CT abd/pelvis without clear evidence of cause of \npain. Likely secondary to recent viral gastroenteritis (1 week \nhistory of nausea/diarrhea, now resolved). \n\n#Osteoarthritis: significant pain to palpation of left lateral \nhip (CT abd/pelvis without evidence of fracture in setting of \nrecent falls, 1 prior to admission, another 2 weeks prior to \nadmission). Pain improved with Bengay. Managing conservatively \nwith home pain medications. ___ evaluated and pt ok to return \nhome w/ home ___. \n\n#Anemia: Baseline Hgb of 10.5, today with lower Hgb of 9.0. \nChronic microcytic anemia, likely secondary to anemia of chronic \ndisease/CKD No acute source of blood loss.\n\nChronic Issues: \n\n# HTN: Continue home amlodipine, metoprolol. Discharged on \nlasix at 40 qD \n\n# Hypercholesterolemia: continue home atorvastatin \n \n# Diabetes Mellitus Type 2: diet controlled \n\n# dCHF: TTE ___ with EF > 55%, normal stress test in ___. \nContinue home furosemide at 40 mg qD\n\n#OA: chronic; continue home: salsalate, acetaminophen, oxycodone', 'medications_prescribed': ['1. Acetaminophen 1000 mg PO Q8H:PRN pain', '2. Allopurinol ___ mg PO DAILY', '3. Amlodipine 10 mg PO DAILY', '4. Aspirin 81 mg PO DAILY', '5. Atorvastatin 80 mg PO QPM', '6. Citalopram 20 mg PO DAILY', '7. Clotrimazole Cream 1 Appl TP BID', '8. Docusate Sodium 100 mg PO BID constipation', '9. Fluticasone Propionate NASAL 1 SPRY NU DAILY', '10. Fluticasone-Salmeterol Diskus (500/50) 1 INH IH BID', '11. Ipratropium Bromide Neb 1 NEB IH QID:PRN wheeze', '12. Isosorbide Mononitrate (Extended Release) 180 mg PO DAILY', '13. Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS', '14. Lidocaine 5% Patch 1 PTCH TD QAM', '15. Lisinopril 20 mg PO DAILY', '16. Metoprolol Tartrate 100 mg PO BID', '17. Multivitamins 1 TAB PO DAILY', '18. OxycoDONE (Immediate Release) 5 mg PO Q6H:PRN severe pain \nnot relieved by Tylenol and salsalate\nRX *oxycodone 5 mg 1 tablet(s) by mouth q6hPRN Disp #*20 Tablet \nRefills:*0', '19. Pantoprazole 40 mg PO Q24H', '20. Salsalate 1000 mg PO TID:PRN pain in addition to Tylenol', '21. Timolol Maleate 0.5% 1 DROP BOTH EYES BID', '22. Vitamin D 400 UNIT PO BID', '23. Albuterol Sulfate (Extended Release) 0.63mg/3mL 1 NEB PO \nQID:PRN SOB or wheezing', '24. Calcium Carbonate 500 mg PO TID:PRN abd pain', '25. Guaifenesin-CODEINE Phosphate ___ mL PO Q6H:PRN cough', '26. Nitroglycerin SL 0.3 mg SL Q5MIN:PRN chest pain', '27. Furosemide 40 mg PO DAILY', '28. Outpatient Lab Work\nBMP ICD-9: 584 \nPlease fax results to Dr. ___ (___)']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'Dyspnea on exertion', 'medical_history': ['- Atrial fibrillation (on coumadin)', '- Hypertension', '- NASH cirrhosis c/b grade ___ varices', '- dCHF', '- Gastritis (h/o recurrent H pylori)', '- h/o colonic adenocarcinoma in situ', '- Gout', '- DMII (diet controlled)', '- Vertigo (approximately ___ years)', '- Arthritis', '- Chronic back pain', '- Venous stasis'], 'family_history': 'Denies family history of colorectal cancer. No family history of \nearly MI, arrhythmia, cardiomyopathies, or sudden cardiac death; \notherwise non-contributory. ', 'present_illness': ' ___ with history of heart failure with preserved ejection \nfraction, atrial fibrillation on Coumadin, cirrhosis, pulmonary \nhypertension and diabetes who presents with dyspnea on exertion \ndespite increasing doses of torsemide in the outpatient setting. \n\n Per outpatient records, patient has been having DOE and weight \ngain (152 lbs to 162 lbs) for approximately 1 month. Torsemide \nwas increased to 60mg BID without significant improvement in \nsymptoms. Repeat TTE was done without significant changes from \nprior. Today, she noted decreased urine output despite taking \nher diuretics, so heart failure team recommended presentation in \nthe ED for further evaluation. Per patient and granddaughter, \nshe cannot identify any precipitating factors such as illness, \ndietary indiscretion or medication non-compliance. \n Patient states that she only has SOB with exertion. She used to \nbe able to walk 60 minutes per day but now can only walk 5 \nminutes without becoming winded. She describe some \nlightheadedness with exertion as well, but no cough, sick \ncontacts, PND or orthopnea. She describes associated \npalpitations. She has had chronic pain in her L arm from a fall, \nbut it is not related to exertion. She has never experienced \nsymptoms like this before. \n In the ED initial vitals were: T97.9, HR 77, BP 136/42, RR 18, \nSpO2 97% RA. Ambulatory O2 sat tested PTA, 97-100% on RA. \n EKG: rate 78, atrial fibrillation, normal axis, QTc 477, RBBB, \nTWI in III, V1-V3, no significant change from prior \n Labs/studies notable for: CBC 10.7, Hgb 10 (baseline), plt 204. \nChem panel with BUN 88, Cr 1.5 (baseline 1.0). Trop 0.03 then \n0.01. BNP 1078 (baseline ~1000). UA with 48 WBC, few bacteria, \nbut 3 epithelial cells. \n CXR showed stable mild cardiomegaly and pulmonary vascular \ncongestion, without evidence of overt edema. Mild bibasilar \natelectasis \n CT Head showed no acute change. \n Patient was given: 1g CTX, 3mg warfarin, 100mg PO gabapentin. \n Discussed with Dr. ___ requested admission to heart \nfailure service. \n Vitals on transfer: T97.8, HR 68, BP 199/55, RR 18, Spo2 99%RA.\n\n On the floor, the patient was resting comfortably in bed and \nable to ambulate without assistance. \n ROS: \n Cardiac review of systems is notable for absence of chest pain, \nparoxysmal nocturnal dyspnea, orthopnea, or syncope. Denies \nexertional buttock or calf pain. \n On further review of systems, denies any prior history of \nstroke, TIA, deep venous thrombosis, pulmonary embolism, \nbleeding at the time of surgery, myalgias, joint pains, cough, \nhemoptysis, black stools or red stools. Denies recent fevers, \nchills or rigors. All of the other review of systems were \nnegative. ', 'medications': [{'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'FoLIC Acid', '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'EPINEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', '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': '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium-Albuterol Inhalation Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H: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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Doxazosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', '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': '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': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H: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': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', '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', 'route': 'PO', 'frequency': 'Q4H: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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': '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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H: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': 'TraMADOL (Ultram)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q4H:PRN', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ONCE', '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': 'irbesartan', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', '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': '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': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': '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': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', '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': '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', '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': 'irbesart', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', '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}]}, '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': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 5.7, '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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'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': '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': '73', 'valuenum': 73.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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 = 47 if non African-American (mL/min/1.73 m2). Estimated GFR = 57 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': 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': '190', 'valuenum': 190.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.7', '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': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42.0', 'valuenum': 42.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '30.6', 'valuenum': 30.6, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', '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': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.69', 'valuenum': 3.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.1', 'valuenum': 7.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.0', 'valuenum': 51.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '62.0', 'valuenum': 62.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '11.0', 'valuenum': 11.0, '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': '48', 'valuenum': 48.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.35', 'valuenum': 7.35, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '302', 'valuenum': 302.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, '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, 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'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, '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': '71', 'valuenum': 71.0, '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': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-3', 'valuenum': -3.0, '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': '1.15', 'valuenum': 1.15, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '132', 'valuenum': 132.0, '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': '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': '95', 'valuenum': 95.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.31', 'valuenum': 7.31, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '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': '37', 'valuenum': 37.0, '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': '61', 'valuenum': 61.0, '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': '14', 'valuenum': 14.0, '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': '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': 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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.7', 'valuenum': 26.7, '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': '30.5', 'valuenum': 30.5, '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': '___', 'valuenum': 91.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.92', 'valuenum': 2.92, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '51.6', 'valuenum': 51.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '13.2', 'valuenum': 13.2, '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': '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': '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': '7.38', 'valuenum': 7.38, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, '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': '57', 'valuenum': 57.0, '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': '29.6', 'valuenum': 29.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, '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': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, '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}, 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'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': '34.1', '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': '103', 'valuenum': 103.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, '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': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '33.5', 'valuenum': 33.5, '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': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '3.07', 'valuenum': 3.07, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.4', 'valuenum': 48.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, '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': 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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.5', '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': '1.4', 'valuenum': 1.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, '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': '9.2', '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.0', 'valuenum': 30.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.9', 'valuenum': 9.9, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', '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': '180', 'valuenum': 180.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.20', 'valuenum': 3.2, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '51.1', 'valuenum': 51.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION EXAM\n===================\nVS: T97.5, BP 126/67, HR 70, RR 18, Spo2 99% RA. Wt = 73.3kg \nstand. \n GENERAL: WDWN elderly female in NAD. Oriented x3. Mood, affect \nappropriate. Lying in bed sleeping comfortably. \n HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. \n NECK: Supple with JVP to mid-way up the neck at a 45 degree \nangle. \n CARDIAC: RR, normal S1, S2. No murmurs/rubs/gallops. No \nthrills, lifts. \n LUNGS: Resp were unlabored, no accessory muscle use. No \ncrackles, wheezes or rhonchi. No CVA tenderness. \n ABDOMEN: Soft, tenderness to palpation in the RUQ, normal bowel \nsounds. \n EXTREMITIES: warm, well-perfused, 1+ spongy, pitting edema to \nthe knees \n NEURO: gait is steady and intact unassisted. \n SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \n PULSES: Distal pulses palpable and symmetric \n\nDISCHARGE EXAM\n====================\nVS: T97.8, 106-139/53-64 57-109 18 99%RA. Wt = 73.3kg stand-> \n73.8kg -> 72.8kg\n___\n GENERAL: WDWN elderly female in NAD. Oriented x3. Mood, affect \nappropriate. Lying in bed sleeping comfortably. \n HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. \n NECK: Supple with JVP 11 cm at 90 degrees. \n CARDIAC: Irregularly irregular, normal S1, S2. No \nmurmurs/rubs/gallops. No thrills, lifts. \n LUNGS: Resp were unlabored, no accessory muscle use. Minimal \ncrackles bilaterally, wheezes or rhonchi. No CVA tenderness. \n ABDOMEN: Soft, tenderness to palpation in the RUQ, normal bowel \nsounds. \n EXTREMITIES: warm, well-perfused, 1+ spongy, pitting edema to \nthe knees \n NEURO: gait is steady and intact unassisted. \n SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \n PULSES: Distal pulses palpable and symmetric ', 'diagnoses': [{'icd_code': 'I350', 'desc': 'Nonrheumatic aortic (valve) stenosis'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'I482', 'desc': 'Chronic atrial fibrillation'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'I9581', 'desc': 'Postprocedural hypotension'}, {'icd_code': 'Z7901', 'desc': 'Long term (current) use of anticoagulants'}, {'icd_code': 'I25119', 'desc': 'Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris'}, {'icd_code': 'Z006', 'desc': 'Encounter for examination for normal comparison and control in clinical research program'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'Z96653', 'desc': 'Presence of artificial knee joint, bilateral'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}, {'icd_code': 'Y832', 'desc': 'Surgical operation with anastomosis, bypass or graft as the cause of abnormal reaction of the patient, or of later complication, without mention of misadventure at the time of the procedure'}], 'summary': "ADMISSION LABS\n====================\n___ 11:15AM proBNP-1076*\n___ 11:15AM UREA N-73* CREAT-1.2* SODIUM-141 \nPOTASSIUM-4.0 CHLORIDE-97 TOTAL CO2-29 ANION GAP-19\n___ 04:45PM URINE BLOOD-NEG NITRITE-NEG PROTEIN-NEG \nGLUCOSE-NEG KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-LG\n___ 04:45PM URINE RBC-0 WBC-48* BACTERIA-FEW YEAST-NONE \nEPI-3 TRANS EPI-<1\n___ 05:35PM ___ PTT-41.3* ___\n___ 05:35PM PLT COUNT-204\n___ 05:35PM NEUTS-74.6* LYMPHS-16.0* MONOS-6.8 EOS-0.3* \nBASOS-0.3 IM ___ AbsNeut-8.02* AbsLymp-1.72 AbsMono-0.73 \nAbsEos-0.03* AbsBaso-0.03\n___ 05:35PM WBC-10.7* RBC-3.51* HGB-10.0* HCT-32.5* \nMCV-93 MCH-28.5 MCHC-30.8* RDW-18.1* RDWSD-60.5*\n___ 05:35PM ALBUMIN-4.0 CALCIUM-9.4 PHOSPHATE-4.0 \nMAGNESIUM-2.7*\n___ 05:35PM proBNP-1078*\n___ 05:35PM cTropnT-0.03*\n___ 05:35PM ALT(SGPT)-27 AST(SGOT)-17 ALK PHOS-131* TOT \nBILI-0.3\n___ 05:35PM GLUCOSE-175* UREA N-88* CREAT-1.5* SODIUM-140 \nPOTASSIUM-4.2 CHLORIDE-99 TOTAL CO2-30 ANION GAP-15\n\nMICROBIOLOGY\n====================\n___ 8:20 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 8:20 pm BLOOD CULTURE\n\n Blood Culture, Routine (Pending): \n__________________________________________________________\n___ 4:45 pm URINE TAKEN FROM 62896M. \n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n PROTEUS MIRABILIS. >100,000 ORGANISMS/ML..\n PRESUMPTIVE IDENTIFICATION. \n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n PROTEUS MIRABILIS\n | \nAMPICILLIN------------ <=2 S\nAMPICILLIN/SULBACTAM-- <=2 S\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nMEROPENEM-------------<=0.25 S\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n\nIMAGES/STUDIES\n=======================\nECG ___:\nAtrial fibrillation, mean ventricular rate 78. Right \nbundle-branch block. \nCannot exclude an inferior myocardial infarction of \nindeterminate age. \nCompared to the previous tracing of ___ there is no \ndiagnostic change. \n\nCXR ___:\nIMPRESSION: \nStable mild cardiomegaly and pulmonary vascular congestion, \nwithout evidence \nof overt edema. \nMild bibasilar atelectasis. \n\nCT Non Con HEAD ___:\nIMPRESSION: \n1. No acute intracranial abnormalities identified. \n2. Atrophy, probable small vessel ischemic changes, and \natherosclerotic \nvascular disease as described. \nPlease note MRI of the brain is more sensitive for the detection \nof acute \ninfarct if there is further clinical concern. \n\nETT ___:\nINTERPRETATION: This is an ___ year old woman here for the \nevaluation \nof chest pain and dyspnea. The patient exercised on a Modified \nGervino \ntreadmill protocol and stopped for fatigue and dyspnea after the \n\ncompletion of 5.75 minutes. The peak estimated metabolic \ncapacity was \n___ METs, a fair functional capacity for age. There were no \nchest, \narm, neck or back discomforts reported throughout the study. \nThere were \nno ischemic ECG changes. The rhythm was atrial fibrillation with \nrare \nPVCs. The blood pressure and heart rate responses to exercise \nwere \nappropriate. \nIMPRESSION: No anginal type symptoms with no ischemic ECG \nchanges to \nthe fair workload achieved. Appropriate hemodynamic response. \n\nETT ___:\nNTERPRETATION: This ___ year old woman with a history of HTN, HL,\nAF and D-CHF was referred to the lab for evaluation of shortness \nof\nbreath and chest discomfort. The patient was infused with 0.142\nmg/kg/min of dipyridamole over 4 minutes. No arm, neck, back or \nchest\ndiscomfort was reported by the patient throughout the study. \nThere were\nno significant ST segment changes during the infusion or in \nrecovery.\nThe rhythm was atrial fibrillation with no vpbs. Appropriate\nhemodynamic response to the infusion and recovery. The \ndipyridamole was\nreversed with 125 mg of aminophylline IV.\nIMPRESSION: No anginal type symptoms or ST segment changes. \nNuclear\nreport sent separately.\n\nCardiac Perfusion ___:\nFINDINGS: \nRest and stress perfusion images reveal uniform tracer uptake \nthroughout the\nleft ventricular myocardium. \nGated images reveal normal wall motion. \nThe calculated left ventricular ejection fraction is 68%\nCompared with prior study of ___ there is no change.\nIMPRESSION: Normal myocardial perfusion. LV ejection fraction \n68%. No change\ncompared to the prior study in ___. \n\nDISCHARGE LABS\n======================\n___ 06:17AM BLOOD WBC-8.7 RBC-3.41* Hgb-9.7* Hct-31.5* \nMCV-92 MCH-28.4 MCHC-30.8* RDW-18.0* RDWSD-60.5* Plt ___\n___ 06:17AM BLOOD Glucose-146* UreaN-62* Creat-1.3* Na-139 \nK-4.1 Cl-101 HCO3-30 AnGap-12\n___ 06:17AM BLOOD Calcium-9.0 Phos-3.5 Mg-2.7* \n___ with HFpEF, pulmonary hypertension, atrial fibrillation, \ncirrhosis and increasing renal mass presenting with worsening \nDOE over the past month despite increases in home diuretics. \n\n # Dyspnea on exertion: Patient with multiple reasons for \ndyspnea on exertion, including heart failure, pulmonary \nhypertension, atrial fibrillation, deconditioning or even angina \nequivalent. Recent TTE showed signs of right ventricular \npressure overload, and in the setting of weight gain (10 lbs), \nlower extremity edema and elevated JVP, this makes heart failure \nexacerbation the most likely culprit. Troponins were 0.02->0.01 \nand therefore difficult to interpret. She is on albuterol \ninhalers, and exertional dyspnea especially taking a few minutes \nto have symptoms, could be consistent with reactive airway \ndisease. However, previous PFTs do not suggest reactive airways \ndisease. Given her age, perhaps aspiration is a possibility. She \nappears to be well-rate controlled in terms of her atrial \nfibrillation, and therefore this is less likely. Patient \nunderwent persantine pharmacologic stress test on ___ which was \nnegative for reversible ischemia or filling defects. Patient was \ndiuresed with 100mg Lasix BID and transitioned to torsemide 60mg \nBID PO. Overall, patient felt somewhat improved, however her \nsymptoms did not completely resolve. Patient should continue to \nhave an outpatient work up for non-cardiac dyspnea on exertion.\n\n # Heart failure with preserved ejection fraction: Weight is up \nto 162 lbs from 152lbs in ___. This does represent an \nincrease, but not an increase over a short period of time per \nse. However, she has elevated JVP and 1+ pitting/spongy edema in \nher lower extremities and crackles bilaterally. No clear \nprecipitating factor, although she does have Proteus >100,000 \ncolonies during this hospitalization, albeit without symptoms. \nContinued lisinopril and metoprolol. Patient was diuresed with \n100mg Lasix BID and transitioned to torsemide 60mg BID PO \nregimen.\n\n # Acute kidney injury: Patient's ___ (Cr 1.7 from normal \nbaseline) likely from cardiorenal state, given that Creatinine \nimproved to baseline after diuresis. Patient had a Cr elevation \nto 1.3 after 100mg IV Lasix BID, likely from overdiuresis. \n\n # Urinary tract infection: Patient with pyruia and bacteriuria \nand growing Proteus > 100,000 sensitive to CTX. Patient treated \nwith CTX for 3 days. Blood cultures remained negative. \n\n # Atrial fibrillation: Patient rate controlled with diltiazem \nand metoprolol. Warfarin was continued. Goal INR ___. \n\n # NASH Cirrhosis: Patient followed by Dr. ___ in hepatology. \nWell-compensated. No current medical therapy. LFTs within normal \nlimits. Alk Phos elevated 131, however has been elevated since \n___. \n\n # Renal mass: Followed by Urology with active surveillance with \ninterval imaging every ___ months. \n\n # Diabetes: Diet controlled. Glucose with AM labs: 150-300 \nwhile hospitalized. A1c was 6.9% in ___. "}}
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{'final_diagnoses': ['Dyspnea on exertion', 'HTN', 'HLD', 'DM', 'Atrial fibrillation (on coumadin)', 'NASH cirrhosis c/b grade ___ varices', 'Heart failure with preserved ejection fraction (~___%)'], 'procedures': ['None'], 'visit_summary': "___ with HFpEF, pulmonary hypertension, atrial fibrillation, \ncirrhosis and increasing renal mass presenting with worsening \nDOE over the past month despite increases in home diuretics. \n\n # Dyspnea on exertion: Patient with multiple reasons for \ndyspnea on exertion, including heart failure, pulmonary \nhypertension, atrial fibrillation, deconditioning or even angina \nequivalent. Recent TTE showed signs of right ventricular \npressure overload, and in the setting of weight gain (10 lbs), \nlower extremity edema and elevated JVP, this makes heart failure \nexacerbation the most likely culprit. Troponins were 0.02->0.01 \nand therefore difficult to interpret. She is on albuterol \ninhalers, and exertional dyspnea especially taking a few minutes \nto have symptoms, could be consistent with reactive airway \ndisease. However, previous PFTs do not suggest reactive airways \ndisease. Given her age, perhaps aspiration is a possibility. She \nappears to be well-rate controlled in terms of her atrial \nfibrillation, and therefore this is less likely. Patient \nunderwent persantine pharmacologic stress test on ___ which was \nnegative for reversible ischemia or filling defects. Patient was \ndiuresed with 100mg Lasix BID and transitioned to torsemide 60mg \nBID PO. Overall, patient felt somewhat improved, however her \nsymptoms did not completely resolve. Patient should continue to \nhave an outpatient work up for non-cardiac dyspnea on exertion.\n\n # Heart failure with preserved ejection fraction: Weight is up \nto 162 lbs from 152lbs in ___. This does represent an \nincrease, but not an increase over a short period of time per \nse. However, she has elevated JVP and 1+ pitting/spongy edema in \nher lower extremities and crackles bilaterally. No clear \nprecipitating factor, although she does have Proteus >100,000 \ncolonies during this hospitalization, albeit without symptoms. \nContinued lisinopril and metoprolol. Patient was diuresed with \n100mg Lasix BID and transitioned to torsemide 60mg BID PO \nregimen.\n\n # Acute kidney injury: Patient's ___ (Cr 1.7 from normal \nbaseline) likely from cardiorenal state, given that Creatinine \nimproved to baseline after diuresis. Patient had a Cr elevation \nto 1.3 after 100mg IV Lasix BID, likely from overdiuresis. \n\n # Urinary tract infection: Patient with pyruia and bacteriuria \nand growing Proteus > 100,000 sensitive to CTX. Patient treated \nwith CTX for 3 days. Blood cultures remained negative. \n\n # Atrial fibrillation: Patient rate controlled with diltiazem \nand metoprolol. Warfarin was continued. Goal INR ___. \n\n # NASH Cirrhosis: Patient followed by Dr. ___ in hepatology. \nWell-compensated. No current medical therapy. LFTs within normal \nlimits. Alk Phos elevated 131, however has been elevated since \n___. \n\n # Renal mass: Followed by Urology with active surveillance with \ninterval imaging every ___ months. \n\n # Diabetes: Diet controlled. Glucose with AM labs: 150-300 \nwhile hospitalized. A1c was 6.9% in ___. ", 'medications_prescribed': ['1. Acetaminophen ___ mg PO Q6H:PRN arthritis', '2. Albuterol Inhaler 2 PUFF IH Q2H:PRN dyspnea, wheeze', '3. Allopurinol ___ mg PO DAILY', '4. Atorvastatin 5 mg PO QPM', '5. Cetirizine 10 mg PO DAILY:PRN itching', '6. Diltiazem Extended-Release 180 mg PO DAILY', '7. Ferrous Sulfate 325 mg PO DAILY', '8. Fluticasone Propionate 110mcg 2 PUFF IH BID', '9. Fluticasone Propionate NASAL 1 SPRY NU DAILY', '10. Gabapentin 100-200 mg PO TID', '11. Lidocaine 5% Ointment 1 Appl TP BID', '12. Lisinopril 20 mg PO DAILY', '13. Meclizine 25 mg PO Q12H:PRN nausea', '14. Pantoprazole 40 mg PO BID:PRN GERD', '15. Senna 17.2 mg PO BID', '16. TraMADol 50 mg PO Q8H:PRN pain', '17. Vitamin D 1000 UNIT PO DAILY', '18. econazole 1 % topical BID feet', '19. Nitroglycerin SL 0.4 mg SL ASDIR', '20. Ondansetron 4 mg PO Q8H:PRN nausea', '21. Metoprolol Succinate XL 100 mg PO DAILY', '22. Torsemide 60 mg PO BID', '23. Warfarin 3 mg PO DAILY16']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'Left lower lobe nodule', 'medical_history': ['Obesity', 'Fhx of thyroid cancer', 'CAD', 'Hyperlipidemia', 'OSA as per sleep study done ___: Pt was seen by Dr. \n___ with OSA that is mild to moderate in severity', 'ID-DM', 'Ankle edema', 'Hypertensive heart disease without heart failure'], 'family_history': 'Mother - ___ disease, died at age ___\nFather - MI, died at age ___\nSiblings - Sister has a history of thyroid cancer', 'present_illness': '___ with COPD and a LLL lung nodule that has grown in a 3 month \nspan 1.2 x 1.6 cm previously 0.9 x 1.5 cm. Previously \nwe had planned on a vats wedge, possible lobectomy but she \ndeclined due to concern regarding her pulmonary function. She \ncan only walk 6 steps before catching her breath and gets SOA \nwith walking from the lobby to the exam room and with chores at \nhome. Her breathing has gotten worse over the past ___ year. She \nnotes that she gained about 100 lbs over the past ___ years and \nfeels that this is contributing as well.\n\nShe is extremely deconditioned and gets short of breath after \nonly 6 or so steps. Because of this progressive dyspnea, she \ndid not want to proceed with an anatomic resection due to the \npotential impact on her well being.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Fleet Enema', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 1%/Epinephrine 1:100000', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.9', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.9', 'valuenum': 36.9, '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': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.1', 'valuenum': 33.1, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '161', 'valuenum': 161.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '44.5', 'valuenum': 44.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '-Admission-\nGENERAL: In no acute distress, pleasant.\nVITAL SIGNS: Blood pressure 130/62, pulse 61.\nNECK: No jugular venous distention, no carotid bruits.\nLUNGS: Clear to auscultation.\nHEART: Regular rhythm, normal S1, S2, no murmur or gallop.\nSKIN: Punctate lesions across the low back on both sides with\nminimal erythema. There is also a small patch on the left arm\nnear the axilla and a small patch on her right arm as well.\nEXTREMITIES: No edema or cyanosis.\n\n-Discharge-\nVS: 97.9, 61, 127/42, 18, 95%\nGen: well-appearing, NAD, AOx3\nCV: RRR\nPulm: no resp distress, CTAB. Lap sites dressed with Dermabond - \nc/d/___. ___ drain removal site dressed - c/d/i\nAbd: obese, soft, NT/ND\nExt: wwp', 'diagnoses': [{'icd_code': '75162', 'desc': 'Congenital cystic disease of liver'}], 'summary': '___ 08:52AM BLOOD WBC-11.3*# RBC-3.55* Hgb-11.0* Hct-31.5* \nMCV-89 MCH-30.9 MCHC-34.8 RDW-13.1 Plt ___\n___ 08:52AM BLOOD Calcium-8.7 Phos-3.5 Mg-1.5*\n\nCXR ___ (post-op)\nStatus post VATS with left chest tube placement and small left \napical pneumothorax\n\nCXR ___\nSmall left pneumothorax is less conspicuous than before. \nRetrocardiac opacities have improved. Vascular congestion has \nresolved. No other interval change from prior study.\n\nCXR ___ ___ removal)\nThere is a questionable tiny left apical pneumothorax. \nCardiomediastinal contours are unchanged. Increasing opacities \nin the left lower chest are a combination of postoperative \nchanges and atelectasis. There are no other interval changes\nMs. ___ is a ___ with suspicious LLL nodules. She presented \non ___ and taken to the OR to undergo a VATS left lower \nwedge resection and mediastinal lymph node dissection. The \nprocedure was uncomplicated and ___ drain was placed at the \nend of the case. Post-op CXR showed expected changes and a small \napical left pneumothorax. After an uneventful PACU course, the \npatient was admitted to the surgical floor for standard post-op \ncare.\n\nShe was given a regular diet and home medications were resumed. \nPOD1 CXR showed improvement of the small pneumothorax, and the \n___ drain was removed. Post-pull CXR was stable. Pain was \nwell-controlled on oral analgesics. She tolerated a regular \ndiet, ambulated independently, and voided without difficulty. \nElectrolytes were repleted. She was discharged home on ___ \nand instructed to follow up in Thoracic Surgery clinic in ___ \nweeks.'}}
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{'final_diagnoses': ['Lung nodule'], 'procedures': ['___: VATS left lower lobe wedge resection and mediastinal \nlymph node dissection.'], 'visit_summary': 'Ms. ___ is a ___ with suspicious LLL nodules. She presented \non ___ and taken to the OR to undergo a VATS left lower \nwedge resection and mediastinal lymph node dissection. The \nprocedure was uncomplicated and ___ drain was placed at the \nend of the case. Post-op CXR showed expected changes and a small \napical left pneumothorax. After an uneventful PACU course, the \npatient was admitted to the surgical floor for standard post-op \ncare.\n\nShe was given a regular diet and home medications were resumed. \nPOD1 CXR showed improvement of the small pneumothorax, and the \n___ drain was removed. Post-pull CXR was stable. Pain was \nwell-controlled on oral analgesics. She tolerated a regular \ndiet, ambulated independently, and voided without difficulty. \nElectrolytes were repleted. She was discharged home on ___ \nand instructed to follow up in Thoracic Surgery clinic in ___ \nweeks.', 'medications_prescribed': ['Acetaminophen 650 mg PO Q6H', 'Amlodipine 10 mg PO DAILY', 'Glargine 40 Units Bedtime\nInsulin SC Sliding Scale using novolog Insulin', 'Lisinopril 40 mg PO DAILY', 'Pioglitazone 30 mg PO DAILY', 'Simvastatin 20 mg PO QPM', 'Timolol Maleate 0.5% 1 DROP BOTH EYES BID', 'Aspirin 81 mg PO DAILY', 'Docusate Sodium 100 mg PO BID \nHold for loose stools. \nRX *docusate sodium 100 mg 1 tablet(s) by mouth twice daily. \nDisp #*30 Tablet Refills:*0', 'OxycoDONE (Immediate Release) ___ mg PO Q4H:PRN pain \nDo not drive or consume alcohol while on this medication. \nRX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours Disp \n#*30 Tablet Refills:*0', 'Senna 8.6 mg PO BID:PRN constipation \nHold for loose stools. \nRX *sennosides [senna] 8.6 mg 1 tablet by mouth twice daily Disp \n#*20 Tablet Refills:*0']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 87, 'gender': 'F', 'symptoms': 'Headache and paresthesias.', 'medical_history': ['- DM2 on Lantus -- Dx at ___, saw Dr. ___ at ___ but not \nsince ___ ', '- HTN ', '- HLD ', '- ___ L caudate/IC CVA with R slurred speech, R weakness, \nand recurrent sxs in ___ admission at ___ ', '- Per ___ notes -- h/o arrythmia (unspecified) and electrical \nablation ___, no CAD '], 'family_history': ' Grandfather with stroke at the age of ___. Parents are both \nalive and well; son is healthy. No other history of MI, HTN, \nDMII, or stroke. ', 'present_illness': "___ yo M with h/o DM2 recently stopped Lantus, HTN recently \nstopped lisinopril, and L caudate/internal capsule CVA in \n___ and recurrence in ___ with facial and L hand \nnumbness, dizziness associated with nausea. Sbp noted to be 220 \nwhen EMS arrived, normal blood sugar per report. Taken to ED \nwhere vitals noted to be 209/98 p71 14 97%RA, and BP's ranged \n162-198/85-109 thereafter. CT head non contrast had evidence of \nprior CVA but was negative for acute process. In the ED he \nreceived 8mg IV Morphine, Zofran 4mg, Labetalol 10 mg IV. He had \nvomiting and developed a headache in the ED. Neuro evaluated him \nand essentially felt that a TIA could not be ruled out but most \nlikely due to malignant HTN. \n. \nHe was transiently on the medical floor where he received 10mg \nof IV hydralazine for SBP~180 and was transferred to the MICU \nfor further mgt given ongoing sxs attributed to HTN emergency. \nIn the MICU, his sxs resolved fairly rapidly and he was started \non lisinopril 5mg daily with reasonably good control. Neurology \nrequested an MRI/MRA which was preliminarily read as: minimal \nchronic changes and nothing acute. \n. \nOn transfer to the floor on ___, he had no complaints. Denied \nHA and vision changes. Denied any cocaine use or use of any \nother illicits. Noted that he was on lisinopril (dose unknown) \nuntil his endocrinologist at ___ recently told him to \nstop--reveiwing his ___ records, there is no documentation of \nthis. The patient's neurological status remained intact while \non the floor.", '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': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', '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': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', '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': 'Pletal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': 'Amlodipine', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '1.5', 'valuenum': 1.5, '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 1.5,. Estimated GFR = 33 if non African-American (mL/min/1.73 m2). Estimated GFR = 40 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': 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': '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. DISCARD GREATER THAN 4 HOURS OLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.0', 'valuenum': 16.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24.2', 'valuenum': 24.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '72.7', 'valuenum': 72.7, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '387', 'valuenum': 387.0, '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': '4.79', 'valuenum': 4.79, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, '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': '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': '20.9', 'valuenum': 20.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '32.0', 'valuenum': 32.0, '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': '25.4', 'valuenum': 25.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '347', 'valuenum': 347.0, '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': '4.11', 'valuenum': 4.11, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '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': '143', 'valuenum': 143.0, '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': '39', 'valuenum': 39.0, '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': '409', 'valuenum': 409.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '346', 'valuenum': 346.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 'Straw', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', 'valuenum': 32.0, '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': 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': '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': '327', 'valuenum': 327.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '155', 'valuenum': 155.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': 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': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '142', 'valuenum': 142.0, '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': '32.2', 'valuenum': 32.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '78', 'valuenum': 78.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '333', 'valuenum': 333.0, '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': '4.12', 'valuenum': 4.12, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.2', 'valuenum': 6.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 120.0, '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': '86.8', 'valuenum': 86.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96.4', 'valuenum': 96.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '13.6', 'valuenum': 13.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 113.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.0', 'valuenum': 24.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '15.4', 'valuenum': 15.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.46', 'valuenum': 4.46, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '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': '9.4', 'valuenum': 9.4, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': "Admission:\n\n98.2 79 165/74 15 96%RA \nLethargic but arousable gentleman in no distress, conversant but \nwith slow speech that is not slurred. Answers correctly. \nOriented to ___, ___. \nCTAB no w/c/r/r \nRRR no m/g noted, 2+ radials palpable \nAbd soft, overweight, NT ND, benign \nNo BLE edema, cyanosis; warm without chronic venous stasis \nchanges \nNegative Kernig's and Brudzinski's \nCN ___ intact except slight loss of R nasolabial fold variably \nnoted with changes in position, otherwise no gross defect. BUE \nabduction ___, RUE triceps slightly weaker than LUE, BUE biceps \n___, BUE wrist flexion and extension ___. BLE hip \nflexion/extension ___, knee flexion/extension ___, ankle \nflex/extension ___. Sensation grossly intact throughout. Finger \ntapping bilaterally is intact but slow; finger-nose-finger also \nslow but intact. \nSkin without worrisome lesion \n\nDischarge:\n98.2 79 165/74 15 96%RA \nAAOX3, nad \nCTAB no w/c/r/r \nRRR no m/g/r noted, 2+ radials palpable \nAbd soft, overweight, NT ND, benign \nNo BLE edema, cyanosis; warm without chronic venous stasis \nchanges \nCN ___ grossly intact, no focal deficits\nBUE abduction ___, RUE triceps slightly weaker than LUE, BUE \nbiceps ___, BUE wrist flexion and extension ___. BLE hip \nflexion/extension ___, knee flexion/extension ___, ankle \nflex/extension ___. \nSensation grossly intact throughout.\nSkin dry, clear, good turgor\nOriented, friendly, appropriate", 'diagnoses': [{'icd_code': '44023', 'desc': 'Atherosclerosis of native arteries of the extremities with ulceration'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '4260', 'desc': 'Atrioventricular block, complete'}, {'icd_code': '4404', 'desc': 'Chronic total occlusion of artery of the extremities'}, {'icd_code': 'V4501', 'desc': 'Cardiac pacemaker in situ'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '70714', 'desc': 'Ulcer of heel and midfoot'}], 'summary': 'Admission:\n\n___ 03:43PM BLOOD WBC-12.3* RBC-5.89 Hgb-15.3 Hct-44.2 \nMCV-75* MCH-25.9* MCHC-34.6 RDW-13.8 Plt ___\n\n___ 03:50PM BLOOD ___ PTT-19.5* ___\n___ 03:43PM BLOOD UreaN-15 Creat-0.8 Na-141 K-4.8 Cl-101 \nHCO3-21* AnGap-24*\n___ 03:47PM BLOOD Glucose-259* Lactate-2.1* Na-142 K-4.3 \nCl-101 calHCO3-26\n___ 03:43PM ASA-NEG ETHANOL-NEG ACETMNPHN-NEG \nbnzodzpn-NEG barbitrt-NEG tricyclic-NEG\n\n___\nCT HEAD W/O CONTRAST\nFINDINGS: \n \nThere is no evidence of acute intracranial hemorrhage, mass \neffect, or shift of normally midline structures. There is no \ncerebral edema or loss of gray-white matter differentiation to \nsuggest an acute ischemic event. The sulci and ventricles are \nprominent, likely age-related involutional changes. Focal \nhypodensities involving left basal ganglia (2:11, 12) likely \nrepresent remote lacunar infarcts, prominent perivascular spaces \nor sequelae of prior hemorrhage. \n \nVisualized osseous structures and soft tissues are unremarkable. \nNo acute \nfracture is seen. Mild mucosal thickening of the ethmoid air \ncells are noted. Remainder of paranasal sinuses appear well \naerated. The mastoid air cells are underpneumatized, which may \nbe congenital or sequela of prior infections. \n \nIMPRESSION: \n \nNo evidence of acute intracranial process. \n\n___\nMR HEAD W/O CONTRAST; MRA BRAIN W/O CONTRAST\nFINDINGS: \n \nMRA BRAIN: \n \nScattered foci of cerebral white matter FLAIR hyperintensities \nwith confluent periventricular signal changes suggesting small \nvessel ischemic changes are demonstrated. There is a small old \ninfarct in the left posterior limb of internal capsule, putamen \nand medial thalamus. The images demonstrate a faint rim of \nartifact in the left posterior limb of internal capsule \nsuggesting possible hemorrhagic transformation. There is no mass \neffect. The major vascular flow voids are present. Mild mucosal \nthickening is seen in the ethmoid air cells. Both orbits are \nunremarkable. \n \nMRA HEAD: \n \nThe anterior circulation demonstrate normal flow-related \nenhancement without evidence of stenosis, aneurysm or vascular \nmalformation. There is a likely stenosis in the left proximal \nand distal posterior cerebral artery. \n \nIMPRESSION: \nSmall old infarct in the left posterior limb of internal capsule \nand putamen an old lacune in the medial left thalamus. No \nevidence of an acute \ninfarction. MRA brain demonstrates probable stenosis in the left \nproximal and distal posterior cerebral artery. \n\nDischarge:\n___ 07:00AM BLOOD WBC-8.1 RBC-5.29 Hgb-13.6* Hct-40.3 \nMCV-76* MCH-25.7* MCHC-33.8 RDW-13.4 Plt ___\n___ 07:00AM BLOOD Glucose-215* UreaN-11 Creat-0.8 Na-140 \nK-4.3 Cl-103 HCO3-26 AnGap-15\n___ 04:02AM BLOOD Triglyc-114 HDL-54 CHOL/HD-4.5 \nLDLcalc-165*\n___ M with PMHx sig poorly controlled DMII, HTN, and prior CVA \npresented with parasthesias, headache, thought to be due to \nhypertensive emergency.'}}
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{'final_diagnoses': ['Hypertensive Emergency.', 'Non-insulin-dependent diabetes', 'Hypertension', 'Hyperlipidemia'], 'procedures': ['None.'], 'visit_summary': '___ M with PMHx sig poorly controlled DMII, HTN, and prior CVA \npresented with parasthesias, headache, thought to be due to \nhypertensive emergency.', 'medications_prescribed': ['1. aspirin 325 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). ', '2. lisinopril 10 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).\nDisp:*30 Tablet(s)* Refills:*2*', '3. Lantus Solostar 100 unit/mL (3 mL) Insulin Pen Sig: Twenty \nSix (26) units Subcutaneous twice a day.\nDisp:*60 pens* Refills:*2*']}
|
Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 75, 'gender': 'M', 'symptoms': '"I was planning to go to the beach, drink a bottle of whiskey, \nand put a gun in my mouth"', 'medical_history': ['PSYCHIATRIC HISTORY:\nDx/Sxs- None\nHospitalizations- None\nSA/SIB- None\nPsychiatrist- None\nTherapist- Briefly saw a therapist ___ s/p testicular injury.\nMedication Trials- None', 'PAST MEDICAL HISTORY:\nh/o Testicular injury ___ hockey accident s/p L orchiectomy, now\nw/ chronic pain requiring nerve blocks ___', 'h/o Concussions ___ hockey', 'Denies seizures.', 'PCP: ___', 'ALLERGIES:\ntoradol (hives)\ncompazine (dystonia)'], 'family_history': 'Aunt w/ ETOH addiction, ?depression. No suicides.', 'present_illness': 'The patient is a ___ y/o ___ with unknown psychiatric hx who \np/w CP and later endorses SI w/ plan to shoot himself. Reports \nSI since his girlfriend\'s suicide by OD in ___ he \ndescribes seeing that she was upset that morning, asking if he \nshould stay home with her and making plans to spend a nice \nevening together after work, then returning home to find her \ndead in their bed. He reports feeling unable to cry more than \none time about her death and has been focused on taking care of \nher belongings and arranging her affairs. When this process \nconcluded, he began to think more about suicide. He took a leave \nof absence from work 2.5 weeks ago. He talked to a friend in \n___ about getting himself a gun and embarked on a 4 day trip \nfrom ___ to ___ with a plan to kill himself at his \nfavorite place on the beach in ___. Reports having written \nletters to each of his children, who are in ___ with their \nmother/his ex-wife. In reference to his plan to kill himself, he \nstates, "I wasn\'t even afraid...I was at peace with it." \nHowever, when he awoke on the bus outside of ___, he was \nexperiencing intense chest, jaw and neck pain,\n"lots of anxiety," and vomited up all food/drink he consumed. He \ngot off the bus and took a cab to ___ to seek medical \nattention. At first, he did not tell the medical team about his \nSI, but he reports that he "started thinking about the kids" and \nhow he "loves those kids so much." He decided to get help for \ntheir sake.\n The patient reports that thinking has been "like a fog" \nrecently and has been "consumed with getting enough money to buy \na gun." Endorses feeling "pissed at" his girlfriend for "leaving \n[him] alone" and also guilty about not being able to prevent her \ndeath. Endorses poor sleep secondary to fear of nightmares about \nhis girlfriend\'s suicide, low energy, anhedonia (usually enjoys \ngoing to the gym and playing golf, but has not been \nparticipating in either in recent months), and weight loss \n(15lbs/3 weeks). Reports difficulty swallowing and abdominal \npain w/ eating (as well as\n___ dark stools in recent weeks), necessitating cutting his food \ninto tiny pieces. \n On psychiatric review of systems, pt endorses anxiety about \ncurrent situation but denies current or past h/o grandiosity, \nimpulsivity, decreased need for sleep, increased goal directed \nbehavior, AVH, ideas of reference, thought \nbroadcasting/insertion, paranoia, panic attacks.', 'medications': [{'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ropinirole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QAM', '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': 'LeVETiracetam', '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': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Atenolol', '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': 'Atorvastatin', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Carbidopa-Levodopa (25-100)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}]}, 'clinical_findings': {'labs': [{'value': '27.7', 'valuenum': 27.7, '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': '24.0', 'valuenum': 24.0, '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': '76', 'valuenum': 76.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '18.0', 'valuenum': 18.0, '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': 6.2, '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', '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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', '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': '19', 'valuenum': 19.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.6, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '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': '9.0', 'valuenum': 9.0, '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': '2.5', 'valuenum': 2.5, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, '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': 'ROUTINE', 'comments': None}, {'value': '69', 'valuenum': 69.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', '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': '6.1', 'valuenum': 6.1, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'ug/dL', 'ref_range_lower': 4.6, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 72.0, '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': '78', 'valuenum': 78.0, 'valueuom': 'ng/dL', 'ref_range_lower': 80.0, 'ref_range_upper': 200.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '75', 'valuenum': 75.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '78.5', 'valuenum': 78.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': '17.9', 'valuenum': 17.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '6.0', 'valuenum': 6.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAMINATION:\nVS: BP: 130/62 HR: 60 temp: 98.4 resp: 16 O2 sat: 100%RA \nweight: 150lb\n \nMENTAL STATUS EXAM:\n--appearance: fair grooming with good eye contact\n--behavior/attitude: cooperative; exhibited no PMR, PMA\n--speech: normal rate, volume and prosody\n--mood (in patient\'s words): "anxious and overwhelmed" \n--affect: full; appropriate to context\n--thought content: no evidence of paranoia or delusions \n--thought process: logical, linear and goal directed\n--perception: denies AVH\n--SI/HI: significant for SI with plan, denies HI\n--insight: fair\n--judgment: fair\n \nCOGNITIVE EXAM:\n--orientation: alert to person, place, time, situation\n--attention/concentration: able to spell WORLD forwards and\nbackwards\n--memory: registration ___, recall ___\n--calculations: 2x3 -4 = 2\n--language: grossly intact\n--fund of knowledge: average \n--proverbs: provided accurate interpretations of "cry over spilt\nmilk" (means "there\'s nothing you can do about it").\n--similarities/analogies: lemons and bananas both grow on trees\n\nPE:\nGeneral: Well-nourished, in no distress.\nHEENT: Normocephalic. PERRL, EOMI. Oropharynx clear.\nNeck: Supple, trachea midline. No adenopathy or thyromegaly.\nLungs: Clear to auscultation; no crackles or wheezes.\nCV: Regular rate and rhythm; no murmurs/rubs/gallops\nAbdomen: Tender to palpation in epigastric area and on R side\nExtremities: No clubbing, cyanosis, or edema.\nSkin: Warm and dry, no rash or significant lesions.\nNeurological:\n *Cranial Nerves-\n I: Not tested\n II: Pupils equally round and reactive to light\nbilaterally. \n III, IV, VI: Extraocular movements intact bilaterally\nwithout nystagmus.\n V, VII: Facial strength and sensation intact and \nsymmetric.\n VIII: Hearing intact to voice.\n IX, X: Palatal elevation symmetrical.\n XI: Sternocleidomastoid and trapezius normal bilaterally.\n XII: Tongue midline without fasciculations.\n *Motor- Normal bulk and tone bilaterally. No abnormal\nmovements, tremors. Strength full power ___ throughout. No\npronator drift.', 'diagnoses': [{'icd_code': '43411', 'desc': 'Cerebral embolism with cerebral infarction'}, {'icd_code': '34292', 'desc': 'Hemiplegia, unspecified, affecting nondominant side'}, {'icd_code': '1629', 'desc': 'Malignant neoplasm of bronchus and lung, unspecified'}, {'icd_code': '1985', 'desc': 'Secondary malignant neoplasm of bone and bone marrow'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '3320', 'desc': 'Paralysis agitans'}, {'icd_code': 'V153'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': '7843', 'desc': 'Aphasia'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}], 'summary': "___:\nCBC: WBC 6.9 Hb 13.6 Hct 39.4 Plt 405\nBMP: Na 140 K 3.9 Cl 104 HCO3 22 BUN 9 Creat 0.8 Glu 116\nINR 1.2\nTrop <0.01 x 3\nTSH 0.25\nD-dimer 168\nSerum tox negative\nUrine tox pos for benzodiazepines and opiates (pt reports he\nrecently had a nerve block done and received Percocet and valium\nassociated with the procedure).\nLegal: ___\nMedical: For the patient's history of chest pain in the ED, \ncardiology was consulted. Labs in the ED showed two negative \ntroponins with EKG of sinus rhythm with 2-2.5 mm ST segment \nelevation in leads II, III, aVF and V6. There was no\nreciprocal ST segment depression noted. This tracing was \nsimilar to previous EKG in the ER on ___ with slightly more \nST elevation. Portable TTE was done and showed normal \nbiventricular cavity sizes with preserved global and regional \nbiventricular systolic function and no pericardial \neffusion.Cardiology felt that this was more likely to be \npericarditis vs ACS. Due to the chest discomfort and abnormal \nEKG, stress test was not done at that time. \nFor the patient's symptoms of abdominal pain and difficulty \nswallowing, GI consult was placed while inpatient who first \nrecommended CT scan with contrast to evaluate which noted a \n?bezoar-like structure in the stomach. He was additionally \nstarted on Protonix 40 mg po daily. They then ecommended upper \nGI system with EGD with showed gastritis with normal pathology \nspecimens. GI also recommended gastric emptying study for \nfurther evaluation, but the patient refused two attempts at \ncompleting this study. For complaints of abdominal pain, he was \nmanaged on Tylenol with Zofran prn nausea. Despite his \ncomplaints of difficulty swallowing, he was continued on a \nregular diet and was able to slowing increase his food \nconsumption without any history of vomiting etc. \n\nPsychiatric: Upon admission, the patient denied any additional \npsych history, medications, or admissions. He initally did not \nallow the team to contact any collateral from family members, \nfriends, or providers that could provide a substantial amount of \ninformation or help. Two weeks into his hospital stay, he \ncontinued to endorse depression with SI thoughts daily, thinking \nof ways to kill himself when he leaves the hospital, and at this \ntime ECT was initiated to acutely treat depression and SI. \n In terms of medication management, he was initally started on \nCelexa that was increased to 40 mg po daily with Doxepin 150 mg \npo qhs for additional augmentation due to the severity of his \ndepression symptoms. For his anxiety he was cautiously given \nvalium and encouraged to improve coping skills through group \ntherapy and assisted family work (via ___ team). He did not have \nany effect from Seroquel prn or Hydroxzyzine prn anxiety, but \ndid feel some anxiety relief from Clonidine 0.2 mg po tid, which \nwas ultimately transitioned to transdermal form. He was \nalsostarted on Seroquel which was subsequently increased to \n500mg/d po augmentation of his antidepressant regimen and \npossible disorganization secondary to depression. Lithium was \nlater added to treat irritability and SI. His Lithium level was \nmaintained at .8. Prolixin 5 mg BID was given to help with \nimpulse control. All medications were tolerated well, and Mr. \n___ reported that they seemed to help; they were thus \ncontinued at discharge, and the patient was discharged with \nmedications in-hand.\n Over the course of this stay, Mr. ___ also completed a \ncourse of ECT. Mood and SI gradually improved, and at the time \nof discharge he consistently reported that his mood was stable \nand that he did not have SI. Mr. ___ has many significant \nlife stressors, including isolation from family and guilt about \nabandoning his children, that continue to make sustained \neuthymia difficult despite ECT and aggressive psychopharmacology \nto attempt to reduce SI. He was encouraged to begin the process \nof repairing the distance between himself and his family, and he \nbegan to attempt contact with his ex-wife while inpatient, with \nthe aid of SW and MD teams.\n We discussed outpatient safety planning extensively, \nincluding options for intensive outpatient treatment programs in \nthe ___ area, which the treatment team recommended. \nUltimately, Mr. ___ decided to return to ___ because he \nthought that being geographically close to his family would be \nmore sustaining in the long run than having outpatient treaters \nin ___. The treatment team at ___ was unable to establish \nnew outpatient care in the ___ area, but the patient \nwas given information for a shelter and for a ___ clinic \nonce he arrives. A bus pass to ___ was also provided to \nthe patient, and he reported that his mood was stable enough to \nstay safe over the 4-day bus trip (this is consistent with his \nstable mood over the last several days of hospitalization). He \nagrees to contact emergency services in the event of severe \ndepression or SI returning, and he is given Dr. ___ \n___ attending) contact information should such an \nemergency arise while he is still in the ___ area."}}
|
{'final_diagnoses': ['Axis I - MDD', 'Axis II -Borderline and Antisocial traits.', 'Axis III -GI pain, and hx of Testicular injury and orchidectomy.', 'Axis IV -Multiple, home based, medical, psych', 'Axis V -39-40'], 'procedures': ['EGD: gastritis', 'refused Gastric Emptying study'], 'visit_summary': "Legal: ___\nMedical: For the patient's history of chest pain in the ED, \ncardiology was consulted. Labs in the ED showed two negative \ntroponins with EKG of sinus rhythm with 2-2.5 mm ST segment \nelevation in leads II, III, aVF and V6. There was no\nreciprocal ST segment depression noted. This tracing was \nsimilar to previous EKG in the ER on ___ with slightly more \nST elevation. Portable TTE was done and showed normal \nbiventricular cavity sizes with preserved global and regional \nbiventricular systolic function and no pericardial \neffusion.Cardiology felt that this was more likely to be \npericarditis vs ACS. Due to the chest discomfort and abnormal \nEKG, stress test was not done at that time. \nFor the patient's symptoms of abdominal pain and difficulty \nswallowing, GI consult was placed while inpatient who first \nrecommended CT scan with contrast to evaluate which noted a \n?bezoar-like structure in the stomach. He was additionally \nstarted on Protonix 40 mg po daily. They then ecommended upper \nGI system with EGD with showed gastritis with normal pathology \nspecimens. GI also recommended gastric emptying study for \nfurther evaluation, but the patient refused two attempts at \ncompleting this study. For complaints of abdominal pain, he was \nmanaged on Tylenol with Zofran prn nausea. Despite his \ncomplaints of difficulty swallowing, he was continued on a \nregular diet and was able to slowing increase his food \nconsumption without any history of vomiting etc. \n\nPsychiatric: Upon admission, the patient denied any additional \npsych history, medications, or admissions. He initally did not \nallow the team to contact any collateral from family members, \nfriends, or providers that could provide a substantial amount of \ninformation or help. Two weeks into his hospital stay, he \ncontinued to endorse depression with SI thoughts daily, thinking \nof ways to kill himself when he leaves the hospital, and at this \ntime ECT was initiated to acutely treat depression and SI. \n In terms of medication management, he was initally started on \nCelexa that was increased to 40 mg po daily with Doxepin 150 mg \npo qhs for additional augmentation due to the severity of his \ndepression symptoms. For his anxiety he was cautiously given \nvalium and encouraged to improve coping skills through group \ntherapy and assisted family work (via ___ team). He did not have \nany effect from Seroquel prn or Hydroxzyzine prn anxiety, but \ndid feel some anxiety relief from Clonidine 0.2 mg po tid, which \nwas ultimately transitioned to transdermal form. He was \nalsostarted on Seroquel which was subsequently increased to \n500mg/d po augmentation of his antidepressant regimen and \npossible disorganization secondary to depression. Lithium was \nlater added to treat irritability and SI. His Lithium level was \nmaintained at .8. Prolixin 5 mg BID was given to help with \nimpulse control. All medications were tolerated well, and Mr. \n___ reported that they seemed to help; they were thus \ncontinued at discharge, and the patient was discharged with \nmedications in-hand.\n Over the course of this stay, Mr. ___ also completed a \ncourse of ECT. Mood and SI gradually improved, and at the time \nof discharge he consistently reported that his mood was stable \nand that he did not have SI. Mr. ___ has many significant \nlife stressors, including isolation from family and guilt about \nabandoning his children, that continue to make sustained \neuthymia difficult despite ECT and aggressive psychopharmacology \nto attempt to reduce SI. He was encouraged to begin the process \nof repairing the distance between himself and his family, and he \nbegan to attempt contact with his ex-wife while inpatient, with \nthe aid of SW and MD teams.\n We discussed outpatient safety planning extensively, \nincluding options for intensive outpatient treatment programs in \nthe ___ area, which the treatment team recommended. \nUltimately, Mr. ___ decided to return to ___ because he \nthought that being geographically close to his family would be \nmore sustaining in the long run than having outpatient treaters \nin ___. The treatment team at ___ was unable to establish \nnew outpatient care in the ___ area, but the patient \nwas given information for a shelter and for a ___ clinic \nonce he arrives. A bus pass to ___ was also provided to \nthe patient, and he reported that his mood was stable enough to \nstay safe over the 4-day bus trip (this is consistent with his \nstable mood over the last several days of hospitalization). He \nagrees to contact emergency services in the event of severe \ndepression or SI returning, and he is given Dr. ___ \n___ attending) contact information should such an \nemergency arise while he is still in the ___ area.", 'medications_prescribed': ['1. pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO DAILY (Daily).\nDisp:*30 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', '2. citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '3. quetiapine 200 mg Tablet Sig: Two (2) Tablet PO HS (at \nbedtime).', '4. quetiapine 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '5. lithium carbonate 300 mg Capsule Sig: One (1) Capsule PO QAM \n(once a day (in the morning)).', '6. lithium carbonate 300 mg Capsule Sig: Two (2) Capsule PO QHS \n(once a day (at bedtime)).', '7. clonidine 0.2 mg/24 hr Patch Weekly Sig: One (1) Patch Weekly \nTransdermal QWED (every ___.', '8. doxepin 25 mg Capsule Sig: Six (6) Capsule PO HS (at \nbedtime).', '9. fluphenazine HCl 2.5 mg Tablet Sig: Two (2) Tablet PO BID (2 \ntimes a day): Take for one week and then stop.\nDisp:*28 Tablet(s)* Refills:*0*', '10. benztropine 1 mg Tablet Sig: One (1) Tablet PO HS (at \nbedtime).', '11. benztropine 1 mg Tablet Sig: One (1) Tablet PO once a day as \nneeded for muscle stiffness.\nDisp:*30 Tablet(s)* Refills:*0*', '12. diazepam 5 mg Tablet Sig: One (1) Tablet PO Q6H (every 6 \nhours) as needed for anxiety.\nDisp:*120 Tablet(s)* Refills:*0*', '13. quetiapine 25 mg Tablet Sig: One (1) Tablet PO QID (4 times \na day) as needed for anxiety.\nDisp:*120 Tablet(s)* Refills:*0*', '14. diphenhydramine HCl 25 mg Capsule Sig: Two (2) Capsule PO HS \n(at bedtime) as needed for insomnia.\nDisp:*60 Capsule(s)* Refills:*0*']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 81, 'gender': 'M', 'symptoms': 'Abnormal liver function tests (direct admission from transplant \noffice)', 'medical_history': ['EtOH cirrhosis s/p liver transplant ___ c/b \ngastrorrhaphy s/p ex lap, omental patch, washout, drain \nplacement, j-tube placement ', 'Hiatal hernia s/p repair', 'Morbid obesity s/p gastric bypass', 'Depression and anxiety'], 'family_history': '- Mother (living) with HTN and COPD.\n- Father (deceased) with brain aneurysm.\n- Diabetes in ___, cousins and aunts.', 'present_illness': 'Ms. ___ is a ___ year old woman with a past medical history\nof alcohol cirrhosis s/p liver transplant ___, alcohol use\ndisorder, morbid obesity s/p gastric bypass, depression, and\nanxiety who presents from home with abnormal liver function\ntests.\n\nThe patient reports the last six months have been very difficult\nfor her. She reports domestic partner violence in ___. Since that time, she has been homeless - moving into rehabs,\n___, ___. She is drinking five drinks per day\nsince that time. She reports compliance with her\nimmunosuppressive medications. \n\nShe drove into the hospital for direct admission today with her\ndaughter after the transplant office requested that she come in.\nShe presents intoxicated. She was verbally abusive to staff and \na\ncode purple was called. The nurse spoke with the patient and\ncalmed her down.\n\nShe does not have headache, chest pain, dyspnea, fatigue. She \nhas\njoint pains. No fevers, chills.', 'medications': [{'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'X1', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Allopurinol', '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': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H: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': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', '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': 'Metoprolol XL (Toprol 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', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'BuPROPion (Sustained Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '31.6', 'valuenum': 31.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.4', 'valuenum': 29.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, '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': '366', 'valuenum': 366.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, '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}, {'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': '27.4', 'valuenum': 27.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '4.0', 'valuenum': 4.0, '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': '123', 'valuenum': 123.0, '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': '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': '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': '139', 'valuenum': 139.0, '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': 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': 'SM .'}, {'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': 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': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.015', 'valuenum': 1.015, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Cloudy.'}, {'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': '582', 'valuenum': 582.0, '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': 'MANY.'}, {'value': 'NONE', 'valuenum': None, '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': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '387', 'valuenum': 387.0, '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': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, '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': '8.7', 'valuenum': 8.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, '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': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '73', 'valuenum': 73.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'POSITIVE RARE EOS.'}, {'value': '54', 'valuenum': 54.0, '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': '387', 'valuenum': 387.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, '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': '33.1', 'valuenum': 33.1, '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': '287', 'valuenum': 287.0, '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': '3.26', 'valuenum': 3.26, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n=======================\nVITALS: T 98.0 BP 146/94 HR 100 RR 18 SaO2 96 RA \nGENERAL: NAD, ___ woman, wearing home clothes, she \nhas several tattoos \nHEENT: AT/NC, anicteric sclera, MMM, poor dentition, she appears\nintoxicated \nNECK: supple, no LAD, no JVD \nCV: RRR, S1/S2, no murmurs, gallops, or rubs \nPULM: CTAB, no wheezes, rales, rhonchi, breathing comfortably \nwithout use of accessory muscles \nGI: abdomen soft, large surgical scar, nondistended, nontender \nin all quadrants, no rebound/guarding, no hepatosplenomegaly \nEXTREMITIES: bilateral trace ___ edema at ankles R > L; right \nknee\nmild effusion, mild increased laxity with Lachmans, no overlying \n\ncellulitis \nPULSES: 2+ radial pulses bilaterally \nNEURO: Alert, moving all 4 extremities with purpose, face \nsymmetric\n\nDISCHARGE PHYSICAL EXAM\n=======================\nGEN: appears well, comfortable, sleeping\nHEENT: sclerae anicteric\nCV: RRR, normal s1/s2, no murmurs\nPulm: clear to auscultation bilaterally\nGI: soft, nontender, nondistended\nEXT: warm, well perfused', 'diagnoses': [{'icd_code': '44024', 'desc': 'Atherosclerosis of native arteries of the extremities with gangrene'}, {'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'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': 'V4975', 'desc': 'Below knee amputation status'}, {'icd_code': 'V441'}, {'icd_code': '60000', 'desc': 'Hypertrophy (benign) of prostate without urinary obstruction and other lower urinary tract symptom (LUTS)'}, {'icd_code': 'V641'}], 'summary': '___ 09:10PM BLOOD WBC-6.9 RBC-3.28* Hgb-11.6 Hct-34.8 \nMCV-106* MCH-35.4* MCHC-33.3 RDW-17.3* RDWSD-68.3* Plt ___\n___ 09:10PM BLOOD Neuts-33.6* ___ Monos-11.7 \nEos-2.0 Baso-0.6 Im ___ AbsNeut-2.30 AbsLymp-3.57 \nAbsMono-0.80 AbsEos-0.14 AbsBaso-0.04\n___ 09:10PM BLOOD ___ PTT-26.3 ___\n___ 09:10PM BLOOD Glucose-78 UreaN-13 Creat-0.9 Na-139 \nK-3.8 Cl-103 HCO3-20* AnGap-16\n___ 09:10PM BLOOD ALT-55* AST-123* LD(LDH)-199 AlkPhos-98 \nTotBili-0.5\n___ 09:10PM BLOOD Albumin-3.6 Calcium-8.3* Phos-2.7 Mg-1.9\n___ 09:10PM BLOOD ASA-NEG ___ Acetmnp-NEG \nTricycl-NEG\n\nPERTINENT LABS\n==============\n___ 05:35AM BLOOD tacroFK-4.1*\n___ 04:37AM BLOOD tacroFK-4.0*\n___ 04:58AM BLOOD tacroFK-4.2*\n___ 05:13AM BLOOD tacroFK-4.1*\n\nDISCHARGE LABS\n==============\n___ 05:13AM BLOOD WBC-4.7 RBC-3.20* Hgb-11.4 Hct-34.7 \nMCV-108* MCH-35.6* MCHC-32.9 RDW-16.5* RDWSD-66.4* Plt ___\n___ 05:13AM BLOOD ___ PTT-27.2 ___\n___ 05:13AM BLOOD Glucose-90 UreaN-16 Creat-1.0 Na-139 \nK-4.4 Cl-103 HCO3-27 AnGap-9*\n___ 05:13AM BLOOD ALT-43* AST-90* AlkPhos-82 TotBili-0.4\n___ 05:13AM BLOOD Calcium-8.7 Phos-3.3 Mg-1.7\nMs. ___ is a ___ year old woman with a past medical history \nof alcohol cirrhosis s/p liver transplant ___, alcohol use \ndisorder, morbid obesity s/p gastric bypass, depression, and \nanxiety who presents from home with abnormal liver function \ntests in the setting on ongoing alcohol use and questionable \nadherence with her immunosuppresion. \n\nACUTE/ACTIVE ISSUES:\n====================\n# Transaminitis:\n# Alcoholic cirrhosis s/p liver transplant ___. AST>ALT 2:1 in \nsetting of heavy alcohol use with serum alcohol 246 on \nadmission. Reporting compliance with immunosuppressive regimen \nbut multiple psychosocial triggers including homelessness may be \ncompromising immunosuppression and also had previously reported \nto the outpatient transplant team that she was not taking her \nimmunosuppressive medications. Notably with similar hospital \npresentation in ___, though at that time reporting less \nalcohol intake. RUQUS with patent vasculature. Given her poor \ncompliance with follow-up she did not undergo liver biopsy as \nshe would not be a good candidate for steroid therapy. LFTs \nimproved throughout admission but were not completely normalized \nby the time she was discharged. She was continued on her daily \ntacrolimus and mycophenolate. Her tacrolimus level on the day of \ndischarge was 4.1.\n\n# Alcohol use disorder\n# Acute alcohol intoxication\nPresented with six months of daily drinking in the setting of \nacute stressor. Patient reported no history of withdrawal \nsymptoms, no prior seizures or hallucinations. She was placed on \nCIWA but not require any benzos she was not scoring. She was \nseen by social work and addiction psychiatry was provided with \nresources to help her engage in outpatient substance use \ntreatment, however she was ambivalent about stopping her alcohol \nuse at this time. She was given thiamine, folate, and \nmultivitamin.\n\n#Borderline low B12, may be contributing to depression. \nMethylmalonic Acid was sent was pending at the time of \ndischarge. She was started on oral B12 supplementation.\n\n#Thrombocytopenia\n#Leukopenia\nPlatelets in 120s, had been in 200s, likely secondary to bone \nmarrow suppression in setting of alcohol abuse, alongside \nleukopenia to 3.9.\n\n#Cocaine abuse. Notably on serum tox screen. ___ also be \ncontributing to liver injury from an ischemic insult. \n\n#Housing insecurity. Social work was consulted to provide her \nwith resources needed to obtain housing. Pt. is aware of the \nprocess for obtaining housing and was encouraged to seek housing \nassistance when she is discharged in order to begin the process \nshe appeared ready to so do. \n\n# Depression\nPatient developed significant depression after a domestic \nviolence incident she reports in ___. She has been \ndrinking daily since that time. Patient reports she has not been\ntaking paroxetine as an outpatient. TSH normal, B12 borderline \nlow. She was seen by psychiatry who recommended resuming her \nhome paroxetine and gabapentin.\n\nTRANSITIONAL ISSUES\n=======================\n[] Patient is working on getting her ___ reinstated in \norder to receive medications. She received a 1 month supply of \nmedications prior to leaving the hospital but if her insurance \nis not restated by the time her medications run out she will \nneed to come to the ___ care pharmacy for medications. \nShe was told to reach out to the liver team when she needs a \nrefill on her medications to help coordinate this.\n[] Home fluoxetine and gabapentin were restarted.\n[] Continue to encourage engagement for treatment and her \nalcohol use disorder.\n[] Patient should have repeat LFTs 1 week after discharge.\n[] Methylmalonic Acid pending at the time of discharge. \n[] Consider alternative pharmacotherapy for depression. She \ndeclined to discuss this with the inpatient psychiatry team \nthough has failed celexa, Prozac and reportedly Wellbutrin in \nthe past'}}
|
{'final_diagnoses': ['Transaminitis', 'Alcoholic liver cirrhosis status post liver transplant', 'Alcohol use disorder', 'Alcohol intoxication', 'Vitamin B12 deficiency', 'Thrombocytopenia', 'Leukopenia', 'Substance use disorder', 'Housing insecurity', 'Depression'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ year old woman with a past medical history \nof alcohol cirrhosis s/p liver transplant ___, alcohol use \ndisorder, morbid obesity s/p gastric bypass, depression, and \nanxiety who presents from home with abnormal liver function \ntests in the setting on ongoing alcohol use and questionable \nadherence with her immunosuppresion. \n\nACUTE/ACTIVE ISSUES:\n====================\n# Transaminitis:\n# Alcoholic cirrhosis s/p liver transplant ___. AST>ALT 2:1 in \nsetting of heavy alcohol use with serum alcohol 246 on \nadmission. Reporting compliance with immunosuppressive regimen \nbut multiple psychosocial triggers including homelessness may be \ncompromising immunosuppression and also had previously reported \nto the outpatient transplant team that she was not taking her \nimmunosuppressive medications. Notably with similar hospital \npresentation in ___, though at that time reporting less \nalcohol intake. RUQUS with patent vasculature. Given her poor \ncompliance with follow-up she did not undergo liver biopsy as \nshe would not be a good candidate for steroid therapy. LFTs \nimproved throughout admission but were not completely normalized \nby the time she was discharged. She was continued on her daily \ntacrolimus and mycophenolate. Her tacrolimus level on the day of \ndischarge was 4.1.\n\n# Alcohol use disorder\n# Acute alcohol intoxication\nPresented with six months of daily drinking in the setting of \nacute stressor. Patient reported no history of withdrawal \nsymptoms, no prior seizures or hallucinations. She was placed on \nCIWA but not require any benzos she was not scoring. She was \nseen by social work and addiction psychiatry was provided with \nresources to help her engage in outpatient substance use \ntreatment, however she was ambivalent about stopping her alcohol \nuse at this time. She was given thiamine, folate, and \nmultivitamin.\n\n#Borderline low B12, may be contributing to depression. \nMethylmalonic Acid was sent was pending at the time of \ndischarge. She was started on oral B12 supplementation.\n\n#Thrombocytopenia\n#Leukopenia\nPlatelets in 120s, had been in 200s, likely secondary to bone \nmarrow suppression in setting of alcohol abuse, alongside \nleukopenia to 3.9.\n\n#Cocaine abuse. Notably on serum tox screen. ___ also be \ncontributing to liver injury from an ischemic insult. \n\n#Housing insecurity. Social work was consulted to provide her \nwith resources needed to obtain housing. Pt. is aware of the \nprocess for obtaining housing and was encouraged to seek housing \nassistance when she is discharged in order to begin the process \nshe appeared ready to so do. \n\n# Depression\nPatient developed significant depression after a domestic \nviolence incident she reports in ___. She has been \ndrinking daily since that time. Patient reports she has not been\ntaking paroxetine as an outpatient. TSH normal, B12 borderline \nlow. She was seen by psychiatry who recommended resuming her \nhome paroxetine and gabapentin.\n\nTRANSITIONAL ISSUES\n=======================\n[] Patient is working on getting her ___ reinstated in \norder to receive medications. She received a 1 month supply of \nmedications prior to leaving the hospital but if her insurance \nis not restated by the time her medications run out she will \nneed to come to the ___ care pharmacy for medications. \nShe was told to reach out to the liver team when she needs a \nrefill on her medications to help coordinate this.\n[] Home fluoxetine and gabapentin were restarted.\n[] Continue to encourage engagement for treatment and her \nalcohol use disorder.\n[] Patient should have repeat LFTs 1 week after discharge.\n[] Methylmalonic Acid pending at the time of discharge. \n[] Consider alternative pharmacotherapy for depression. She \ndeclined to discuss this with the inpatient psychiatry team \nthough has failed celexa, Prozac and reportedly Wellbutrin in \nthe past', 'medications_prescribed': ['Cyanocobalamin 250 mcg PO DAILY \nRX *cyanocobalamin (vitamin B-12) 1,000 mcg 1 tablet(s) by mouth \nonce a day Disp #*30 Tablet Refills:*0 ', 'FoLIC Acid 1 mg PO DAILY \nRX *folic acid 1 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*0 ', 'Multivitamins 1 TAB PO DAILY \nRX *multivitamin 1 tab-cap by mouth once a day Disp #*30 \nCapsule Refills:*0 ', 'Thiamine 100 mg PO DAILY \nRX *thiamine HCl (vitamin B1) 100 mg 1 tablet(s) by mouth once a \nday Disp #*30 Tablet Refills:*0 ', 'Gabapentin 300 mg PO BID \nRX *gabapentin 300 mg 1 capsule(s) by mouth twice a day Disp \n#*60 Capsule Refills:*0 ', 'Mycophenolate Mofetil 500 mg PO BID \nRX *mycophenolate mofetil 500 mg 1 tablet(s) by mouth twice a \nday Disp #*60 Tablet Refills:*0 ', 'PARoxetine 20 mg PO DAILY \nRX *paroxetine HCl 20 mg 1 tablet(s) by mouth once a day Disp \n#*30 Tablet Refills:*0 ', 'Tacrolimus 2 mg PO Q12H \nRX *tacrolimus 1 mg 2 capsule(s) by mouth twice a day Disp #*120 \nCapsule Refills:*0 ', 'Outpatient Lab Work\nLiver function tests\n___.4 \nPlease fax results to ___ ___ ']}
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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': 'diarrhea', 'medical_history': ['Gout.', 'Chronic thrombocytopenia.', 'Coronary artery disease.', 'Hypertension.', 'Hyperlipidemia.', 'Last colonoscopy in ___ was normal.', 'Pancreatic cancer'], 'family_history': '1. Mother with ___ disease.\n2. Father with pancreatic cancer.\n3. Brother with esophageal cancer.', 'present_illness': "___ M with metastatic pancreatic ca on chemo\n(FOLFIRNOX) presenting with n/v/d.\n\nPt reports having diarrhea since his last\ntreatment on ___. In addition, he reports nausea, vomiting and\nminimal po intake. He mentions that he has been having 2 B M\neveryday which is very soft and watery, no abdominal pain\nreported. He does not feel dizzy after BM or have blood in his\nstools. \n\n He mentions that he feels nauseaous when he tries to eat food.\nVomiting occurs very rarely and none in the last ___ days.\nBecause of the nausea, pt has not been able to eat like before.\nHe denies more than 3 episodes of diarrhea per day. Usually he\nhas diarrhea right after he eats something. He has not checked\nhis stools to see if it floats in the bowl or not. He also \ndenies\nseeing oily residue around the stool but he isn't sure.", 'medications': [{'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': 'Allopurinol', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H: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': 'Metoprolol Tartrate', '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': 'Dextran 40 in NaCl', 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': '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': '35.5', 'valuenum': 35.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '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': '31.2', 'valuenum': 31.2, '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': '32.5', 'valuenum': 32.5, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '162', 'valuenum': 162.0, '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': '3.36', 'valuenum': 3.36, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '135', 'valuenum': 135.0, '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}], 'exams': 'Gen: Sitting in bed in NAD\nVitals: Afebrile and vital signs stable (reviewed in POE) \nHEENT: Anicteric, eyes conjugate, MMM, no JVD\nCardiovascular: RRR no MRG, nl. S1 and S2\nPulmonary: Lung fields clear to auscultation throughout\nGastroinestinal: Soft, non-tender, non-distended, bowel sounds\npresent, no HSM\nMSK: No edema\nSkin: No rashes or ulcerations evident\nNeurological: Alert, interactive, speech fluent, face symmetric,\nmoving all extremities\nPsychiatric: pleasant, appropriate affect', 'diagnoses': [{'icd_code': '43310', 'desc': 'Occlusion and stenosis of carotid artery without mention of cerebral infarction'}, {'icd_code': '41400', 'desc': 'Coronary atherosclerosis of unspecified type of vessel, native or graft'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}], 'summary': "___ 11:45AM BLOOD WBC-6.9# RBC-3.14* Hgb-9.7* Hct-28.6* \nMCV-91 MCH-30.9 MCHC-33.9 RDW-14.7 RDWSD-48.4* Plt Ct-73*\n___ 11:45AM BLOOD Glucose-101* UreaN-12 Creat-1.0 Na-126* \nK-3.1* Cl-91* HCO3-19* AnGap-19\n\nDISCHARGE LABS\n___ 06:04AM BLOOD WBC-14.7* RBC-2.84* Hgb-8.7* Hct-26.8* \nMCV-94 MCH-30.6 MCHC-32.5 RDW-15.3 RDWSD-51.8* Plt ___\n___ 11:45AM BLOOD Neuts-58 Bands-9* Lymphs-16* Monos-13 \nEos-0 Baso-0 ___ Metas-1* Myelos-3* AbsNeut-4.62 \nAbsLymp-1.10* AbsMono-0.90* AbsEos-0.00* AbsBaso-0.00*\n___ 06:04AM BLOOD Glucose-96 UreaN-8 Creat-0.9 Na-136 K-3.7 \nCl-103 HCO3-22 AnGap-___\niarrhea-- Low suspicion for C.Diff as pt only reported a few \nBM's per day and they were relatively low volume. SSx of having \na loose diarrhea right after meals was felt to be consistent \nwith pancreatic insufficiency. Spoke with patient's OP \noncologist Dr. ___ felt that his diarrhea was more \nchronic and did not warrant w/u for infectious causes. He was \nstarted on creon which improved his symptoms.\n\n# Hypoosmolar Hyponatremia-- ___ presented with Na: 126. This \nwas felt to be most likely hypovolemic hyponatremia given poor \nPO intake over last few days. Improved to 130's s/p fluid \nresuscitation\n\n# Normocytic Anemia/thrombocytopenia--Hb down to 8's-9's from \nbaseline in ___. Felt to be ___ chemo as no e/o bleeding.\n\n# Gout- continued allopurinol\n\n# HTN- Held Amlodipine and lisinopril considering possible \nvolume depletion. resumed post-discharge.\n\nBILLING: greater than 30 minutes spent on discharge coordination \nand counseling."}}
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{'final_diagnoses': ['Noninfectious diarrhea', 'Hyponatremia'], 'procedures': ['none'], 'visit_summary': "iarrhea-- Low suspicion for C.Diff as pt only reported a few \nBM's per day and they were relatively low volume. SSx of having \na loose diarrhea right after meals was felt to be consistent \nwith pancreatic insufficiency. Spoke with patient's OP \noncologist Dr. ___ felt that his diarrhea was more \nchronic and did not warrant w/u for infectious causes. He was \nstarted on creon which improved his symptoms.\n\n# Hypoosmolar Hyponatremia-- ___ presented with Na: 126. This \nwas felt to be most likely hypovolemic hyponatremia given poor \nPO intake over last few days. Improved to 130's s/p fluid \nresuscitation\n\n# Normocytic Anemia/thrombocytopenia--Hb down to 8's-9's from \nbaseline in ___. Felt to be ___ chemo as no e/o bleeding.\n\n# Gout- continued allopurinol\n\n# HTN- Held Amlodipine and lisinopril considering possible \nvolume depletion. resumed post-discharge.\n\nBILLING: greater than 30 minutes spent on discharge coordination \nand counseling.", 'medications_prescribed': ['Creon 12 1 CAP PO TID W/MEALS \nRX *lipase-protease-amylase [Creon] 12,000 unit-38,000 \nunit-60,000 unit 1 capsule(s) by mouth three times per day with \nmeals Disp #*90 Capsule Refills:*0', 'Allopurinol ___ mg PO DAILY', 'amLODIPine 2.5 mg PO DAILY', 'Ascorbic Acid ___ mg PO DAILY', 'biotin 2,500 mcg oral DAILY', 'clotrimazole 10 mg mucous membrane 5 X daily', 'Cyanocobalamin 1000 mcg PO DAILY', 'Dexamethasone 4 mg PO DAILY', 'DiphenhydrAMINE ___ mg PO QHS:PRN insomnia', 'Docusate Sodium 100 mg PO BID', 'Fluticasone Propionate NASAL 1 SPRY NU BID', 'ketotifen fumarate (bulk) 0.025% both eyes Q12H', 'Lisinopril 5 mg PO DAILY', 'LOPERamide 2 mg PO QID:PRN diarrhea', 'LORazepam 0.5 mg PO Q8H:PRN nausea', 'Multivitamins 1 TAB PO DAILY', 'Nystatin Oral Suspension 5 mL PO QID:PRN thrush', 'Ondansetron 8 mg PO Q8H:PRN nausea', 'Pegfilgrastim (Onpro) 6 mg SC ONCE', 'Pravastatin 20 mg PO QPM', 'Prochlorperazine 10 mg PO Q6H:PRN nausea', 'Vitamin D 4000 UNIT PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 81, 'gender': 'F', 'symptoms': 'Falls', 'medical_history': ['1. Actinic keratoses', "2. Bowen's disease", '3. Basal and squamous cell carcinomas', '4. Mild cognitive impairment', '5. Diverticular bleeds', '6. Falls', '7. Depression', '8. Atrial fibrillation - not anticoagulated', '9. Hypothyroidism', '10. Type 2 diabetes', '11. Hypertension', '12. Diastolic dysfunction', '13. Anemia', '14. Pneumonia - ___', '15. Lymphocytic colitis', '16. Peripheral neuropathy', '17. Bilateral rotator cuff injury - Right greater than left.', '18. Coronary artery disease status post LAD stenting x2', '___. C. difficile - ___', '20. Prostate cancer - s/p external beam ___ ago', '21. Right hamstring tear - ___', '22. S/P bilateral TKR and THR'], 'family_history': 'Father with bipolar and committed suicide.', 'present_illness': "___ male with multiple medical \nproblems, who presents s/p mechanical fall. He recently moved to \n___ from ___ to be closer to his daughter. He lives \nw/ wife at the ___ apartment. Pt walks with rolling \nwalker and believes he tripped in the bathroom. Pt denies chest \npain, palpitiation, lightheadedness, LOC. There were no \nwitnesses or report of seizure activity / loss of control of \nbowel or bladder at the time. In addition, no fevers, chills, \nHA, visual changes, abdominal pain, orthopnea, PND, swelling.\n.\nOf significance patient has feels out of it lately. He admits to \nalso falling one week ago, that time he can't remember whether \nor not he was dizzy or simply lost his balance. He fell again 3 \ndays before that.\n.\nOn this past fall he hit his head / shoulder, but otherwise does \nnot have any pain. He has a small laceration on the top of his \nhead.\n.\nHe has a nurse check up on him twice per week. He starting \nseeing physical therapy last week for shoulder physical therapy. \nPt recently evaluated at ___ for rotator cuff problems.\n.\nHe also recently was complaining of worsening depression, and \nhis sertraline was increased from 100mg to 150mg. He has had a \ngood appetite and recent weight loss.\n.\nHe has difficutly controlling his bowel movements at baseline - \nno recent change.\n.\nED course: He presented with vital signs: 98, 82, 162/92, 22, \n97% ra. He had his Cspine cleared. Initial labs showed \nhyperglycemia and hyponatremia Na 126. CXR and UA unremarkable. \nHe was admitted for further workup.", 'medications': [{'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': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', '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': '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 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': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ferrous Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Simvastatin', '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': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'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': '32.9', 'valuenum': 32.9, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, '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': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.39', 'valuenum': 3.39, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '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': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.8', 'valuenum': 14.8, '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': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, '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': '205', 'valuenum': 205.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.41', 'valuenum': 3.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.9', 'valuenum': 6.9, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', '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': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': "PHYSICAL EXAM~\nVs- 97.1 130/80 80 18 98%ra\nGen- Elderly male lying in bed, gauze on crown of head, \npleasant, interactive, NAD\nHeent- Normocephalic, traumatic laceration on top of head, EOMI, \nPERRL, OP clear, anicteric, no hemotympanum, dry MM.\nNeck- supple, no Cspine tenderness, no LAD\nCor- Irreg irreg, soft I/VI HSM, no S3.\nChest- Clear anteriorlly\nAbd- Soft, nt, nd, pos bs, no organomegaly.\nExt- no c/c/e.\nNeuro- AAO x 3, CN intact, no pronator drift, ___ strength UE, \n4+/5 in ___. Decreased light touch sensation in ___, R foot in \nparticular decreased pin point.\nSkin- Multiple AK's over head and SebK's over chest. Echymotic \ndorsum of hands\nMsk- Scars from TKR and THR.", 'diagnoses': [{'icd_code': '5780', 'desc': 'Hematemesis'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '2948', 'desc': 'Other persistent mental disorders due to conditions classified elsewhere'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '2851', 'desc': 'Acute posthemorrhagic anemia'}], 'summary': "ADMISSION LABS\n___ 10:00PM BLOOD WBC-10.3 RBC-4.01* Hgb-12.6* Hct-38.0* \nMCV-95 MCH-31.4 MCHC-33.1 RDW-14.5 Plt ___\n___ 10:00PM BLOOD Neuts-89.3* Lymphs-6.3* Monos-4.1 Eos-0.2 \nBaso-0.1\n___ 10:00PM BLOOD Plt ___\n___ 10:00PM BLOOD Glucose-254* UreaN-25* Creat-1.1 Na-126* \nK-4.6 Cl-91* HCO3-24 AnGap-16\n___ 10:00PM BLOOD TSH-0.96\n___ 10:00AM BLOOD %HbA1c-7.3*\n___ 10:00AM BLOOD VitB12-508\n___ 10:00PM BLOOD T4-7.7 T3-84\n___ 10:00PM BLOOD T4-7.7 T3-84\nRADIOLOGY Final Report\n.\nCT HEAD W/O CONTRAST ___ 9:30 ___\n.\nFINDINGS: There is no acute intracranial hemorrhage, shift of \nnormally midline structures, hydrocephalus, or major vascular \nterritorial infarction. Several low-attenuation areas in the \nperiventricular and subcortical white matter are consistent in \nappearance with chronic small vessel disease. The density values \nof the brain parenchyma are otherwise maintained. Heavy \ncalcification of the cavernous portions of the carotid arteries \nand the vertebral arteries bilaterally is noted. The visualized \nportions of the paranasal sinuses and mastoid air cells appear \nwell aerated. The patient is status post bilateral scleral \nbuckling procedures.\n.\nGround-glass appearing bony material is noted to protrude into \nthe right maxillary sinus (2:2). Evaluation of the maxilla \ndemonstrates expansion of the bone is this area (3:1). \nComparision with the concurrent c-spine CT reveals an expansile \nmixed lytic/sclerotic lesion with central cystic focus centered \nwithin the maxillary alveolus.\n.\nIMPRESSION:\n1. No acute intracranial hemorrhage.\n2. Incidentally noted expansile lesion in the right maxillary \nalveolus, representing calcifying odontogenic cystic process (or \none of its variants) or, less likely, fibrous dysplasia.\nRADIOLOGY Final Report\n.\nCT C-SPINE W/O CONTRAST ___ 9:31 ___\nFINDINGS: There is no prevertebral soft tissue swelling. There \nis compensatory hyperlordosis of the cervical spine, with no \nacute alignment abnormality or fracture. There is multilevel \ndegenerative disease with atlanto-dental osteophytes and \nextensive facet hypertrophy bilaterally. Additionally, there is \npartial fusion of the vertebral bodies at the C3-4 level. The \nvisualized outline of the thecal sac is unremarkable and no \ncanal stenosis is present. Calcification and soft tissue \nthickening is noted at the right lung apex and appears chronic, \nlikely related to old granulomatous disease.\nIMPRESSION:\n1. No acute fracture or alignment abnormality.\n2. Multilevel degenerative change, without canal stenosis.\n3. Incidental expansile cystic lesion emanating from the right \nmaxillary alveolus (___): calcifying odontogenic cyst or, less \nlikely, fibrous dysplasia.\n___ male with multiple medical problems who presents from ___ \n___ with multiple falls. The falls initially appeared to be \nmechanical in nature, however on further questioning and \nexamination there were probably several factors that contributed \nto patients fall. Patients sertraline was recently increased \nfrom 100mg to 150mg one week ago, this may have added to a \nfoggyness that he had been complaining about for the past week. \nThere is also a high suspicion that patient had become \northostatic from current diuretic regimen. Although not \northostatic he appeared hypovolemic when admitted to the \nhospital. Patient was noted to be hyponatremic to 126 on \nadmission. This was another likely contributor to balance \nissues. Patient also complained of viral syndromes, which may \nhave been another trigger. On history and neuro exam there were \nno signs of stroke or TIA, but there were findings consistent \nwith a peripheral sensory neuropathy. Patient was also noted to \nhave significant proximal muscle weakness. Interventions \nincluded stopping diuretics, decreasing sertraline levels, IV \nfluids, and increased amounts of home physical therapy, \noccupational therapy and visiting nursing services.\n.\n# Falls: Initially appeared to be mechanical, but now appears \nmultifactorial, polypharmacy recent sertraline increase, \nhypovolemia ___ to diuretics, combined with hyponatremia, \ndeconditionin, and neuropathy. No infectious causes.\n-No orthostasis w/ ___ but pt still complains of dizziness.\n-dizziness may be seconary to BPV, viral syndrome or \npolypharmacy.\n-___ medical causes found for dizziness, despite work up, \npossibly cerebellar atrophy. No signs or history of stroke.\n-___ REHAB vs. Home w/ ___\n.\n# Diabetes: There was no demonstratabl evidence of hypoglycemia. \nPt was continued on his home dose of glyburide. HbA1c was 7.3. \nPatient's labs were notable for urine prot/cr 35.2 ratio, strong \nevidence for diabetic nephropathy. Given current problem of \northostasis ace-i was not started.\n.\n# Hyponatremia: Resolved 132, from 126 on admit. Patient most \nlikely had a hypovolemic hyponatremia. Na level likely also \nadded to propensity to fall.\n.\n# Hypertension: Patient was discharged on a trial off of \nspironolactone/hydrochlorothiazide 25 mg/25 mg daily. It was \nfelt that these anti-hypertensives may have been causing \northostasis though not documented during hospital stay.\n.\n# Hyperlipidemia: Patient was continued on pravastatin.\n.\n# Depression: Reduce Sertraline to 100mg daily down from 150mg \ndaily. This higher dose of Sertraline may have been causing \ndizziness and leading to increased propensity to fall.\n.\n# Hypothyroidism: Continued synthroid, TSH was less than 1.\n.\n# Code status: Full, discussed with patient.\n.\n# Communication: daughter ___ is HCP ___.\n.\n#Follow up is as indicated below in discharge worksheet."}}
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{'final_diagnoses': ['1.Fall', '2.Hyponatremia', '3.Viral Syndrome', '1. Actinic keratoses', "2. Bowen's disease", '3. Basal and squamous cell carcinomas', '4. Mild cognitive impairment', '5. Diverticular bleeds', '6. Falls', '7. Depression', '8. Atrial fibrillation - not anticoagulated', '9. Hypothyroidism', '10. Type 2 diabetes', '11. Hypertension', '12. Diastolic dysfunction', '13. Anemia', '14. Hx of Pneumonia - ___', '15. Lymphocytic colitis', '16. Peripheral neuropathy', '17. Bilateral rotator cuff injury - Right greater than left.', '18. Coronary artery disease status post LAD stenting x2', '___. C. difficile - ___', '20. Prostate cancer - s/p external beam ___ ago', '21. Right hamstring tear - ___', '22. S/P bilateral TKR and THR'], 'procedures': ['none'], 'visit_summary': "___ male with multiple medical problems who presents from ___ \n___ with multiple falls. The falls initially appeared to be \nmechanical in nature, however on further questioning and \nexamination there were probably several factors that contributed \nto patients fall. Patients sertraline was recently increased \nfrom 100mg to 150mg one week ago, this may have added to a \nfoggyness that he had been complaining about for the past week. \nThere is also a high suspicion that patient had become \northostatic from current diuretic regimen. Although not \northostatic he appeared hypovolemic when admitted to the \nhospital. Patient was noted to be hyponatremic to 126 on \nadmission. This was another likely contributor to balance \nissues. Patient also complained of viral syndromes, which may \nhave been another trigger. On history and neuro exam there were \nno signs of stroke or TIA, but there were findings consistent \nwith a peripheral sensory neuropathy. Patient was also noted to \nhave significant proximal muscle weakness. Interventions \nincluded stopping diuretics, decreasing sertraline levels, IV \nfluids, and increased amounts of home physical therapy, \noccupational therapy and visiting nursing services.\n.\n# Falls: Initially appeared to be mechanical, but now appears \nmultifactorial, polypharmacy recent sertraline increase, \nhypovolemia ___ to diuretics, combined with hyponatremia, \ndeconditionin, and neuropathy. No infectious causes.\n-No orthostasis w/ ___ but pt still complains of dizziness.\n-dizziness may be seconary to BPV, viral syndrome or \npolypharmacy.\n-___ medical causes found for dizziness, despite work up, \npossibly cerebellar atrophy. No signs or history of stroke.\n-___ REHAB vs. Home w/ ___\n.\n# Diabetes: There was no demonstratabl evidence of hypoglycemia. \nPt was continued on his home dose of glyburide. HbA1c was 7.3. \nPatient's labs were notable for urine prot/cr 35.2 ratio, strong \nevidence for diabetic nephropathy. Given current problem of \northostasis ace-i was not started.\n.\n# Hyponatremia: Resolved 132, from 126 on admit. Patient most \nlikely had a hypovolemic hyponatremia. Na level likely also \nadded to propensity to fall.\n.\n# Hypertension: Patient was discharged on a trial off of \nspironolactone/hydrochlorothiazide 25 mg/25 mg daily. It was \nfelt that these anti-hypertensives may have been causing \northostasis though not documented during hospital stay.\n.\n# Hyperlipidemia: Patient was continued on pravastatin.\n.\n# Depression: Reduce Sertraline to 100mg daily down from 150mg \ndaily. This higher dose of Sertraline may have been causing \ndizziness and leading to increased propensity to fall.\n.\n# Hypothyroidism: Continued synthroid, TSH was less than 1.\n.\n# Code status: Full, discussed with patient.\n.\n# Communication: daughter ___ is HCP ___.\n.\n#Follow up is as indicated below in discharge worksheet.", 'medications_prescribed': ['1. Acetaminophen 325 mg Tablet Sig: One (1) Tablet PO Q6H (every \n6 hours) as needed. ', '2. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO BID (2 times a day). ', '3. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily). ', '5. Glyburide 1.25 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily). ', '6. Levothyroxine 50 mcg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '7. Hexavitamin Tablet Sig: One (1) Cap PO DAILY (Daily). ', '8. Pravastatin 10 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '9. Sertraline 100 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).\nDisp:*30 Tablet(s)* Refills:*1*']}
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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': 'lower back pain with b/l lower extremity radiculopathy', 'medical_history': ['1. DM2 with peripheral neuropathy', '2. Osteoporosis s/p hip and pelvic fracture', '3. Complex L renal cyst (stable on ___ - ___ year f/u \nurology/CT)', '4. Spinal stenosis', '5. Hyperlipidemia', '6. Prior tobacco abuse - not current', '7. Trigeminal neuralgia', '8. Depression/anxiety', '9. Weight Loss', '10. Peripheral neuropathy', '11. Adrenal Adenoma (1.8 x 1.9 cm on MRI ___', '12. Abdominal aortic aneurysm (~3 cm) - f/u U/S ___ ___. \n___', '13. Peripheral arterial disease (55-90% stenosis of R iliac \nartery with moderately reduced ABI)', '14. Appendectomy', '15. C-section x 2'], 'family_history': 'Not elicited.', 'present_illness': '___ y/o female who underwent L3-L5 laminectomy with bilateral \nforaminotomies on ___ comes in today with the chief \ncomplaint of back pain with radiation to groin and thigh. \n\nShe was seen for her postop visit on ___ and was doing well. \n\nShe states a week later she started to develop severe pain in \nher\nback lower left side with radiation to the left hip and left\nanterior thigh. She has a known labral tear in the left hip. \nShe has been taking percocet up to three per day; she has tried\nice without relief. She was recommended on last visit to have \n___\nbut she states ___ would not take her due to her hip and pain. \nShe\nsaw a Dr. ___ in ___ who recommended she return to\nneurosurgery.', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': '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', 'doses_per_24_hrs': 4.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Mineral Oil', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bacitracin Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '44.9', 'valuenum': 44.9, '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': '29.3', 'valuenum': 29.3, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '195', 'valuenum': 195.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.03', 'valuenum': 5.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, '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': '33.3', 'valuenum': 33.3, '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': '180', 'valuenum': 180.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, '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': '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': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '36.4', 'valuenum': 36.4, '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': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.7', 'valuenum': 32.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.00', 'valuenum': 4.0, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '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': '8.3', 'valuenum': 8.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, 'valueuom': '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Admission PE: \nBack incision well healed. Pain on palpation left lower back \nand increased tone. Pain any movement for straight leg raise on \nthe left with radiation to the groin. Exam limited by pain.\n.\nDischarge PE:\nVitals- Tc 98.2, 110-140s/50-70s, 50-60s, 18, 94-98% RA\nFingerstick: ___: ___\nGeneral- elderly woman, looks stated age, lying in bed, in NAD \nHEENT- PERRL, Sclera anicteric, oropharynx clear \nNeck- supple\nCV- RRR, brief ___ systolic murmur best at RUSB\nLungs- CTAB, breathing comfortable, speaks in full sentences, no \naccessory muscle use\nAbdomen- soft, non-tender, nondistended, bowel sounds present\nExt- warm, well perfused, 2+ pulses, no ___ edema, pinkness at \nheals\nNeuro- CNs2-12 intact, motor function grossly normal\nBack- surgical site clean dry and intact with staples in place; \npink around incision/staples, no purulent drainage, no palpable \nfluid collections', 'diagnoses': [{'icd_code': '185', 'desc': 'Malignant neoplasm of prostate'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '36510', 'desc': 'Open-angle glaucoma, unspecified'}], 'summary': ">> Studies:\n___ CXR \nCardiac size is top normal. Bilateral pleural effusions are \nsmall to moderate and associated with adjacent atelectasis, \nlarger on the right side. Mild pulmonary edema has improved. \nThere are no new lung opacities or pneumothorax. \n.\n___ TTE:\nThe left atrium is normal in size. 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 ascending aorta is mildly dilated. There \nis a minimally increased gradient consistent with minimal aortic \nvalve stenosis. The mitral valve appears structurally normal \nwith trivial mitral regurgitation. There is no mitral valve \nprolapse. There is moderate pulmonary artery systolic \nhypertension. There is no pericardial effusion. \n.\n___ CT Chest \n1. Bilateral nondependent upper lobe predominant opacities have \nimproved since yesterday, most consistent with moderate \npulmonary edema, accompanied by bilateral small pleural \neffusions. \n2. Two less than 4 mm lung nodules, left upper lobe. It is \nuncertain if they were present on the previous exam. Chest CT \nfollowup is suggested in six months. \n.\n___ KUB: no bowel obstruction\n.\n>> MICRO:\nbl cx ___: pending\nucx ___: >100K pansensitive e coli \n.\nPertinent labs:\n___ 10:26PM URINE Blood-TR Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n___ 10:26PM URINE RBC-2 WBC-1 Bacteri-FEW Yeast-NONE Epi-<1\n___ 08:20PM URINE Blood-TR Nitrite-POS Protein-TR \nGlucose-NEG Ketone-10 Bilirub-NEG Urobiln-2* pH-5.5 Leuks-MOD\n___ 08:20PM URINE RBC-2 WBC-16* Bacteri-FEW Yeast-NONE \nEpi-0\n.\n>> Discharge Labs:\n___ 06:50AM BLOOD WBC-6.5 RBC-3.54* Hgb-11.5* Hct-34.2* \nMCV-97 MCH-32.4* MCHC-33.6 RDW-12.3 Plt ___\n___ 06:50AM BLOOD Glucose-125* UreaN-13 Creat-0.4 Na-141 \nK-4.2 Cl-100 HCO3-30 AnGap-15\n___ 06:50AM BLOOD Calcium-8.6 Phos-3.6 Mg-2.1\nNeurosurgical course: Patient was admitted to Neurosurgery on \n___ and underwent the above stated procedure. Please \nreview dictated operative report for details. Patient was \nextubated without incident and transferred to PACU then floor or \nICU in stable condition. Diet was advanced slowly and IV fluids \nwas discontinued. Foley was removed in routine fashion and pt \nvoided without incident. Pain medication was titrated and \ntransitioned from IV to oral regimen. Postop course complicated \nby SOB, hypoxia with imaging c/w pulmonary edema. Pt transferred \nto medicine for further management on PDO3.\n.\nMedicine course: ___ y/o woman with DM, HLD, prior smoking \nhistory, severe lumbar stenosis s/p exploratory laminectomy \n___, with postop period c/b pulmonary edema, hypotension, \nand abd pain.\n.\n>> Active issues:\n# Hypotension: On POD4 pt noted to have SBPS in 70-90s. No \ntachycardia. Hypotension likely related mostly to narcotics as \noccurred in the setting of somnolence. Pt received narcan x1 \nwith good effect. In the setting of pulmonary edema and O2 \nrequirements IVF resuscitation minimized though likely some \ncomponent of overdiuresis. Pt transferred to MICU on ___ for \nobservation. UA positive on ___ though negative on ___, so \nconcern for some contribution as well from UTI. Pt did well in \nICU and called out ___. BPs normalized.\n.\n# Hypoxia: Likely secondary to acute pulmonary edema based on \nCXR and CT chest findings. Pt received significant amt of IVF \nintraop and immediate postop period. TTE without evidence of \nsystolic dysfunction but concern for diastolic dysfunction \ncontributing to pulmonary edema. Pt not clearly with PNA based \non CT chest. Also likely component from splinting from postop \npain resulting in atelectasis. Pt diuresed. Pt weaned from O2 \nafter ICU course and pt satting in high ___ on RA.\n.\n# Fevers, UTI: Pt with multiple fevers in postop period. DDx \nincluded atelectasis, UTI, PNA, and VTE. No evidence of PE on or \nPNA on chest CT. Elevated WBC initially postop resolved. UA on \n___ negative on transfer to medicine service. Repeat UA ___ \npositive, so pt started on ceftriaxone ___. Bl and urine cx \nsent. Ucx ___ with >100K e coli (pansensitive). Pt will \ncomplete 7d course of ABX for complicated UTI \n(catheter-associated). Pt received 3d of ceftriaxone during \nadmission and will complete 4d of Bactrim at rehab.\n.\n# Constipation: Pt went multiple days in postop period without a \nBM. On day of MICU transfer, pt complained of increasing abd \npain. KUB without evidence of bowel obstruction. Pt maintained \non strong bowel regimen. Pt had BM and abd exam, as well as \nsubjective discomfort, improved.\n.\n# Urinary retention: Pt with issues with urinary retention \naround POD3-4, likely related to opiates. Required straight cath \nprior to MICU stay, foley during MICU then d/c'ed. Pt passed \nvoiding trial without difficulty.\n.\n# DM: Fingersticks bottoming out to ___ around ___ for \nmultiple days. Backed off on home lantus (16u ___ to 4u ___, \nthen increased this to 8 units ___ on discharge. Pt maintained \non HSSI. Will need to uptitrate insulin as requirements \nincrease.\n.\n# Postop from exploratory laminectomy: difficulties with postop \npain control in setting of somnolence, urinary retention, \nhypotension from oxycodone."}}
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{'final_diagnoses': ['Urinary tract infection', 'L1-3 lumbar stenosis \nwith exploratory laminectomy', 'chronic lower back pain', 'pulmonary \nedema', 'opioid intoxication', 'hypotension', 'urinary retention', 'type \n2 diabetes', 'Spinal stensosis', 'peripheral neuropathy'], 'procedures': ['___ L1-3 lumbar decompressive laminectomies'], 'visit_summary': "Neurosurgical course: Patient was admitted to Neurosurgery on \n___ and underwent the above stated procedure. Please \nreview dictated operative report for details. Patient was \nextubated without incident and transferred to PACU then floor or \nICU in stable condition. Diet was advanced slowly and IV fluids \nwas discontinued. Foley was removed in routine fashion and pt \nvoided without incident. Pain medication was titrated and \ntransitioned from IV to oral regimen. Postop course complicated \nby SOB, hypoxia with imaging c/w pulmonary edema. Pt transferred \nto medicine for further management on PDO3.\n.\nMedicine course: ___ y/o woman with DM, HLD, prior smoking \nhistory, severe lumbar stenosis s/p exploratory laminectomy \n___, with postop period c/b pulmonary edema, hypotension, \nand abd pain.\n.\n>> Active issues:\n# Hypotension: On POD4 pt noted to have SBPS in 70-90s. No \ntachycardia. Hypotension likely related mostly to narcotics as \noccurred in the setting of somnolence. Pt received narcan x1 \nwith good effect. In the setting of pulmonary edema and O2 \nrequirements IVF resuscitation minimized though likely some \ncomponent of overdiuresis. Pt transferred to MICU on ___ for \nobservation. UA positive on ___ though negative on ___, so \nconcern for some contribution as well from UTI. Pt did well in \nICU and called out ___. BPs normalized.\n.\n# Hypoxia: Likely secondary to acute pulmonary edema based on \nCXR and CT chest findings. Pt received significant amt of IVF \nintraop and immediate postop period. TTE without evidence of \nsystolic dysfunction but concern for diastolic dysfunction \ncontributing to pulmonary edema. Pt not clearly with PNA based \non CT chest. Also likely component from splinting from postop \npain resulting in atelectasis. Pt diuresed. Pt weaned from O2 \nafter ICU course and pt satting in high ___ on RA.\n.\n# Fevers, UTI: Pt with multiple fevers in postop period. DDx \nincluded atelectasis, UTI, PNA, and VTE. No evidence of PE on or \nPNA on chest CT. Elevated WBC initially postop resolved. UA on \n___ negative on transfer to medicine service. Repeat UA ___ \npositive, so pt started on ceftriaxone ___. Bl and urine cx \nsent. Ucx ___ with >100K e coli (pansensitive). Pt will \ncomplete 7d course of ABX for complicated UTI \n(catheter-associated). Pt received 3d of ceftriaxone during \nadmission and will complete 4d of Bactrim at rehab.\n.\n# Constipation: Pt went multiple days in postop period without a \nBM. On day of MICU transfer, pt complained of increasing abd \npain. KUB without evidence of bowel obstruction. Pt maintained \non strong bowel regimen. Pt had BM and abd exam, as well as \nsubjective discomfort, improved.\n.\n# Urinary retention: Pt with issues with urinary retention \naround POD3-4, likely related to opiates. Required straight cath \nprior to MICU stay, foley during MICU then d/c'ed. Pt passed \nvoiding trial without difficulty.\n.\n# DM: Fingersticks bottoming out to ___ around ___ for \nmultiple days. Backed off on home lantus (16u ___ to 4u ___, \nthen increased this to 8 units ___ on discharge. Pt maintained \non HSSI. Will need to uptitrate insulin as requirements \nincrease.\n.\n# Postop from exploratory laminectomy: difficulties with postop \npain control in setting of somnolence, urinary retention, \nhypotension from oxycodone.", 'medications_prescribed': ['1. Simvastatin 20 mg PO DAILY', '2. Vitamin D 800 UNIT PO DAILY', '3. Multivitamins 1 TAB PO DAILY', '4. traZODONE 50 mg PO HS', '5. Aspirin 81 mg PO DAILY', '6. Calcium Carbonate 600 mg PO DAILY', '7. fish oil-dha-epa *NF* ___ mg Oral daily', '8. Glargine 8 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', '9. Gabapentin 1200 mg PO TID', '10. Sulfameth/Trimethoprim DS 1 TAB PO BID Duration: 4 Days', '11. Acetaminophen 1000 mg PO Q8H', '12. Restasis *NF* (cycloSPORINE) 0.05 % ___', '13. Fluoxetine 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': 82, 'gender': 'M', 'symptoms': '___ toe ulcer', 'medical_history': ['DM(II)', 'HTN', '^chol', 'Hep C', 's/p hysterectomy for fibroids\nh/o toxic/metabolic encephalopathy reportedly related to\nneurontin and amitriptyline use'], 'family_history': 'DM, CAD, stroke', 'present_illness': 'This is a ___ woman who had a nonhealing ulcer of the \nleft foot. Noninvasive arterial studies suggested bilateral \niliac arterial disease. Given\nthese findings, the patient was consented for arteriogram,\npossible angioplasty to assist her with wound healing.', 'medications': [{'medication': 'Tolterodine', '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': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'CeftriaXONE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '4.1', '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}], 'exams': 'PE:\n\nAFVSS\n\nNEURO:\n\nPERRL / EOMI\n\nMAE equally\n\nAnswers simple commands\n\nNeg pronator drift\n\nSensation intact to ST\n\n2 plus DTR\n\n___\n\n___:\n\nNCAT \n\nNeg lesions nares, oral pharnyx, auditory\n\nSupple / FAROM\n\nneg lyphandopathy, supra clavicular nodes\n\nLUNGS: CTA b/l\n\nCARDIAC: RRR without murmers\n\nABDOMEN: Soft, NTTP, ND, pos BS, neg CVA tenderness\n\nEXT:\n\nPulses: fem DP ___\n\nR 1+ mono mono \n\nL 1+ mono mono', 'diagnoses': [{'icd_code': '59971', 'desc': 'Gross hematuria'}, {'icd_code': '59689', 'desc': 'Other specified disorders of bladder'}, {'icd_code': '1889', 'desc': 'Malignant neoplasm of bladder, part unspecified'}, {'icd_code': 'V4589', 'desc': 'Other postprocedural status'}, {'icd_code': '4148', 'desc': 'Other specified forms of chronic ischemic heart disease'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '412', 'desc': 'Old myocardial infarction'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '2749', 'desc': 'Gout, unspecified'}, {'icd_code': '78057', 'desc': 'Unspecified sleep apnea'}, {'icd_code': 'V5869', 'desc': 'Long-term (current) use of other medications'}, {'icd_code': 'V1046', 'desc': 'Personal history of malignant neoplasm of prostate'}], 'summary': '___ 05:40AM BLOOD \n\nWBC-11.8* RBC-3.46* Hgb-10.8* Hct-31.0* MCV-90 MCH-31.2 \nMCHC-34.7 RDW-13.5 Plt ___\n\n___ 05:40AM BLOOD \n\nGlucose-65* UreaN-13 Creat-0.7 Na-140 K-4.2 Cl-103 HCO3-30 \nAnGap-11\n___ was admitted on ___ with B/L lower extremity \nclaudication. She agreed to have an elective surgery. \nPre-operatively, she was consented. A CXR, EKG, UA, CBC, \nElectrolytes, T/S - were obtained, all other preperations were \nmade.\n\nIt was decided that she would undergo:\n\nOPERATION PERFORMED:\n1. Ultrasound-guided puncture of right common femoral\n artery.\n2. Ultrasound-guided puncture of left common femoral\n artery.\n3. Contralateral second-order catheterization of left common femoral artery.\n4. Serial arteriograms of the left lower extremity.\n5. Aortic catheter placement.\n6. Serial arteriograms of the right lower extremity.\n7. Bilateral common iliac artery stent.\n8. Stenting of left external iliac artery.\n\nShe was prepped, and brought down to the endo suite room for \nsurgery. Intra-operatively, she was closely monitored and \nremained hemodynamically stable. She tolerated the procedure \nwell without any difficulty or complication.\n\nPost-operatively, transferred to the PACU for further \nstabilization and monitoring. \n\nShe was then transferred to the VICU for further recovery. While \nin the VICU she recieved monitered care. When stable she was \ndelined. Her diet was advanced. When she was stabalized from \nthe acute setting of post operative care, she was transfered to \nfloor status \n\nOn the floor, she remained hemodynamically stable with her pain \ncontrolled. She continues to make steady progress without any \nincidents. She was discharged home in stable condition.\n\nShe did recieve preoperative hydration. On DC her creatinine is \nstable.'}}
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{'final_diagnoses': ['b/l claudication', 'DM(II)', 'HTN', 'HLD', 'HCV+', 'PAD', 'toxic/metabolic encephalopathy (due \nto neurontin and amitriptyline)', 's/p hysterectomy for fibroids', 'ulcer debridements.'], 'procedures': ['Ultrasound-guided puncture of right common femoral artery.', 'Ultrasound-guided puncture of left common femoral artery.', 'Contralateral second-order catheterization of left common femoral artery.', 'Serial arteriograms of the left lower extremity.', 'Aortic catheter placement.', 'Serial arteriograms of the right lower extremity.', 'Bilateral common iliac artery stent.', 'Stenting of left external iliac artery.'], 'visit_summary': '___ was admitted on ___ with B/L lower extremity \nclaudication. She agreed to have an elective surgery. \nPre-operatively, she was consented. A CXR, EKG, UA, CBC, \nElectrolytes, T/S - were obtained, all other preperations were \nmade.\n\nIt was decided that she would undergo:\n\nOPERATION PERFORMED:\n1. Ultrasound-guided puncture of right common femoral\n artery.\n2. Ultrasound-guided puncture of left common femoral\n artery.\n3. Contralateral second-order catheterization of left common femoral artery.\n4. Serial arteriograms of the left lower extremity.\n5. Aortic catheter placement.\n6. Serial arteriograms of the right lower extremity.\n7. Bilateral common iliac artery stent.\n8. Stenting of left external iliac artery.\n\nShe was prepped, and brought down to the endo suite room for \nsurgery. Intra-operatively, she was closely monitored and \nremained hemodynamically stable. She tolerated the procedure \nwell without any difficulty or complication.\n\nPost-operatively, transferred to the PACU for further \nstabilization and monitoring. \n\nShe was then transferred to the VICU for further recovery. While \nin the VICU she recieved monitered care. When stable she was \ndelined. Her diet was advanced. When she was stabalized from \nthe acute setting of post operative care, she was transfered to \nfloor status \n\nOn the floor, she remained hemodynamically stable with her pain \ncontrolled. She continues to make steady progress without any \nincidents. She was discharged home in stable condition.\n\nShe did recieve preoperative hydration. On DC her creatinine is \nstable.', 'medications_prescribed': ['Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3 \ntimes a day).', 'Simvastatin 10 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', 'Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily).', 'Clopidogrel 75 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily): PCP to fill.\nDisp:*30 Tablet(s)* Refills:*6*', 'Insulin\nSliding Scale & Fixed Dose\n\nFingerstick QACHS\n\nInsulin SC \n\nFixed Dose Orders \n\nBreakfast Bedtime \n\nNPH 27 Units NPH 27 Units \n\nInsulin SC Sliding Scale \n\nBreakfast Lunch Dinner Bedtime \n\nRegular \n\nGlucose Insulin Dose \n \n___ mg/dL 4 oz. Juice \n51-150 mg/dL 0 Units 0 Units 0 Units 0 Units \n151-200 mg/dL 2 Units 2 Units 2 Units 2 Units \n201-250 mg/dL 4 Units 4 Units 4 Units 4 Units \n251-300 mg/dL 6 Units 6 Units 6 Units 6 Units \n301-350 mg/dL 8 Units 8 Units 8 Units 8 Units \n351-400 mg/dL 10 Units 10 Units 10 Units 10 Units \n> 400 mg/dL ___ M.D.', 'Hydrochlorothiazide 25 mg Tablet Sig: One (1) Tablet PO once \na day.', 'Lisinopril 40 mg Tablet Sig: One (1) Tablet PO once a day.', 'Metformin 500 mg Tablet Sig: One (1) Tablet PO twice a day: \nStart on ___.']}
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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': '"I was not doing anything for the last ___ weeks"', 'medical_history': ['none'], 'family_history': "Family psychiatric history: Mother has a psychiatric history \nthat seems consistent with bipolar disorder, possibly with \npsychotic features (long periods of depression with occasional \nelevated mood and increased goal-directed behavior such as \ncleaning the whole house. Her mother would also say that god \nspoke to her and she would see images of god that other people \ncouldn't see). Grandfather also had depression and hung himself. \nMs. ___ mother hung herself 2 months later. She says \nneither of them could control their anger and she also has the \nsame problem herself.", 'present_illness': 'Ms. ___ is a ___ F ___ graduate student with a \nhistory of 2 suicide attempts ___ years ago sent to the ___ ED \non a ___ by a therapist at ___ \n___ who was concerned about the patient\'s risk of harm to \nself. Ms. ___ self-presented to the ___ \n___ today and asked to speak with someone because she \nhas been feeling badly for the last 2 months and has gotten \nacutely worse over the last several weeks. She reports not \neating, getting out of bed, showering or leaving her house for \nthe last several weeks and has started to feel suicidal. For the \npast week Ms. ___ has thought about buying several bottles of \nover the counter sleeping pills and overdosing. She had to give \na presentation today and was hoping it would help improve her \nmood, but she reports feeling "just as bad afterwards as \nbefore," and she knew that she needed to get help before things \ngot worse.\n\nMs. ___ has felt like this in the past in the context of her \ngrandfather and mother committing suicide 2 months apart, both \nby hanging. She describes her mother\'s death as especially \ntraumatizing as she found her mother afterwards and had to help \ncut her down. She became profoundly depressed and attempted \nsuicide by overdosing on her mother\'s psychiatric medications. \nShe was hospitalized and started on an antidepressant, which \ncaused her to feel much worse. She later overdosed on her \nantidepressant and again required hospitalization. She said \nafter this "my father gave up on me" and identifies her \nboyfriend at the time (now her husband) as her only emotional \nsupport.\n\nRecently her sleep has been erratic, ranging from ___ hours per \nnight but she always feels tired. She also has low energy, poor \nconcentration, poor appetite, anhedonia, low mood, profound \nguilt. She says she used to love cooking and eating but has lost \nall interest in food. She describes herself as "lost, a failure" \nand has a constant pressure that her mother wants her to be a \nsuccess and she is not meeting expectations. She also reports \nfeeling\nquite isolated in the ___ away from her husband,\nfamily, and friends in ___. "I have no friends, no people I \ncan\ntrust in this country." Has been experiening suicidal thoughts \nfor the past week with a plan to overdose on over the counter \nsleeping pills. Prior to a week ago she would think about \ncommitting suicide but did not have a plan.\n\nShe says while she was in ___ 2 months ago she was happy, in a \ngood mood, going out with friends and feeling much better. She \ndescribes her sleep at that time as normal but says she had 2 \noutbursts of rage which in hindsight were over minimal things. \nPt denies any personal h/o sustained impulsivity, grandiosity, \ndecreased need for sleep, or increased goal directed activity. \nDenies AVH, delusions.\n\nIn the ED, she was in good behavioral control and did not \nrequire any medications.', 'medications': [{'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Metoprolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H', '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': 'PNEUMOcoccal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'ASDIR8', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '119', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, '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': '10.0', 'valuenum': 10.0, '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': '32.8', 'valuenum': 32.8, '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': '431', 'valuenum': 431.0, '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': '3.56', 'valuenum': 3.56, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, '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': '___', 'valuenum': 14.6, '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': '26.2', 'valuenum': 26.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.6', 'valuenum': 30.6, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '509', 'valuenum': 509.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, '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': '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': '33.8', 'valuenum': 33.8, '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': '33.1', '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': '645', 'valuenum': 645.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.01', 'valuenum': 4.01, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': 'Vitals: BP: 105/70 HR:84 T:afebrile RR:16 O2sat:100% RA \nheight:5\'4" weight:122.4 lbs\nNeurological:\n- station and gait: Normal\n- tone and strength: Normal tone, full strength\n- cranial nerves: CN II - XII intact\n- abnormal movements: No PMR/PMA\nAppearance: Young woman, appears stated age, appears well \ngroomed\nBehavior: Answering questions appropriately\nMood and Affect: "sad" affect dysthymic\nThought process: organized, linear. Occasionally circumstantial. \nNo LoA, FoI\nThought Content: No AVH, no HI, no SI currently but would be \nfeeling suicidal if she were alone.\nJudgment and Insight: Fair, fair\nCognition: \nAttention, orientation, and executive function: 100, 93, 86, 79, \n72\nMemory: ___ registration and recall at 5 minutes\nFund of knowledge: Good, recites presidents and cites current \naffair "Protests in ___\nCalculations: 9 quarters = $2.25\nAbstraction: "Don\'t cry over spilled milk" = "Don\'t cry over \nthings that are over"\nSpeech: Regular rate, volume, tone\nLanguage: Fluent', 'diagnoses': [{'icd_code': '5400', 'desc': 'Acute appendicitis with generalized peritonitis'}, {'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'}], 'summary': "Urine Benzos, Barbs, Opiates, Cocaine, Amphet, Mthdne: Negative \nUCG: Neg \nUA: Tr leukocytes, Few bacteria, 50 ketones, otherwise wnl\n\n140 | 103 | ___ / ___ AGap=15 \n3.7 | 26 | 0.7 \\\n\nALT: 17 AP: 73 Tbili: 0.4 \nAST: 21 \n\nSerum ASA, EtOH, Acetmnphn, Benzo, Barb, Tricyc: Negative \n\nTSH:1.5 \n\n9.8 > 14.0 / 38.7 < 283 \nN:83.8 L:13.1 M:2.4 E:0.3 Bas:0.4\n___ is a ___ year old graduate student at ___ \nwith a history of severe depression ___ years ago with 2 prior \nsuicide attempts by OD on psych meds following mother's suicide. \n She was admitted with several weeks of depressed mood and SI \nwith plan to OD on sleeping pills. She has also has not been \ngetting out of bed or leaving house. \n\n# Psychiatric, severe MDD: This is the her second episode of \nmajor depression (last was ___ years ago when she attempted \nsuicide following mother's suicide). On arrival, patient met \ncriteria for MDD including depressed mood nearly every day for \nseveral weeks prior to admission, diminished interest in \nactivities she previously enjoyed like cooking and eating, \ndecreased appetite and desire to eat, insomnia alternating with \nhypersomnia, fatigue and loss of energy, feelings of \nworthlessness and excessive guilt, and recurrent suicidal \nideation with a plan. She has several sources of stress \nincluding difficulty with her graduate work, few friends or \nsources of support in this country, residual feelings and \nmemories from her mother's suicide, and a strained relationship \nwith her father. She was initial started on Seroquel at bedtime \nfor sleep, but this was discontinued due to excessive drowsiness \nduring the day. The risks and benefits of starting medications \n(offered either Lamictal, given family history of BPAD, or \nCelexa) were reviewed, but the patient was not interested in \nstarting medications during this hospitalization (due to her \nbelief that psych medications were involved in her mother's \nsuicide and her personal history of increased suicidality on \nantidepressants). She will consider medications as an \noutpatient if depressive symptoms recur despite therapy. It was \nrecommended that patient, her husband and her therapist work to \ndevelop crisis prevention and intervention plan, with monitoring \nfor early warning signs and appropriate intervention. Her sleep \nand appetite improved throughout hospitalization, as did her \nmotivation and outlook. She denied suicidal ideation throughout \nhospitalization. While in the hospital she attended all groups \nand was pleasant and cooperative with all patients and staff. \nShe was engaged in individual therapy and very eager to continue \nwork as an outpatient.\n\n# Legal: ___\n# Safety: Patient was maintained on 15 min checks, as there were \nno acute safety concerns."}}
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{'final_diagnoses': ['Axis I: Major depressive disorder (r/o Bipolar disorder, current \nepisode depressed)', 'Axis II: Deferred', 'Axis III: None active'], 'procedures': ['None'], 'visit_summary': "___ is a ___ year old graduate student at ___ \nwith a history of severe depression ___ years ago with 2 prior \nsuicide attempts by OD on psych meds following mother's suicide. \n She was admitted with several weeks of depressed mood and SI \nwith plan to OD on sleeping pills. She has also has not been \ngetting out of bed or leaving house. \n\n# Psychiatric, severe MDD: This is the her second episode of \nmajor depression (last was ___ years ago when she attempted \nsuicide following mother's suicide). On arrival, patient met \ncriteria for MDD including depressed mood nearly every day for \nseveral weeks prior to admission, diminished interest in \nactivities she previously enjoyed like cooking and eating, \ndecreased appetite and desire to eat, insomnia alternating with \nhypersomnia, fatigue and loss of energy, feelings of \nworthlessness and excessive guilt, and recurrent suicidal \nideation with a plan. She has several sources of stress \nincluding difficulty with her graduate work, few friends or \nsources of support in this country, residual feelings and \nmemories from her mother's suicide, and a strained relationship \nwith her father. She was initial started on Seroquel at bedtime \nfor sleep, but this was discontinued due to excessive drowsiness \nduring the day. The risks and benefits of starting medications \n(offered either Lamictal, given family history of BPAD, or \nCelexa) were reviewed, but the patient was not interested in \nstarting medications during this hospitalization (due to her \nbelief that psych medications were involved in her mother's \nsuicide and her personal history of increased suicidality on \nantidepressants). She will consider medications as an \noutpatient if depressive symptoms recur despite therapy. It was \nrecommended that patient, her husband and her therapist work to \ndevelop crisis prevention and intervention plan, with monitoring \nfor early warning signs and appropriate intervention. Her sleep \nand appetite improved throughout hospitalization, as did her \nmotivation and outlook. She denied suicidal ideation throughout \nhospitalization. While in the hospital she attended all groups \nand was pleasant and cooperative with all patients and staff. \nShe was engaged in individual therapy and very eager to continue \nwork as an outpatient.\n\n# Legal: ___\n# Safety: Patient was maintained on 15 min checks, as there were \nno acute safety concerns.", 'medications_prescribed': ['Herbal supplement for hemorrhoids']}
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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': 'Food Impaction', 'medical_history': ['Barretts esophagus', 'Hypertension', 'Peridontal disease'], 'family_history': 'NC', 'present_illness': '___ year old female presents to ___ ED after eating some \nchicken breast without bones at around 9:00 last night. Since \nthat time she has had the feeling that something is stuck in her \nthroat and she has had difficulty swallowing her saliva. She \ndenies any respiratory difficulty, trismus, fevers/chills. She \nwas evaluated by GI who felt the chicken was too high in the \nesophagus for them to retrieve. ENT also attempted retrieval but \nwere unsuccessful. The patient was admitted to the ICU for \nairway monitoring for repeat EGD.\n\nOn speaking with the patient, she is in no respiratory distress. \nShe is not stridorous. She has had food impaction before with \nunclear cause, ? dysmotility. Food impaction only occurs with \nhigh protein foods, like meats. Never with liquids. She has not \nhad odynophagia or weight loss. Denies reflux, although \ndiagnosed with Barretts. Sometimes says has regurgitation with \npills. No halitosis. \n\nOn arrival to the MICU, the patient has no complaints.', 'medications': [{'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q12H', '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': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H: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': 'Spironolactone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin EC', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate', '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': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atropine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'X1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY: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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aluminum-Magnesium Hydrox.-Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'BREAKFAST', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IM', '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', '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 via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H: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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q3H: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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Simvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Carvedilol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Metoclopramide', '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': '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': 'Spironolactone', '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': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '41.2', 'valuenum': 41.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, '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': '5.5', 'valuenum': 5.5, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '220', 'valuenum': 220.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 198.0, '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': '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': '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, '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': '98', 'valuenum': 98.0, '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': '1.6', 'valuenum': 1.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, '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': '141', 'valuenum': 141.0, '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': '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': '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': '114', 'valuenum': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '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': '116', 'valuenum': 116.0, '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': '10.2', 'valuenum': 10.2, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.43', 'valuenum': 7.43, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '190', 'valuenum': 190.0, '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': '277', 'valuenum': 277.0, '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': '13.7', 'valuenum': 13.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 25.5, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': None, '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': '35.0', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75.5', 'valuenum': 75.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': '14.1', 'valuenum': 14.1, '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': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 12.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 100.0, 'ref_range_upper': 112.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.30', 'valuenum': 1.3, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.7', 'valuenum': 11.7, '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': '46', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '166', 'valuenum': 166.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 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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': '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': '1', 'valuenum': 1.0, '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': '126', 'valuenum': 126.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '42', 'valuenum': 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'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': '143', 'valuenum': 143.0, '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, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '32.2', 'valuenum': 32.2, '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': '28.6', 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'valuenum': 11.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, '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': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '29.3', 'valuenum': 29.3, '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': '29.0', 'valuenum': 29.0, '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': '86', 'valuenum': 86.0, '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': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.42', 'valuenum': 3.42, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.10', 'valuenum': 1.1, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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': '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': '13', 'valuenum': 13.0, '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 106.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '26', 'valuenum': 26.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': '%', 'ref_range_lower': 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': '28.6', 'valuenum': 28.6, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.0', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals- 98, 86, 163/60, 94% RA \nGeneral- NAD\nHEENT- micrognathia, anicteric \nCV- RRR, no mumurs\nLungs- CTAB\nAbdomen- soft, NT, ND\nGU- no Foley\nExt- no edema\nNeuro- nonfocal', 'diagnoses': [{'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4148', 'desc': 'Other specified forms of chronic ischemic heart disease'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '27800', 'desc': 'Obesity, unspecified'}, {'icd_code': '7245', 'desc': 'Backache, unspecified'}, {'icd_code': '70901', 'desc': 'Vitiligo'}], 'summary': 'CXR:\nET tube in standard position. Lungs fully expanded and clear. \nNormal \ncardiomediastinal and hilar silhouettes and pleural surfaces. \n\nEGD:\nImpression: Food in the esophagus\nThere was localized erythema like from trauma from the food \nbolus that was noted at the UES.\nAt approximately 17cm from the incisors, the esophagus was \nnarrowed from external compression. The compression was \nsymmetric.\nOtherwise normal EGD to stomach \nRecommendations: Okay to extubate.\nFood bolus successful disimpacted from upper esophagus.\nEtiology of solid food dysphagia likely ___ to extrernal \ncompression of upper esophagus./\nObtain CT neck and chest to identify cause of external \ncompression. \nClear liquids today and pureed diet starting tomorrow.\nThis is a ___ yo F admitted to the ICU for food impaction unable \nto be removed in the ED. After intubation, a pediatric scope was \nable to traverse the blockage and push the food bolus into the \nstomach. On withdrawing the scope, extrinsic compression of the \nmid-esophagus was noted. No esophageal webs or strictures were \nseen. She will be on clears for 24 hours and then advance only \nto pureed foods therafter until the compression of the esophagus \ncan be better evaluated. Prior to discharge, the patient was \nordered for a CT neck and chest to evaluate the compression. The \npatient will schedule this to be performed on ___. The results \nwill be followed up by GI and her PCP. The patient will \nfollow-up with her PCP as needed and with GI as dictated by the \nresults of imaging. The patient understood the plan.'}}
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{'final_diagnoses': ['Food Impaction'], 'procedures': ['EGD'], 'visit_summary': 'This is a ___ yo F admitted to the ICU for food impaction unable \nto be removed in the ED. After intubation, a pediatric scope was \nable to traverse the blockage and push the food bolus into the \nstomach. On withdrawing the scope, extrinsic compression of the \nmid-esophagus was noted. No esophageal webs or strictures were \nseen. She will be on clears for 24 hours and then advance only \nto pureed foods therafter until the compression of the esophagus \ncan be better evaluated. Prior to discharge, the patient was \nordered for a CT neck and chest to evaluate the compression. The \npatient will schedule this to be performed on ___. The results \nwill be followed up by GI and her PCP. The patient will \nfollow-up with her PCP as needed and with GI as dictated by the \nresults of imaging. The patient understood the plan.', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Atenolol 50 mg PO DAILY', 'Doxycycline Hyclate 50 mg PO Q12H', 'Hydrochlorothiazide 25 mg PO DAILY', 'Multivitamins 1 TAB PO DAILY', 'Omeprazole 40 mg 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': 58, 'gender': 'M', 'symptoms': 'seizure', 'medical_history': ['T1DM c/b avascular necrosis of bilateral hips and shoulders', '?Hx of Sz disorder', 'Hx of EtOH abuse', 'Bipolar disorder', 'PTSD'], 'family_history': 'Unable to obtain', 'present_illness': "Mr. ___ is a ___ w/ T1DM (c/b bilateral hip and shoulder \navascular necrosis s/p joint replacements) on an insulin pump, \nprior Hx of EtOH abuse (reportedly hasn't drank in years), Hx of \nseizure disorder who presented to ___ following a \nwitnessed seizure at home. His partner witnessed him have a \nseizure at home and called EMS, who brought him to the ED. He \nwas reportedly post-ictal and confused on arrival. He seized \nagain in the ED and received 2 mg Ativan; the seizure broke \nquickly (<5 min). He then seized a \nsecond time and was keppra loaded, intubated, started on \nprecedex, and admitted to the MICU. Labs were notable for Utox \npositive for methadone (which is not one of his home meds), K \n2.8 (repleted), serum EtOH negative, Lactate 2.9, glucose 288, \nAGap 17, Albumin 2.5, and UA suggestive of UTI. UA was without \nketones. CXR was unremarkable. CT head was negative. EEG \nshowed ongoing seizure activity. The the MICU he continued to \nseize and received a total of 8 mg of Ativan, and precedex was \nswitched to propofol. Neurology was consulted and felt his \nseizures were c/w status epilepticus; however, intensivist felt \nsz activity was more intermittent. Poison control was consulted \nand felt his symptoms were suggestive of isoniazid overdose; it \nis unclear on what they based this assessment, and isoniazid is \nnot one of his home medications.\n\nInitial ABG in the MICU was notable for pH 7.07 and HCO3 13; \nlactate at that time was 9.3. He received 2 amps of HCO3 and \nwas started on a bicarb gtt. His ABG subsequently improved to \npH 7.56 HCO3 26, so his bicarb was stopped. Initial vent \nsettings were 550 x 18, 5 x 75%. He was started on NS @ 100 \ncc's/hr and received Ceftriaxone for suspected UTI. \n\nOf note, the patient is normally on insulin pump at home, but it \nwas apparently not working for the past week. ___ MD told him \nto take subQ insulin in the meantime (his pump was taken off \nwhen he was admitted). On admission, he was started on an \ninsulin gtt for sugars in the 300s; he came down to 160s on 4.5 \nu/hr. Also of note, placement of OG tube drained ~100 cc's of \ncoffee-ground emesis. GI was consulted and thought this was c/w \ngastritis, for which he was started on a PPI gtt. \n\nNeurology recommended continuous EEG monitoring, so the patient \nwas transferred to ___. He has remained hemodynamically \nstable and has not required pressors. Most recent ABG prior to \ntransfer was 7.44/42/318\n\nOn arrival to the MICU, the patient was intubated and sedated \nand completely unarousable to painful stimuli.", 'medications': [{'medication': 'Senna', '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': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', '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 via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Levofloxacin', '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': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Amlodipine', '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', 'route': 'PO', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Levofloxacin', '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', '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': 'Paroxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', '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': 'Oxycodone-Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', '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}]}, 'clinical_findings': {'labs': [{'value': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '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': '3.6', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, '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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.4', 'valuenum': 16.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '30.9', 'valuenum': 30.9, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.1', 'valuenum': 16.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', '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': '5.8', 'valuenum': 5.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, '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': '8', 'valuenum': 8.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '93', 'valuenum': 93.0, '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': '101', 'valuenum': 101.0, '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': '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': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On Admission:\nVS: 99.2 86 123/65 20 100% \nGENERAL: Intubated, sedated\nHEENT: Sclera anicteric, MMM, pupils 5 mm and sluggishly \nreactive to 4 mm bilat\nNECK: supple, JVP not elevated, no LAD \nLUNGS: Clear to auscultation bilaterally, no wheezes, rales, \nrhonchi \nCV: Regular rate and rhythm, normal S1 S2, I/VI systolic murmur \nat apex, no rubs, gallops \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 \nNEURO: Completely unresponsive to painful stimuli, no myoclonic \njerks observed\n\nOn Discharge:\nVS - 98.4 HR 68 153/90 97% RA.\nGeneral: Appears comfortable. Oriented x3.\nHEENT: small ulcer on underside of tongue. \nCV: regular, borderline tach. no murmurs. \nLungs: BS reduced at bases. bronchial breath sounds in mid lung \nfields bilaterally. \nAbdomen: Much less tense, minimally distended, non-tender. Bowel \nsounds normoactive. non-tender this AM. \nExt: WWP. No edema in upper extremities.\nSkin: No obvious lesions ', 'diagnoses': [{'icd_code': '1628', 'desc': 'Malignant neoplasm of other parts of bronchus or lung'}, {'icd_code': '486', 'desc': 'Pneumonia, organism unspecified'}, {'icd_code': '1987', 'desc': 'Secondary malignant neoplasm of adrenal gland'}, {'icd_code': '42822', 'desc': 'Chronic systolic heart failure'}, {'icd_code': '5771', 'desc': 'Chronic pancreatitis'}, {'icd_code': '4254', 'desc': 'Other primary cardiomyopathies'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '07054', 'desc': 'Chronic hepatitis C without mention of hepatic coma'}], 'summary': "___ 02:24AM BLOOD WBC-6.9 RBC-3.84* Hgb-12.2* Hct-36.4* \nMCV-95 MCH-31.7 MCHC-33.5 RDW-14.5 Plt ___\n___ 02:24AM BLOOD Neuts-80.8* Lymphs-12.5* Monos-5.3 \nEos-1.0 Baso-0.3\n___ 02:24AM BLOOD ___ PTT-28.7 ___\n___ 02:24AM BLOOD Glucose-106* UreaN-18 Creat-1.5* Na-145 \nK-3.0* Cl-111* HCO3-27 AnGap-10\n___ 02:24AM BLOOD ALT-16 AST-22 LD(LDH)-200 AlkPhos-90 \nTotBili-0.4\n___ 02:24AM BLOOD Albumin-3.4* Calcium-7.8* Phos-1.9* \nMg-2.7*\n___ 07:27AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-POS\n___ 06:00PM BLOOD Carbamz-1.3*\n___ 02:23AM BLOOD Type-ART Temp-37.2 Rates-20/ Tidal V-500 \nFiO2-40 pO2-122* pCO2-40 pH-7.43 calTCO2-27 Base XS-2 \nIntubat-INTUBATED\n___ 02:51AM BLOOD Lactate-1.4\n\nMicrobiology:\n___ urine culture - negative\nBlood Cx ___ negative, ___ pending\nsputum culture ___: negative\n\nImaging/Studies:\n___ CXR\nAn ET tube is present, tip approximately 3.8 cm above the \ncarina, at the level of the mid/lower clavicular heads. An NG \ntube is present -- the distal portion of the tube is poorly seen \ndue to underpenetration. Its position is difficult to confirm. \nConsider repeat film centered at the diaphragm, with increased \npenetration. However, it does appear to extend beneath the \ndiaphragm. A right subclavian central line tip overlies the \ndistal SVC. \nTubing, which appears slightly coiled overlying the lower neck, \ncould either lie within or outside of the patient. Clinical \ncorrelation is requested. \nNo CHF, focal infiltrate, or effusion is detected. No \npneumothorax is \nidentified. \nAir is seen in the left upper quadrant off the abdomen, question \ncombination of gastric and colonic air. \nRounded density at the expected site of the right humerus \nsuggests a shoulder arthroplasty, not fully evaluated. \n\n___ CT Head without contrast\nThere is no evidence of hemorrhage, edema, mass effect, or acute \ninfarction. Ventricles and sulci are normal in size and \nconfiguration. Basal cisterns are patent. Gray-white matter \ndifferentiation is preserved. \nNo fracture is identified. Partially imaged paranasal sinuses \ndemonstrate mild mucosal thickening of the ethmoid air cells and \nthe right sphenoid sinus. There is fluid opacification of a few \nair cells at the mastoid apices, bilaterally. There is no fluid \nin either middle ear cavity. Orbits are unremarkable. \n\n___ EEG\nThis is an abnormal continuous ICU video EEG monitoring study \ndue\nto the presence of a slow background, bursts of frontal \nintermittent rhythmic delta activity, and rare bifrontally \npredominant triphasic waves. These findings indicate a diffuse \nencephalopathy which implies widespread cerebral dysfunction but \nis non-specific as to etiology. Over the course of the \nrecording, the background activity improves. No epileptiform \nfeatures are seen at any time.\n\n___ CXR\nNew small vague left lung base airspace opacity which may be due \nto infection or aspiration.\n\n___ CXR\nRight PICC line tip is at the level of cavoatrial junction. \nHeart size and\nmediastinum are unchanged. Left lower lung opacity is still \npresent,\npotentially representing atelectasis although infection is a \npossibility. The stomach continues to be substantially distended \nand the opacity might reflect atelectasis due to elevated left \nhemidiaphragm. Stoma decompression might be considered with \nreassessment of the chest x-ray afterwards.\n\n___ CXR: In comparison with the study of ___, there is \nlittle change in the \nappearance of the heart and lungs. There is still some \nprominence of the \ndilated gas-filled stomach, although it is much less than on the \nprevious \nstudy. \n\n___ KUB: Diffuse bowel dilitation, consistent with ileus. No \nfree air. \nThe study and the report were reviewed by the staff radiologist. \n\n\n___ RUE doppler: no DVT\n\nDischarge labs:\n___ 07:20AM BLOOD WBC-4.3 RBC-3.36* Hgb-10.7* Hct-32.6* \nMCV-97 MCH-31.9 MCHC-32.9 RDW-14.7 Plt ___\n___ 07:20AM BLOOD Plt ___\n___ 07:20AM BLOOD Glucose-244* UreaN-20 Creat-0.7 Na-140 \nK-4.4 Cl-105 HCO3-25 AnGap-14\n___ 07:20AM BLOOD Calcium-9.0 Phos-3.8 Mg-1.8\n___ 07:05AM BLOOD TotBili-0.3\nMr. ___ is a ___ w/ T1DM (c/b bilateral hip and shoulder \navascular necrosis s/p joint replacements) on an insulin pump, \nprior Hx of EtOH abuse (reportedly hasn't drank in years), who \npresented to the ___ MICU from ___ after a suicide \nattempt by quetiapine overdose with seizures and concern for \nstatus epilepticus. He was intubated and stabilized using \npropofol and a short Keppra burst/taper. He was extubated and \ndischarged to the floor, where he was treated for HAP and ileus. \nOnce medically stable he was discharged to an inpatient \npsychiatric facility for further treatment. "}}
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{'final_diagnoses': ['Seroquel overdose', 'seizures', 'hospital-acquired pneumonia', 'Ileus', 'Diabetes Mellitus'], 'procedures': ['intubation/mechanical ventilation'], 'visit_summary': "Mr. ___ is a ___ w/ T1DM (c/b bilateral hip and shoulder \navascular necrosis s/p joint replacements) on an insulin pump, \nprior Hx of EtOH abuse (reportedly hasn't drank in years), who \npresented to the ___ MICU from ___ after a suicide \nattempt by quetiapine overdose with seizures and concern for \nstatus epilepticus. He was intubated and stabilized using \npropofol and a short Keppra burst/taper. He was extubated and \ndischarged to the floor, where he was treated for HAP and ileus. \nOnce medically stable he was discharged to an inpatient \npsychiatric facility for further treatment. ", 'medications_prescribed': ['Glargine 30 Units Breakfast\nGlargine 30 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Lisinopril 40 mg PO DAILY ', 'Omeprazole 20 mg PO DAILY ', 'Guaifenesin ___ mL PO Q6H:PRN cough ', 'Levofloxacin 750 mg PO DAILY \nLast day of antibiotics: ___ ', 'Lorazepam 2 mg IV Q4H:PRN myoclonic jerks ', 'Nicotine Patch 14 mg TD DAILY:PRN cravings ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 49, 'gender': 'M', 'symptoms': 'chest pain', 'medical_history': ['Aortic Stenosis', 'Hypothyroidism', 'Lyme disease- reports diagnosed in ___; has left arm weakness; history of "brain lesions" seen on CT scan in ___; has been intermittently on antibiotics for years', 'Psoriasis'], 'family_history': 'Father - lung cancer', 'present_illness': '___ recently found to have heart murmur on exam in ___. \nEcho revealed severe aortic stenosis. She subsequently \ndeveloped chest discomfort with exertion. She previously walked \n6x a week and now is unable to do so because of the chest pain. \nCardiac cath at ___ did not reveal any\nsignificant CAD. She is transferred for evaluation of AVR. \nAdditional workup done includes CXR and CT scan for RUL \npulmonary nodule, with recommendations to repeat CT chest in 6 \nmonths.\nShe denies shortness of breath, chest pain. No history of \nsyncope.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Duloxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Golytely', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol', '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': '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: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 via patient discharge', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol', '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': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ropinirole HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QAM', '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': 'Mirapex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}]}, 'clinical_findings': {'labs': [{'value': '27.8', 'valuenum': 27.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '189', 'valuenum': 189.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.23', 'valuenum': 3.23, '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': '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': '26.0', 'valuenum': 26.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '13.3', 'valuenum': 13.3, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.0', 'valuenum': 25.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27.5', 'valuenum': 27.5, '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': '30.6', 'valuenum': 30.6, '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': '175', 'valuenum': 175.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.19', 'valuenum': 3.19, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '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': '112', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '20', 'valuenum': 20.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': 'GREATER THAN 20.'}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '244', 'valuenum': 244.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '188', 'valuenum': 188.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', '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': '486', 'valuenum': 486.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, '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': '9.8', 'valuenum': 9.8, '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': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '183', 'valuenum': 183.0, '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': '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': '8.1', 'valuenum': 8.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '113', 'valuenum': 113.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, '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': '180', 'valuenum': 180.0, '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': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Pulse: 68 Resp: 18 O2 sat: 95 % RA\nB/P ___\nHeight: 64" Weight: 165lb\n\n___:\nSkin: Dry [] intact [X]\nHEENT: PERRLA [X] EOMI [X]\nNeck: Supple [X] Full ROM [X]\nChest: Lungs clear bilaterally [X]\nHeart: RRR [X] Irregular [] Murmur [X] grade __5/6 SEM____ \nAbdomen: Soft [X] non-distended [X] non-tender [X] bowel sounds\n+\n[]\nExtremities: Warm [X], well-perfused [X] Edema [] _____\nVaricosities: None [X]\nNeuro: Left arm ___\nPulses:\nFemoral Right: 2+ Left: 1+\nDP Right: 2+ Left: 1+\n___ Right: 2+ Left: 1+\nRadial Right: 2+ Left: 2+\n\nCarotid Bruit: transmitted SEM', 'diagnoses': [{'icd_code': '5579', 'desc': 'Unspecified vascular insufficiency of intestine'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '5693', 'desc': 'Hemorrhage of rectum and anus'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '27652', 'desc': 'Hypovolemia'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '32723', 'desc': 'Obstructive sleep apnea (adult)(pediatric)'}, {'icd_code': '4550', 'desc': 'Internal hemorrhoids without mention of complication'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': '___ 03:20AM BLOOD WBC-8.6 RBC-2.86* Hgb-8.8* Hct-27.1* \nMCV-95 MCH-30.8 MCHC-32.5 RDW-13.2 RDWSD-45.7 Plt ___\n___ 03:20AM BLOOD ___ PTT-28.6 ___\n___ 03:20AM BLOOD Glucose-110* UreaN-16 Creat-0.8 Na-138 \nK-4.6 Cl-98 HCO3-32 AnGap-8*\n\nFindings \nLEFT ATRIUM: Normal LA size. \n\nRIGHT ATRIUM/INTERATRIAL SEPTUM: Normal RA size. No ASD or PFO \nby 2D, color Doppler or saline contrast with maneuvers. \n\nLEFT VENTRICLE: Mild symmetric LVH. Normal LV cavity size. \nOverall normal LVEF (>55%). \n\nRIGHT VENTRICLE: Normal RV chamber size and free wall motion. \n\nAORTA: Mildly dilated ascending aorta. Focal calcifications in \nascending aorta. Normal descending aorta diameter. Focal \ncalcifications in descending aorta. \n\nAORTIC VALVE: Severely thickened/deformed aortic valve leaflets. \nSevere AS (area <1.0cm2). Trace AR. \n\nMITRAL VALVE: Mildly thickened mitral valve leaflets. Mild (1+) \nMR. \n\n___ VALVE: Mild [1+] TR. \n\nPULMONIC VALVE/PULMONARY ARTERY: Physiologic (normal) PR. \n\nPERICARDIUM: No pericardial effusion. \n\n___ COMMENTS: Informed consent was obtained. The patient was \nunder ___ anesthesia throughout the procedure. The TEE probe \nwas passed with assistance from the anesthesioology staff using \na laryngoscope. No TEE related complications. \n\nREGIONAL LEFT VENTRICULAR WALL MOTION: \n\nBasal InferoseptalBasal AnteroseptalBasal Anterior\nBasal InferiorBasal InferolateralBasal Anterolateral Mid \nInferoseptalMid AnteroseptalMid Anterior\nMid InferiorMid InferolateralMid Anterolateral Septal \nApexAnterior Apex\nInferior ApexLateral Apex Apex \n \n N = Normal, H = Hypokinetic, A = Akinetic, D = Dyskinetic \n\nConclusions \npre bypass: The left atrium is normal in size. No atrial septal \ndefect or patent foramen ovale is seen by 2D, color Doppler. \nThere is mild symmetric left ventricular hypertrophy. The left \nventricular cavity size is normal. Overall left ventricular \nsystolic function is normal (LVEF>55%). Right ventricular \nchamber size and free wall motion are normal. The ascending \naorta is mildly dilated. The aortic valve leaflets are severely \nthickened/deformed. There is severe aortic valve stenosis (valve \narea 0.58 cm2 using VTI). Trace aortic regurgitation is seen. \nThe mitral valve leaflets are mildly thickened. Mild (1+) mitral \nregurgitation is seen. There is no pericardial effusion.\n\n Post bypass:\n 1. On PE, AV pacing\n 2. AV: no perivalvular leak appreciated, tissue leaflets seen \nopening on AoSAX, peak and mean gradients ___. \n 3. Global RV/LV systolic function unchanged.\n 4. Remainder of pre bypass exam unchanged.\n 5. Results diuscused with surgical team. \nThe patient was brought to the Operating Room on ___ \nwhere the patient underwent tissue AVR with 21 mm ___ \nValve via median sternotomy. Overall the patient tolerated the \nprocedure well and post-operatively was transferred to the CVICU \nin stable condition for recovery and invasive monitoring. \n POD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable. The patient was gently diuresed \ntoward the preoperative weight. The patient was transferred to \nthe telemetry floor for further recovery. Her post operative \ncourse was complicated by complete heart block and the EP \nservice was consulted. The decision was made to place a dual \nchamber pacer and this was placed on ___ (see details \nbelow). Beta blocker was initiated after permanent pacemaker \nplacement and the.Chest tubes and pacing wires were discontinued \nwithout complication. The patient was evaluated by the physical \ntherapy service for assistance with strength and mobility. By \nthe time of discharge on POD 6 the patient was ambulating \nfreely, the wound was healing and pain was controlled with oral \nanalgesics. of note, her surgery was postponed due a rash under \nher breasts and she was seen by Infectious disease, who felt \nthat this was her psoriasis. Dermatology was then consulted and \nthey felt the rash was consistent with inverse psoriasis, with \nvery low concern for infectious etiology. They recommended \ncalcipotriene cream BID to plaques and she was restarted on her \ndicloxacillin and fluconazole. '}}
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{'final_diagnoses': ['Aortic Stenosis', 'Hypothyroidism', 'Lyme disease- reports diagnosed in 1990s; has left arm weakness; \n\nhistory of "brain lesions" seen on CT scan in 1990s; has been \nintermittently on antibiotics for years', 'Psoriasis'], 'procedures': ['s/p AVR(21mm tissue) ___', 's/p permanent pacermaker placement ___'], 'visit_summary': 'The patient was brought to the Operating Room on ___ \nwhere the patient underwent tissue AVR with 21 mm ___ \nValve via median sternotomy. Overall the patient tolerated the \nprocedure well and post-operatively was transferred to the CVICU \nin stable condition for recovery and invasive monitoring. \n POD 1 found the patient extubated, alert and oriented and \nbreathing comfortably. The patient was neurologically intact \nand hemodynamically stable. The patient was gently diuresed \ntoward the preoperative weight. The patient was transferred to \nthe telemetry floor for further recovery. Her post operative \ncourse was complicated by complete heart block and the EP \nservice was consulted. The decision was made to place a dual \nchamber pacer and this was placed on ___ (see details \nbelow). Beta blocker was initiated after permanent pacemaker \nplacement and the.Chest tubes and pacing wires were discontinued \nwithout complication. The patient was evaluated by the physical \ntherapy service for assistance with strength and mobility. By \nthe time of discharge on POD 6 the patient was ambulating \nfreely, the wound was healing and pain was controlled with oral \nanalgesics. of note, her surgery was postponed due a rash under \nher breasts and she was seen by Infectious disease, who felt \nthat this was her psoriasis. Dermatology was then consulted and \nthey felt the rash was consistent with inverse psoriasis, with \nvery low concern for infectious etiology. They recommended \ncalcipotriene cream BID to plaques and she was restarted on her \ndicloxacillin and fluconazole. ', 'medications_prescribed': ['1. Acetaminophen ___ mg PO Q6H:PRN Pain - Mild', '2. Clindamycin 300 mg PO Q6H Duration: 1 Day', '3. DiCLOXacillin 500 mg PO BID', '4. Docusate Sodium 100 mg PO BID', '5. Fluconazole 100 mg PO Q24H', '6. Furosemide 20 mg PO DAILY Duration: 5 Days', '7. HYDROmorphone (Dilaudid) 2 mg PO Q3H:PRN Pain - Moderate \nDuration: 3 Days \nRX *hydromorphone [Dilaudid] 2 mg 1 tablet(s) by mouth q3h PRN \nDisp #*20 Tablet Refills:*0', '8. Metoprolol Tartrate 12.5 mg PO BID', '9. Senna 17.2 mg PO BID:PRN constipation', '10. Aspirin EC 81 mg PO DAILY', '11. Atorvastatin 10 mg PO QPM', '12. Calcipotriene 0.005% Cream 1 Appl TP BID', '13. Cyanocobalamin 500 mcg PO DAILY', '14. Levothyroxine Sodium 50 mcg PO DAILY', '15. QUEtiapine Fumarate 100 mg PO QHS', '16. Thyroid 60 mg PO DAILY', '17. Vitamin D 800 UNIT 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': 'Requesting detox.', 'medical_history': ['- HIV infection. Diagnosed ___ and started on HAART. CD4 count\nwas in 400 range and viral load undetectable. Recent poor\ncompliance with medications secondary to alcohol abuse. Viral\nload 2500 and CD4 191. Stopped drinking alcohol and has been\nrestarted on HIV therapy since late ___ reports taking HAART \nand compliance on admission', '- Alcohol abuse x ___ years. Previous admissions to ___ for \nwithdrawal', '- Depression, anxiety', '- bilateral knee pain being evaluated by orthopedics; \npatellofemoral chondrosis'], 'family_history': 'Father died from complications of alcohol abuse. Mother is alive \nand well, brother is healthy.', 'present_illness': 'Mr. ___ is a ___ with h/o EtOH abuse, HIV, who presents with \nEtOH intoxication.\n\nHe reports coming increasing alcohol use and desire to stop. He \ndrinks 1pint vodka per day for the past 5 days. The week prior \nhe had been sober for a week. He was recently admitted to ___ ~ \n2 weeks ago for alcohol withdrawal. He reports 5 previous ICU \nadmissions for alcohol withdrawal including seizures. His last \ndrink was on ___ at 4pm. He feels anxious, has palpitations \nassociated with SOB, also with nausea and stomach cramps. He \nfeels slightly feverish with chills. He reports diarrhea, dark, \n3 days ago. He hasn\'t had anything to eat for 5 days except for \nTrader Joes echinacea drink. He is nervous about his health. He \nreports feeling shaky now and only some relief from the \nlorazepam in the ED. Also reports seen a "brown spot" floating \nearlier. His has had hallucinations in the past, such as, "white \ncartoons." He feels depressed and in the past has had thoughts \nof hurting himself, but does not have any active thoughts now. \nInitial VS in the ED: 98.6 116 ___ 98% RA. \nExam notable for intoxicated, unkempt. Labs notable for serum \nEtoH 321, WBC 2.8, Hgn 13.7, Plt 36, INR 0.9, AG 14. \nPatient was given lorazepam 2mg IV x3. Also given zofran and \n2LNS but not yet given thiamine or vitamins. \nVS prior to transfer: HR 92 119/66 18 98%. \n\nOn the floor, he feels anxious and shaky. He says he can\'t get \nthe hiccups to stop. During his last admission to ___ he says he \nwas started on Keppra, but he is unsure of the dose, for \nseizures. He denies any co-ingestions. \nReview of systems: \n(+) Per HPI. Also reports falling prior to last admission to \n___, but none recently. Also reports sore throat. \n(-) Denies cough, chest pain or tightness. Denied vomiting. No \nrecent change in bowel or bladder habits. No dysuria. Denied \narthralgias or myalgias.', 'medications': [{'medication': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', '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': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Nortriptyline', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'ADMISSION Physical Exam:\nVitals: T: 98.8 BP: 146/89 P: 107 R: 18 O2: 97%RA\nGeneral: mildly fatigued, mildly anxious, slightly unkempt, NAD, \nfrequently hiccuping\nHEENT: PERRL, few beats of nystagmus to extremes of lateral \ngaze, EOMI, NCAT, dry MM\nNeck: supple, no JVD\nCV: tachycaric, regular, nl S1 S2, no murmurs\nLungs: no use of accessory muscles, CTAB\nAbdomen: +BS, soft, NTND, no HSM\nExt: warm, dry, no ___: A&Ox3, CN2-12 intact, ___ strength, intact finger to nose \nbut with slight dysmetria of L>R, no dysdiadochokinesia, mild \ntremor to outstretched hands, intact heel to shin, gait deferred\nSkin: ~ 3cm ecchymoses on left back\n\nDISCHARGE exam\nGeneral- appears comfortable, alert, oriented, no acute \ndistress, well nourished\nHEENT- Sclera anicteric, MMM, oropharynx clear\nNeck- supple, JVP not elevated, no LAD\nLungs- CTA bilaterally\nCV- RR no m/r/g\nAbdomen- soft, no rebound, no hepatomegaly\nGU- no foley\nExt- warm, no pedal edema\nNeuro- moving all 4 extremities, answers appropriately, speech \nis fluent, faint bilateral coarse tremor of arms. Able to climb \nout of bed with all 4 side rails up and walk down the hallway \nwithout any difficulty or loss of balance.\nSkin: hypopigemented macule 2cm circular on L forearm, \necchymoses on back', 'diagnoses': [{'icd_code': 'N8110', 'desc': 'Cystocele, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'N393', 'desc': 'Stress incontinence (female) (male)'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'N3641', 'desc': 'Hypermobility of urethra'}, {'icd_code': 'H409', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'R7309', 'desc': 'Other abnormal glucose'}], 'summary': 'ADMISSION LABS\n___ 07:40PM BLOOD WBC-2.8* RBC-4.19* Hgb-13.7* Hct-39.1* \nMCV-93 MCH-32.7* MCHC-35.1* RDW-12.7 Plt Ct-36*\n___ 07:40PM BLOOD Neuts-44.2* Lymphs-48.0* Monos-5.4 \nEos-0.8 Baso-1.6\n___ 07:40PM BLOOD ___ PTT-29.5 ___\n___ 07:40PM BLOOD Glucose-102* UreaN-5* Creat-0.8 Na-144 \nK-3.5 Cl-96 HCO3-35* AnGap-17\n___ 07:40PM BLOOD ALT-172* AST-256* AlkPhos-112 \nTotBili-1.6*\n___ 07:40PM BLOOD Lipase-39\n___ 07:40PM BLOOD Albumin-5.3* Calcium-9.6 Phos-3.2 Mg-2.0\n___ 07:40PM BLOOD ___\n\nDISCHARGE LABS\n___ 06:24AM BLOOD WBC-2.3* RBC-3.67* Hgb-11.8* Hct-34.9* \nMCV-95 MCH-32.0 MCHC-33.7 RDW-12.1 Plt Ct-58*#\n___ 06:24AM BLOOD ___\n___ 06:24AM BLOOD Glucose-97 UreaN-9 Creat-0.8 Na-135 K-4.2 \nCl-96 HCO3-31 AnGap-12\n___ 06:24AM BLOOD ALT-108* AST-118* AlkPhos-113 \nTotBili-3.4*\n___ 08:30AM BLOOD Albumin-4.6 Phos-2.3* Mg-1.7\n\nOTHER PERTINENT LABS\n___ 08:25AM BLOOD Hypochr-NORMAL Anisocy-NORMAL Poiklo-1+ \nMacrocy-1+ Microcy-NORMAL Polychr-NORMAL Ovalocy-1+\n___ 08:25AM BLOOD WBC-1.8* Lymph-26 Abs ___ CD3%-79 \nAbs CD3-371* CD4%-38 Abs CD4-177* CD8%-40 Abs CD8-189* \nCD4/CD8-0.9\n___ 07:35AM BLOOD VitB12-378\n___ 03:45PM BLOOD Hapto-47\n___ 07:35AM BLOOD HBsAb-POSITIVE HBcAb-POSITIVE HAV \nAb-POSITIVE\n___ 08:25AM BLOOD Bnzodzp-POS Barbitr-NEG\n___ 07:35AM BLOOD HCV Ab-NEGATIVE\n\nURINE STUDIES\n___ 05:28PM URINE bnzodzp-POS barbitr-NEG opiates-NEG \ncocaine-NEG amphetm-NEG mthdone-NEG\n\nSTUDIES\nEKG\nSinus tachycardia. Non-diagnostic Q waves inferiorly. Early R \nwave transition. Non-specific ST segment changes. No previous \ntracing available for comparison.\n___\n___\nBRIEF HOSPITAL COURSE\n================\nMr. ___ is a ___ with h/o EtOH abuse, HIV, depression, who \npresents with EtOH intoxication, admitted due to alcohol \nwithdrawal and cytopenias. He has leukopenia and \nthrombocytopenia. He was confirmed to have leukopenia and \nthrombocytopenia by ___ records, though platelets on this \nadmission were lower. He was also noted to have transaminitis \nand elevated bilirubin, which was attributed to alcohol abuse vs \nHAART side effects. Alcohol withdrawal was treated with \ndiazepam. He was seen by social work and had a plan to abstain \nwith help from SW at ___. Of note, his Hepatitis B core \nantibody returned positive after discharge; he did not report a \nhistory of this to his ID physician or to us; recommend HBsAg as \noutpatient.\n\nACTIVE ISSUES\n=========\n# Alcohol withdrawal: On initial presentation, he was \nintoxicated, but began to withdraw once he was admitted to the \nfloor. Given his history of withdrawal requiring admissions to \nICU for seizures, and DTs (white cartoons on the ceiling) he was \non Q1hr CIWA scale. He required substantial doses of benzos \nfrom his CIWA scale. His symptoms improved and he was out of \nthe window of withdrawal prior to discharge. He was insistent \nseen by Social work and felt that he would do best with ___ \nbased social work and therapy. He was given a list of numbers \nfrom Fast Path at ___, in adission number for ___, \nand a list of all AA meetings in the area per his request. He \nwas also managed with thiamine, multivitamin, and folic acid.\n\n# Transaminitis: Per ___ records faxed by PCP office, he did not \nhave significant transaminitis in the past. On admission his \nALT/AST were elevated 100s/200s, and tbili 1.6. His discrimant \nfunction was 3. He had a RUQ US that showed liver diffusely \nincreased in echogenicity consistent with fatty deposition, \nsplenomegaly, sludge in the gallbladder with no evidence of \ncholecystitis. His HBV sAb (returned after discharge) and cAb \nwere positive. It was recommended that he have a HBV sAg \nchecked.\n\n# Indirect Hyperbilirubinemia: See above for RUQ US results. His \ntbili continued to rise to 5.1. An indirect bili was checked \nand noted to be 4.1, thus his hyperbilirubinemia was \npredominantly indirect. LDH and haptoglobin was not consistent \nwith hemolysis. It was felt that his indirect \nhyperbilirubinemia could be secondary to his atazanivir which he \nis largely non-compliant with as an outpatient but was receiving \nas an inpatient. His outpatient ID physician was contacted \nregarding this and it was recommended that he continue on his \ncurrent regimen and the same doses. His tbili on discharge was \n3.9; he was told to follow up with his outpatient ID physician.\n\n# Leukopenia, thrombocytopenia: Overall, this is most likely \nfrom HIV vs alcohol toxicity vs medication effect (HAART). He \nwas close to his baseline (outpatient labs from ___ showed \nthrombocytopenia in ___, had no evidence of bleeding.\n\nCHRONIC ISSUES\n===========\n# Depression: Endorsed depression and anxiety currently, but \ndenied SI. Continued lexapro, wellbutrin; he was also seen by \nPsych nurse and social work.\n\n# HIV: He reports compliance intermittently with his HAART \nmedications when he is not drinking. We continued norvir, \ntruvada, reyataz. CD4 count was 371.\n\nTRANSITIONAL ISSUES\n==============\n# Code: Full code, confirmed.\n- Studies pending on discharge: Hepatitis B core antibody \nreturned positive and S antibody positive. He should have a \nHBsAg checked as an outpatient.\n- Please check a follow up LFT panel, including albumin, alk \nphos, and direct and total bili. RUQ U/S showed evidence of \ncirrhosis, please consider outpatient workup of cirrhosis vs \nreferral to hepatology (may need EGD, biopsy, etc). \n- Please check t bili and indirect bili; consider tailoring \nHAART. We notified Dr. ___ email after discharge.'}}
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{'final_diagnoses': ['Alcohol withdrawal', 'Alcohol intoxication, elevated LFTs'], 'procedures': ['None.'], 'visit_summary': 'BRIEF HOSPITAL COURSE\n================\nMr. ___ is a ___ with h/o EtOH abuse, HIV, depression, who \npresents with EtOH intoxication, admitted due to alcohol \nwithdrawal and cytopenias. He has leukopenia and \nthrombocytopenia. He was confirmed to have leukopenia and \nthrombocytopenia by ___ records, though platelets on this \nadmission were lower. He was also noted to have transaminitis \nand elevated bilirubin, which was attributed to alcohol abuse vs \nHAART side effects. Alcohol withdrawal was treated with \ndiazepam. He was seen by social work and had a plan to abstain \nwith help from SW at ___. Of note, his Hepatitis B core \nantibody returned positive after discharge; he did not report a \nhistory of this to his ID physician or to us; recommend HBsAg as \noutpatient.\n\nACTIVE ISSUES\n=========\n# Alcohol withdrawal: On initial presentation, he was \nintoxicated, but began to withdraw once he was admitted to the \nfloor. Given his history of withdrawal requiring admissions to \nICU for seizures, and DTs (white cartoons on the ceiling) he was \non Q1hr CIWA scale. He required substantial doses of benzos \nfrom his CIWA scale. His symptoms improved and he was out of \nthe window of withdrawal prior to discharge. He was insistent \nseen by Social work and felt that he would do best with ___ \nbased social work and therapy. He was given a list of numbers \nfrom Fast Path at ___, in adission number for ___, \nand a list of all AA meetings in the area per his request. He \nwas also managed with thiamine, multivitamin, and folic acid.\n\n# Transaminitis: Per ___ records faxed by PCP office, he did not \nhave significant transaminitis in the past. On admission his \nALT/AST were elevated 100s/200s, and tbili 1.6. His discrimant \nfunction was 3. He had a RUQ US that showed liver diffusely \nincreased in echogenicity consistent with fatty deposition, \nsplenomegaly, sludge in the gallbladder with no evidence of \ncholecystitis. His HBV sAb (returned after discharge) and cAb \nwere positive. It was recommended that he have a HBV sAg \nchecked.\n\n# Indirect Hyperbilirubinemia: See above for RUQ US results. His \ntbili continued to rise to 5.1. An indirect bili was checked \nand noted to be 4.1, thus his hyperbilirubinemia was \npredominantly indirect. LDH and haptoglobin was not consistent \nwith hemolysis. It was felt that his indirect \nhyperbilirubinemia could be secondary to his atazanivir which he \nis largely non-compliant with as an outpatient but was receiving \nas an inpatient. His outpatient ID physician was contacted \nregarding this and it was recommended that he continue on his \ncurrent regimen and the same doses. His tbili on discharge was \n3.9; he was told to follow up with his outpatient ID physician.\n\n# Leukopenia, thrombocytopenia: Overall, this is most likely \nfrom HIV vs alcohol toxicity vs medication effect (HAART). He \nwas close to his baseline (outpatient labs from ___ showed \nthrombocytopenia in ___, had no evidence of bleeding.\n\nCHRONIC ISSUES\n===========\n# Depression: Endorsed depression and anxiety currently, but \ndenied SI. Continued lexapro, wellbutrin; he was also seen by \nPsych nurse and social work.\n\n# HIV: He reports compliance intermittently with his HAART \nmedications when he is not drinking. We continued norvir, \ntruvada, reyataz. CD4 count was 371.\n\nTRANSITIONAL ISSUES\n==============\n# Code: Full code, confirmed.\n- Studies pending on discharge: Hepatitis B core antibody \nreturned positive and S antibody positive. He should have a \nHBsAg checked as an outpatient.\n- Please check a follow up LFT panel, including albumin, alk \nphos, and direct and total bili. RUQ U/S showed evidence of \ncirrhosis, please consider outpatient workup of cirrhosis vs \nreferral to hepatology (may need EGD, biopsy, etc). \n- Please check t bili and indirect bili; consider tailoring \nHAART. We notified Dr. ___ email after discharge.', 'medications_prescribed': ['1. Atazanavir 300 mg PO DAILY', '2. BuPROPion (Sustained Release) 100 mg PO QAM', '3. Emtricitabine-Tenofovir (Truvada) 1 TAB PO DAILY', '4. Escitalopram Oxalate 30 mg PO DAILY', '5. FoLIC Acid 1 mg PO DAILY', '6. LeVETiracetam 750 mg PO BID', '7. Multivitamins 1 TAB PO DAILY', '8. RiTONAvir 100 mg PO DAILY', '9. Thiamine 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': 46, 'gender': 'F', 'symptoms': 'abdominal discomfort, pressure and gas pains', 'medical_history': ['Atrial fibrillation', 'hypertension', 'gastroesophageal reflux disease', 'osteopenia', 'pituitary adenoma', 'history of supraventricular tachycardia', 'varicose veins', 'hypothyroidism and history of a small bowel obstruction at ___ in ___ relieved non-surgically', 'A complete \nreview\nof systems was notable for fatigue, some chronic visual changes\nand constipation, history of rectal bleeding in the past, not\ncurrently active, abdominal pain related to her recent symptoms\nand easy bruising', 'All other remaining systems were negative.'], 'family_history': 'Sister with a history of stage II colon cancer\ndiagnosed in ___, doing well now. Mother, history of high \nblood\npressure; father and two brothers with history of cardiac\ndisease, both of her brothers are deceased from cardiac\nconditions. No known history of breast, ovarian, or uterine\ncancers.', 'present_illness': '___ is a lovely ___ gravida 0 who\npresented with symptoms of abdominal discomfort, pressure and \ngas\npains that all began in the weeks following the holidays. Prior\nto this, the patient reports feeling in her normal state of\nhealth. You evaluated the patient and in the course of that\nevaluation obtained a CT scan at ___ on ___\nfindings from that CT scan are concerning for ovarian cancer \nwith\nascites, omental cake, extensive peritoneal carcinomatosis, a\nlarge presumed right ovarian mass measuring 10 x 6 x 7 cm in\naddition to a liver capsular solid deposit measuring 2.5 x 2 x 1\ncm. The lung bases were largely clear, but a small right \npleural\neffusion was noted. Given the findings on the CT scan, she was\nreviewed to our Gynecologic Oncology practice for further workup\nof a presumed ovarian cancer.\n\nToday, the patient reports that she continues to have the\nabdominal symptoms described above but is otherwise feeling \nwell.\nShe is tolerating a regular diet. She reports normal bowel\nfunction for her, which is constipation at baseline for which \nshe\ntakes Colace and laxative. No urinary symptoms. No fevers,\nchills, nausea, vomiting or other concerning symptoms. Of note,\non the CT scan, there was evidence of diverticulosis and no \nbowel\nobstruction. ', 'medications': [{'medication': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Morphine Sulfate', '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': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Fosphenytoin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Fentanyl Citrate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Infusion – Comfort Care Guidelines', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'Q72H', 'doses_per_24_hrs': 0.0}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': 0.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ipratropium Bromide MDI', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LeVETiracetam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 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'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.1', 'valuenum': 27.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.1', 'valuenum': 41.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.7', 'valuenum': 23.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '354', 'valuenum': 354.0, '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': '3.73', 'valuenum': 3.73, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'On 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\n___: nontender, nonedematous', 'diagnoses': [{'icd_code': '96500', 'desc': 'Poisoning by opium (alkaloids), unspecified'}, {'icd_code': '78001', 'desc': 'Coma'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '3453', 'desc': 'Grand mal status'}, {'icd_code': '51289', 'desc': 'Other pneumothorax'}, {'icd_code': '80708', 'desc': 'Closed fracture of eight or more ribs'}, {'icd_code': '30471', 'desc': 'Combinations of opioid type drug with any other drug dependence, continuous'}, {'icd_code': '9694', 'desc': 'Poisoning by benzodiazepine-based tranquilizers'}, {'icd_code': '9670', 'desc': 'Poisoning by barbiturates'}, {'icd_code': '97081', 'desc': 'Poisoning by cocaine'}, {'icd_code': '9654', 'desc': 'Poisoning by aromatic analgesics, not elsewhere classified'}, {'icd_code': 'E9800', 'desc': 'Poisoning by analgesics, antipyretics, and antirheumatics, undetermined whether accidentally or purposely inflicted'}, {'icd_code': 'E9803', 'desc': 'Poisoning by tranquilizers and other psychotropic agents, undetermined whether accidentally or purposely inflicted'}, {'icd_code': 'E9801', 'desc': 'Poisoning by barbiturates, undetermined whether accidentally or purposely inflicted'}, {'icd_code': 'E9804', 'desc': 'Poisoning by other specified drugs and medicinal substances, undetermined whether accidentally or purposely inflicted'}, {'icd_code': 'V1253', 'desc': 'Personal history of sudden cardiac arrest'}, {'icd_code': '7905', 'desc': 'Other nonspecific abnormal serum enzyme levels'}, {'icd_code': '4928', 'desc': 'Other emphysema'}, {'icd_code': '2767', 'desc': 'Hyperpotassemia'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'E9888', 'desc': 'Injury by other specified means, undetermined whether accidentally or purposely inflicted'}, {'icd_code': 'E8499', 'desc': 'Accidents occurring in unspecified place'}, {'icd_code': 'E0009', 'desc': 'Unspecified external cause status'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': 'V667'}], 'summary': 'Initial:\n.\n___ 11:55AM BLOOD WBC-8.2 RBC-4.29 Hgb-13.4 Hct-39.9 MCV-93 \nMCH-31.2 MCHC-33.6 RDW-11.9 RDWSD-40.5 Plt ___\n___ 08:00PM BLOOD Glucose-117* UreaN-10 Creat-0.7 Na-136 \nK-4.4 Cl-103 HCO3-17* AnGap-20\n___ 10:09PM BLOOD CK(CPK)-459*\n___ 10:09PM BLOOD CK-MB-5 cTropnT-<0.01\n___ 08:00PM BLOOD Calcium-7.3* Phos-5.1* Mg-1.4*\n.\nOther Pertinent:\n.\n___ 08:00PM BLOOD WBC-11.5* RBC-4.24 Hgb-13.3 Hct-40.7 \nMCV-96 MCH-31.4 MCHC-32.7 RDW-11.9 RDWSD-41.3 Plt ___\n___ 10:30AM BLOOD WBC-19.5* RBC-4.07 Hgb-12.8 Hct-40.1 \nMCV-99* MCH-31.4 MCHC-31.9* RDW-12.4 RDWSD-44.3 Plt ___\n___ 09:00AM BLOOD WBC-14.2* RBC-3.77* Hgb-11.6 Hct-36.3 \nMCV-96 MCH-30.8 MCHC-32.0 RDW-12.4 RDWSD-44.0 Plt ___\n___ 07:05AM BLOOD WBC-11.3* RBC-4.04 Hgb-12.5 Hct-38.2 \nMCV-95 MCH-30.9 MCHC-32.7 RDW-12.5 RDWSD-43.2 Plt ___\n___ 07:27AM BLOOD WBC-9.8 RBC-3.70* Hgb-11.5 Hct-35.5 \nMCV-96 MCH-31.1 MCHC-32.4 RDW-12.6 RDWSD-44.4 Plt ___\n___:47AM BLOOD WBC-10.6* RBC-3.74* Hgb-11.4 Hct-36.0 \nMCV-96 MCH-30.5 MCHC-31.7* RDW-12.7 RDWSD-44.2 Plt ___\n___ 06:25AM BLOOD WBC-7.6 RBC-3.47* Hgb-10.6* Hct-33.2* \nMCV-96 MCH-30.5 MCHC-31.9* RDW-13.2 RDWSD-45.3 Plt ___\n___ 06:28AM BLOOD WBC-8.0 RBC-3.68* Hgb-11.2 Hct-35.6 \nMCV-97 MCH-30.4 MCHC-31.5* RDW-13.2 RDWSD-46.7* Plt ___\n___ 10:30AM BLOOD Neuts-83.9* Lymphs-6.3* Monos-9.0 \nEos-0.0* Baso-0.3 Im ___ AbsNeut-15.86*# AbsLymp-1.18* \nAbsMono-1.69* AbsEos-0.00* AbsBaso-0.05\n___ 06:34AM BLOOD Neuts-85.5* Lymphs-5.6* Monos-8.3 \nEos-0.0* Baso-0.1 Im ___ AbsNeut-11.41* AbsLymp-0.74* \nAbsMono-1.11* AbsEos-0.00* AbsBaso-0.01\n___ 07:27AM BLOOD Neuts-80.4* Lymphs-8.8* Monos-10.1 \nEos-0.0* Baso-0.4 Im ___ AbsNeut-7.81* AbsLymp-0.85* \nAbsMono-0.98* AbsEos-0.00* AbsBaso-0.04\n___ 05:00AM BLOOD Glucose-116* UreaN-11 Creat-0.8 Na-134 \nK-5.1 Cl-102 HCO3-15* AnGap-22*\n___ 06:34AM BLOOD Glucose-134* UreaN-18 Creat-0.7 Na-129* \nK-4.5 Cl-98 HCO3-25 AnGap-11\n___ 06:52AM BLOOD Glucose-128* UreaN-15 Creat-0.5 Na-129* \nK-4.3 Cl-96 HCO3-25 AnGap-12\n___ 07:05AM BLOOD Glucose-106* UreaN-16 Creat-0.4 Na-135 \nK-4.4 Cl-100 HCO3-25 AnGap-14\n___ 07:27AM BLOOD Glucose-132* UreaN-14 Creat-0.4 Na-137 \nK-3.5 Cl-103 HCO3-27 AnGap-11\n___ 07:47AM BLOOD Glucose-96 UreaN-8 Creat-0.4 Na-138 K-4.0 \nCl-105 HCO3-25 AnGap-12\n___ 06:25AM BLOOD Glucose-121* UreaN-7 Creat-0.4 Na-138 \nK-3.4 Cl-105 HCO3-26 AnGap-10\n___ 06:28AM BLOOD Glucose-107* UreaN-4* Creat-0.4 Na-138 \nK-3.6 Cl-103 HCO3-29 AnGap-10\n___ 10:09PM BLOOD CK(CPK)-459*\n___ 06:25AM BLOOD ALT-9 AST-15\n___ 10:30AM BLOOD Calcium-7.4* Phos-4.9* Mg-2.6\n___ 09:00AM BLOOD Calcium-8.0* Phos-3.2 Mg-2.1\n___ 06:55PM BLOOD Calcium-7.8* Phos-2.8 Mg-1.9\n___ 08:06PM BLOOD Calcium-7.6* Phos-2.7 Mg-2.1\n___ 01:00PM BLOOD Calcium-7.9* Phos-2.2* Mg-1.7\n___ 06:30AM BLOOD Calcium-7.8* Phos-3.2 Mg-2.0\n___ 06:10AM BLOOD Calcium-8.2* Phos-3.9 Mg-1.6\n___ 06:28AM BLOOD Calcium-8.4 Phos-3.9 Mg-1.7\n___ 09:20PM BLOOD Digoxin-0.4*\n___ 05:16PM BLOOD ___ pO2-89 pCO2-43 pH-7.29* \ncalTCO2-22 Base XS--5\n___ 02:59PM BLOOD Lactate-1.2\n___ 01:58PM URINE Color-Yellow Appear-Clear Sp ___\n___ 01:58PM URINE Blood-TR Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-150 Bilirub-NEG Urobiln-2* pH-6.0 Leuks-NEG\n___ 01:58PM URINE RBC-3* WBC-1 Bacteri-NONE Yeast-NONE \nEpi-0\n___ 01:58PM URINE CastHy-38*\n___ 08:06PM URINE Color-Yellow Appear-Hazy Sp ___\n___ 08:06PM URINE Blood-TR Nitrite-NEG Protein-30 \nGlucose-NEG Ketone-150 Bilirub-NEG Urobiln-2* pH-7.5 Leuks-MOD\n___ 08:06PM URINE RBC-1 WBC-49* Bacteri-FEW Yeast-NONE \nEpi-0\n___ 08:06PM URINE CastHy-1*\n___ 10:50 pm URINE Site: NOT SPECIFIED\n\n **FINAL REPORT ___\n\n URINE CULTURE (Final ___: \n PROTEUS VULGARIS. >100,000 ORGANISMS/ML..\n\n SENSITIVITIES: MIC expressed in \nMCG/ML\n \n_________________________________________________________\n PROTEUS VULGARIS\n | \nAMPICILLIN------------ =>32 R\nAMPICILLIN/SULBACTAM-- 8 S\nCEFAZOLIN------------- =>64 R\nCEFEPIME-------------- <=1 S\nCEFTAZIDIME----------- <=1 S\nCEFTRIAXONE----------- <=1 S\nCIPROFLOXACIN---------<=0.25 S\nGENTAMICIN------------ <=1 S\nLEVOFLOXACIN----------<=0.12 S\nMEROPENEM-------------<=0.25 S\nNITROFURANTOIN-------- 128 R\nPIPERACILLIN/TAZO----- <=4 S\nTOBRAMYCIN------------ <=1 S\nTRIMETHOPRIM/SULFA---- <=1 S\n___ 8:56 am STOOL CONSISTENCY: WATERY Source: \nStool. \n\n **FINAL REPORT ___\n\n C. difficile DNA amplification assay (Final ___: \n ___ Reported to and read back by ___ AT 3:00 ___. \n CLOSTRIDIUM DIFFICILE. \n Positive for toxigenic C. difficile by the Illumigene \nDNA\n amplification. (Reference Range-Negative). \n.\nDischarge:\n___ 06:29AM BLOOD WBC-7.8 RBC-3.38* Hgb-10.4* Hct-32.8* \nMCV-97 MCH-30.8 MCHC-31.7* RDW-13.2 RDWSD-46.5* Plt ___\n___ 06:29AM BLOOD Glucose-108* UreaN-7 Creat-0.4 Na-136 \nK-3.8 Cl-101 HCO3-29 AnGap-10\nMs. ___ was admitted to the gynecologic oncology service \nafter undergoing diagnostic laparoscopic converted to open total \nabdominal hysterectomy, bilateral salpingo-oophorectomy, and \nomentectmy with optimal cytoreduction, and intraperitoneal port \nplacement for likely primary peritoneal cancer. Please see the \noperative report for full details. \n\nHer post-operative course is detailed as follows. \n\nIn terms of pain control, immediately postoperatively, her pain \nwas controlled with an epidural managed by the acute pain \nservice. The epidural was removed on post-operative day 5 and \nshe was transitioned to IV acetaminophen and toradol, with IV \ndilaudid as needed for severe pain. She was transitioned to oral \ntylenol and ibuprofen on post-operative day 7 once she was \ntolerating adequate oral intake. \n\nHer diet was advanced to clear liquids by post-operative day 1, \nbut she had nausea and abdominal distention so her diet was \nbacked down to NPO with Pepcid and maintenance IV fluids. On \npost-operative day 2, she had persistent abdominal distention \nconcerning for post-operative ileus and an NGT was placed. Her \nNGT fell out on post-operative day 3 and was replaced. On \npost-operative day 5, her abdominal distention improved and she \nbegan to pass flatus and bowel movements. She passed an NGT \nclamp trial, but the patient continued to report abdominal \ndistention so the NGT remained in place overnight and was \nremoved the next morning following improvement in symptoms of \ndistention. Her diet was slowly advanced as tolerated. On \npost-operative day 6, she had several episodes of loose bowel \nmovements, and in the setting of IV antibiotics (see below), C \ndiff stool culture was sent. At this time, she had no \nleukocytosis, though of note, she had leukocytosis previously on \npost-operative day 1 with negative urinalysis, normal lactate, \nstable EKG, negative troponin, and no signs of infection. C diff \nwas positive on post-operative day 7 and she was started on oral \nmetronidazole with improvement in symptoms. She will continue on \noral metronidazole for 10 days following completion of \nciprofloxacin for her urinary tract infection (see below).\n\nIn terms of her urine output, she initially had a Foley in place \nwhile the epidural was in place. During this time, on \npost-operative day 4, she was started on IV ceftriaxone given UA \nconcerning for a urinary tract infection and two episodes of \ndelirium. She was found to have low urine output on \npost-operative day 5 with resolution following Foley catheter \nreplacement. On post-operative day 6, her urine output was \nadequate so her Foley catheter was removed and she voided \nspontaneously. She was continued on IV ceftriaxone with her \nurine culture growing gram negative rods, speciated to Proteus \nvulgaris, and she was transitioned to oral ciprofloxacin on \npost-operative day 8 to complete a 10 day course of antibiotics \n(to finish on ___. \n\nIn terms of neurological concerns, her post-operative course was \ncomplicated by right upper extremity neuropathy, likely due to \nintra-operative brachial plexus injury. Neurology was consulted \nand she underwent CT and CTA of the head and neck, which showed \nno acute intracracial process and patent vasculature, as well as \nMRI of the head and cervical spine, showing degenerative disease \nof the cervical spine. Neurology recommended physical and \noccupational therapy and follow up with neurology outpatient for \nfurther evaluation. Her neuropathy improved throughout her \nhospital course, and neurology recommended continued \noccupational therapy with range of movement exercises, and \noutpatient follow-up, which was scheduled. Otherwise, as \nmentioned above, she had two episodes of delirium at night-time \nwith confusion but was easily re-oriented and was found to have \nno new neurological deficits and had no further episodes of \ndelirium after post-operative day 4.\n\nShe was monitored on telemetry for her history of persistent \natrial fibrillation. She had atrial fibrillation RVR with \npalpitations on post-operative day 1 that improved with IV \nmetoprolol. Cardiology was consulted. On post-operative day 3, \nshe again had sustained tachycardia with atrial fibrillation and \nwas given IV metoprolol and was started on IV metoprolol while \nshe was not tolerating oral medications. On post-operative day \n___, she was transitioned to home oral digoxin and diltiazem. She \nhad intermittent episodes of tachycardia and her diltiazem \ndosage was increased to 360mg daily per cardiology. Cardiology \nrecommended continuing this regimen on discharge and follow up \noutpatient.\n\nOn post-operative day 6, she developed a maculopapular rash over \nher groin area that was non-tender and not itchy. She was \nstarted on nystatin cream on ___ but the rash worsened, and on \n___, IV ceftriaxone was discontinued for concern of drug rash \n(she was started on ciprofloxacin as per above). Dermatology was \nconsulted and agreed with drug rash from ceftriaxone as etiology \nof rash, and suggested discontinuing nystatin and applying \ntriamcinolone ointment as needed. Her rash improved.\n\nShe was monitored for bilateral pleural effusion but remained \nasymptomatic throughout her hospital course. She was continued \non home medications for hypertension, hypothyroidism and \npituitary adenoma. Her blood glucose was initially monitored \nwith finger-sticks for borderline diabetes mellitus. These \nremained normal and was discontinued. On post-operative day 6, \nshe was noted to have hyperglycemia on routine labs, and \ndextrose was discontinued from her maintenance IV fluids. She \nwas given lovenox, pneumaboots, and incentive spirometry for \nprophylaxis, and will continue lovenox for DVT prophylaxis for \n4 weeks following discharge. \n\nHer staples were removed on post-operative day 10. By \npost-operative day ___, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was discharged to rehab \nfor physical therapy for her right upper extremity, in stable \ncondition with outpatient follow-up scheduled.'}}
|
{'final_diagnoses': ['Malignancy of likely gynecologic origin'], 'procedures': ['Diagnostic laparoscopy converted to exploratory laparotomy', 'extensive lysis of adhesions', 'omentectomy', 'total abdominal hysterectomy', 'bilateral salpingo-oophorectomy', 'plasma jet ablation of tumor implants'], 'visit_summary': 'Ms. ___ was admitted to the gynecologic oncology service \nafter undergoing diagnostic laparoscopic converted to open total \nabdominal hysterectomy, bilateral salpingo-oophorectomy, and \nomentectmy with optimal cytoreduction, and intraperitoneal port \nplacement for likely primary peritoneal cancer. Please see the \noperative report for full details. \n\nHer post-operative course is detailed as follows. \n\nIn terms of pain control, immediately postoperatively, her pain \nwas controlled with an epidural managed by the acute pain \nservice. The epidural was removed on post-operative day 5 and \nshe was transitioned to IV acetaminophen and toradol, with IV \ndilaudid as needed for severe pain. She was transitioned to oral \ntylenol and ibuprofen on post-operative day 7 once she was \ntolerating adequate oral intake. \n\nHer diet was advanced to clear liquids by post-operative day 1, \nbut she had nausea and abdominal distention so her diet was \nbacked down to NPO with Pepcid and maintenance IV fluids. On \npost-operative day 2, she had persistent abdominal distention \nconcerning for post-operative ileus and an NGT was placed. Her \nNGT fell out on post-operative day 3 and was replaced. On \npost-operative day 5, her abdominal distention improved and she \nbegan to pass flatus and bowel movements. She passed an NGT \nclamp trial, but the patient continued to report abdominal \ndistention so the NGT remained in place overnight and was \nremoved the next morning following improvement in symptoms of \ndistention. Her diet was slowly advanced as tolerated. On \npost-operative day 6, she had several episodes of loose bowel \nmovements, and in the setting of IV antibiotics (see below), C \ndiff stool culture was sent. At this time, she had no \nleukocytosis, though of note, she had leukocytosis previously on \npost-operative day 1 with negative urinalysis, normal lactate, \nstable EKG, negative troponin, and no signs of infection. C diff \nwas positive on post-operative day 7 and she was started on oral \nmetronidazole with improvement in symptoms. She will continue on \noral metronidazole for 10 days following completion of \nciprofloxacin for her urinary tract infection (see below).\n\nIn terms of her urine output, she initially had a Foley in place \nwhile the epidural was in place. During this time, on \npost-operative day 4, she was started on IV ceftriaxone given UA \nconcerning for a urinary tract infection and two episodes of \ndelirium. She was found to have low urine output on \npost-operative day 5 with resolution following Foley catheter \nreplacement. On post-operative day 6, her urine output was \nadequate so her Foley catheter was removed and she voided \nspontaneously. She was continued on IV ceftriaxone with her \nurine culture growing gram negative rods, speciated to Proteus \nvulgaris, and she was transitioned to oral ciprofloxacin on \npost-operative day 8 to complete a 10 day course of antibiotics \n(to finish on ___. \n\nIn terms of neurological concerns, her post-operative course was \ncomplicated by right upper extremity neuropathy, likely due to \nintra-operative brachial plexus injury. Neurology was consulted \nand she underwent CT and CTA of the head and neck, which showed \nno acute intracracial process and patent vasculature, as well as \nMRI of the head and cervical spine, showing degenerative disease \nof the cervical spine. Neurology recommended physical and \noccupational therapy and follow up with neurology outpatient for \nfurther evaluation. Her neuropathy improved throughout her \nhospital course, and neurology recommended continued \noccupational therapy with range of movement exercises, and \noutpatient follow-up, which was scheduled. Otherwise, as \nmentioned above, she had two episodes of delirium at night-time \nwith confusion but was easily re-oriented and was found to have \nno new neurological deficits and had no further episodes of \ndelirium after post-operative day 4.\n\nShe was monitored on telemetry for her history of persistent \natrial fibrillation. She had atrial fibrillation RVR with \npalpitations on post-operative day 1 that improved with IV \nmetoprolol. Cardiology was consulted. On post-operative day 3, \nshe again had sustained tachycardia with atrial fibrillation and \nwas given IV metoprolol and was started on IV metoprolol while \nshe was not tolerating oral medications. On post-operative day \n___, she was transitioned to home oral digoxin and diltiazem. She \nhad intermittent episodes of tachycardia and her diltiazem \ndosage was increased to 360mg daily per cardiology. Cardiology \nrecommended continuing this regimen on discharge and follow up \noutpatient.\n\nOn post-operative day 6, she developed a maculopapular rash over \nher groin area that was non-tender and not itchy. She was \nstarted on nystatin cream on ___ but the rash worsened, and on \n___, IV ceftriaxone was discontinued for concern of drug rash \n(she was started on ciprofloxacin as per above). Dermatology was \nconsulted and agreed with drug rash from ceftriaxone as etiology \nof rash, and suggested discontinuing nystatin and applying \ntriamcinolone ointment as needed. Her rash improved.\n\nShe was monitored for bilateral pleural effusion but remained \nasymptomatic throughout her hospital course. She was continued \non home medications for hypertension, hypothyroidism and \npituitary adenoma. Her blood glucose was initially monitored \nwith finger-sticks for borderline diabetes mellitus. These \nremained normal and was discontinued. On post-operative day 6, \nshe was noted to have hyperglycemia on routine labs, and \ndextrose was discontinued from her maintenance IV fluids. She \nwas given lovenox, pneumaboots, and incentive spirometry for \nprophylaxis, and will continue lovenox for DVT prophylaxis for \n4 weeks following discharge. \n\nHer staples were removed on post-operative day 10. By \npost-operative day ___, she was tolerating a regular diet, \nvoiding spontaneously, ambulating independently, and pain was \ncontrolled with oral medications. She was discharged to rehab \nfor physical therapy for her right upper extremity, in stable \ncondition with outpatient follow-up scheduled.', 'medications_prescribed': ['Bromocriptine Mesylate 2.5 mg PO ___ TABLET PO QOD', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium 100 mg 1 capsule(s) by mouth twice a day \nDisp #*50 Capsule Refills:*2', 'Enoxaparin Sodium 60 mg SC Q12H \nStart: ___, First Dose: Next Routine Administration Time \nRX *enoxaparin 60 mg/0.6 mL 60 mg SC every twelve (12) hours \nDisp #*30 Syringe Refills:*0', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Simvastatin 20 mg PO QPM', 'Acetaminophen 650 mg PO TID:PRN pain \nRX *acetaminophen 325 mg 2 tablet(s) by mouth three times a day \nDisp #*50 Tablet Refills:*1', 'Digoxin 0.125 mg PO DAILY', 'Diltiazem Extended-Release 360 mg PO DAILY \nRX *diltiazem HCl 360 mg 1 capsule(s) by mouth DAILY Disp #*30 \nCapsule Refills:*1', 'Ciprofloxacin HCl 500 mg PO Q12H \nPlease take this until ___ \nRX *ciprofloxacin HCl 500 mg 1 tablet(s) by mouth every twelve \n(12) hours Disp #*5 Tablet Refills:*0', 'Ibuprofen 400 mg PO Q8H:PRN pain \ntake with food \nRX *ibuprofen 400 mg 1 tablet(s) by mouth every eight (8) hours \nDisp #*50 Tablet Refills:*1', 'MetRONIDAZOLE (FLagyl) 500 mg PO TID \nPlease take this until ___ \nRX *metronidazole 500 mg 1 tablet(s) by mouth three times a day \nDisp #*38 Tablet Refills:*0', 'Triamcinolone Acetonide 0.1% Ointment 1 Appl TP BID:PRN \nitching Duration: 14 Days \nRX *triamcinolone acetonide 0.1 % apply to affected areas twice \na day Disp #*30 Gram Gram Refills:*0', 'Multivitamins 1 TAB PO DAILY', 'Vitamin D 3000 UNIT PO DAILY']}
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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': 'SOB', 'medical_history': ['Hypertension', 'Non-compliance with medications', 'Low Back Pain with occasional radiculopathy to bilateral feet \n(pain & numbness)', 'Urinary Urge Incotinence', 'Intermittent lower extremity edema', 'Nodularities ___ (? decades) per history'], 'family_history': '-per daughter, no known conditions run in family ', 'present_illness': '___ woman who presents with SOB and hypoxia; initially \npresented to PCP ___ left sided rib/chest pleuritic pain on \n___. Pt refused CXR and was given 5 day course of \nazithromycin. She took this for three days, then subsequently \nthe pain worsened and had DOE plus dyspnea at reast and she was \nbrought to the ED by family. \n\nIn the ED, initial vs were: T98.4 84 152/53 21 94%RA. Labs were \nremarkable for sodium 121. CXR showed left sided pneumonia, \n?effusion/edema. Patient was given prednisone 40mg, ceftriaxone, \nazithromycin, duoneb. Dyspnea improved with nebulizer. Got 1L \nNS. She was initially on 2L NC satting mid-90s. On the floor, \nthere was not significant wheezing and so systemic steroids were \nstopped. \n\nShe triggered yesterday morning for tachypnea to ___, and was \nbroadened to vanc/cefepime/levo, although has not had recent \nhospitalizations. Nebs were continued and she looked somewhat \nbetter over the day yesterday. However, overnight she worsened \nagain and this morning is on 6L FM satting 93% with tachycardia \nand signficant anxiety. \n\nRepeat xray showed stable left-sided whiteout as well as new \nright-sided infiltrates. She was given 10mg IV Lasix. The team \ntalked w/IP re: thoracentesis on left. \n\nHer course has also been c/b hyponatremia to 120 coming in; got \nunclear amount of fluids and improved to 124, but subsequently \nback down to 120. Has gotten about 1.5-2L NS over yesterday.\n\nPortable xray showed widening of mediastinum, and pa and lat vs. \nCT were recommended, but she was felt to be too clinically \nunstable to travel. \n\nOn arrival to the MICU, she is quite anxious and appears \ntachypneic. She speaks ___ and upon attempt of use of \ntelephonic translator, she was not able to participate and per \nthe interpreter and her daughter, was speaking ___.', 'medications': [{'medication': 'CeleBREX', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': 0.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID: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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'traZODONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Verapamil SR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'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': 'Oxybutynin', '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': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'CeleBREX', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'ORAL', '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': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': 28.0, 'valueuom': 'IU/L', 'ref_range_lower': 29.0, 'ref_range_upper': 201.0, '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': '1', 'valuenum': 1.0, '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': '0.3', 'valuenum': 0.3, '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': '34.1', 'valuenum': 34.1, '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': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '4.7', 'valuenum': 4.7, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '79.6', 'valuenum': 79.6, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '390', 'valuenum': 390.0, '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': '3.97', 'valuenum': 3.97, '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': '35.1', 'valuenum': 35.1, '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': '29.7', 'valuenum': 29.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, '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': '13.1', 'valuenum': 13.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '9.2', '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': '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': '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': '6.4', 'valuenum': 6.4, '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': '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 Exam:\nVitals: T: 97.9 BP: 205/76 P: 101 R: 18 O2: 975 on 15L face mask \n\nGeneral- Anxious, not oriented to place or time, mumbling, mild \ndistress with accessory muscle use\nHEENT- Sclera anicteric, MM difficult to assess ___ mask\nNeck- supple, JVP difficult to assess but does not appear \nelevated\nLungs- Anterior wheezing ?upper airway. Crackles in entire left \nlung field. \nCV- mild tachycardia, Regular rhythm, normal S1 + S2, no \nmurmurs, rubs, gallops \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:\nNo apparent distress, lying in bed\nAVSS\npain ___\nrr, nl rate, no murmur\nsome crackles on right lung, left lung mostly clear, no cough\nsoft, nontender, nondistended, positive bowel sounds\nno edema', 'diagnoses': [{'icd_code': '85221', 'desc': 'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': 'E8859', 'desc': 'Fall from other slipping, tripping, or stumbling'}, {'icd_code': '4011', 'desc': 'Benign essential hypertension'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '71590', 'desc': 'Osteoarthrosis, unspecified whether generalized or localized, site unspecified'}, {'icd_code': '59651', 'desc': 'Hypertonicity of bladder'}, {'icd_code': '7866', 'desc': 'Swelling, mass, or lump in chest'}, {'icd_code': '78093', 'desc': 'Memory loss'}, {'icd_code': '2753', 'desc': 'Disorders of phosphorus metabolism'}, {'icd_code': '7802', 'desc': 'Syncope and collapse'}, {'icd_code': '73300', 'desc': 'Osteoporosis, unspecified'}, {'icd_code': '28860', 'desc': 'Leukocytosis, unspecified'}, {'icd_code': 'V4986', 'desc': 'Do not resuscitate status'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}], 'summary': ' \n___ 09:30AM BLOOD WBC-26.8*# RBC-4.14* Hgb-12.1 Hct-37.0 \nMCV-89 MCH-29.2 MCHC-32.7 RDW-12.5 Plt ___\n___ 05:06AM BLOOD WBC-13.6* RBC-3.75* Hgb-10.6* Hct-34.0* \nMCV-91 MCH-28.2 MCHC-31.1 RDW-13.2 Plt ___\n___ 09:30AM BLOOD Glucose-239* UreaN-15 Creat-0.7 Na-121* \nK-4.3 Cl-89* HCO3-24 AnGap-12\n___ 05:06AM BLOOD Glucose-113* UreaN-17 Creat-1.4* Na-137 \nK-3.9 Cl-98 HCO3-29 AnGap-14\n___ 12:42PM BLOOD UreaN-18 Creat-1.3*\n___ 06:10AM BLOOD ALT-24 AST-24 AlkPhos-128* TotBili-0.4\n___ 02:00PM BLOOD CK-MB-6 cTropnT-<0.01\n___ 06:10AM BLOOD proBNP-1166*\n___ 06:05AM BLOOD Calcium-8.3* Phos-3.9 Mg-1.7\n___ 09:30AM BLOOD Osmolal-261*\n___ 09:30AM BLOOD TSH-1.4\n___ 09:30AM BLOOD Free T4-1.2\n___ 08:33AM BLOOD Cortsol-21.7*\n___ 06:05AM BLOOD Vanco-17.8\n\nPleural fluid: \nGRAM STAIN (Final ___: \n 4+ (>10 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n This is a concentrated smear made by cytospin method, \nplease refer to\n hematology for a quantitative white blood cell count..\n\n FLUID CULTURE (Final ___: NO GROWTH. \n\n ANAEROBIC CULTURE (Final ___: NO GROWTH. \n\n FUNGAL CULTURE (Preliminary): NO FUNGUS ISOLATED\n\n___ CXR: 1. New large left middle and lower lung zone \nopacity, most consistent with pneumonia. A component of pleural \nfluid is difficult to completely exclude. Recommend follow-up \nto resolution to exclude an underlyingmass. 2. Smaller opacity \nat the right base may represent atelectasis or second focus of \npneumonia. 3. Apparent widening of the mediastinum may be \nrelated to the AP technique and patient rotation. Recommend a \nrepeat PA and lateral radiograph when the patient is more \nclinically stable, if high clinical concern for acute \nmediastinal/aortic process, CT is more sensitive. \n\nCT Chest: 1. Severe multifocal pneumonia affecting nearly the \nentire right lung. Additional left lower lobe consolidation \nthough slightly different in morphology is likely an additional \nfocus of pneumonia. \n2. Multiple areas of loculated effusion on the left with fluid \ntracking along the anterior pleural surface at the left apex, \nalong the major fissure as well as a small subpulmonic component \nwith multiple locules of gas situated with the fluid which is \nlikely from a recent chest tube. \n\n___ CXR: Pneumonia in the right mid and upper lung is still \nquite severe, though minimally improved in the upper lobe since \n___. Previous mild pulmonary edema seen in the left \nlung has improved. The left lower lobe atelectasis is still \npresent. Heart size normal. Pleural effusions are small if \nany. Right PICC line has been withdrawn to the origin of the \nsuperior vena cava. \n___ who presents with severe multifocal pneumonia.\n\n# Pneumonia:\n# Hypoxic respiratory distress:\nShe presented with respiratory distress and pneumonia. She was \nstarted on antibiotics and was transfered to the ICU. She was \nstarted on cefepime, vancomycin, levofloxacin. Lasix was \nattempted with minimal improvement. IP was consulted and \ninserted a chest tube for a parapneumonic effusion (culture \nnegative). The regimen was changed to vancomycin and zosyn. She \nimproved and was eventually on room air and symptom free. Her \nCXR still appeared to have significant opacities but she was \nsymptom free. The plan was to give 14 days of IV antibiotics \ngiven the severity of her infection. However, the patient and \nfamily wanted to go home and were unwilling to do IV \nantibiotics. She received over 8 days of IV antibiotics. She was \nswitched to PO levofloxacin for 6 more days for a total course \nof 14 days. She was warned that this coverage was not as good \nand to represent with any worsening symptoms. In addition, she \nwill have very close follow up with labs and PCP. She should \nhave a repeat CXR to make sure there is no underlying mass \n(although not demonstrated by CT).\n\n# Hyponatremia:\nShe presented with hyponatremia. This was due to SIADH. She was \nfluid restricted with eventual improvement. Her nadir was 116. \nAt discharge her sodium had normalized. Her fluid restriction \nwas lifted at the time of discharge. She will have follow up \nlabs a few days after discharge.\n\n# Acute renal failure:\nThis was thought to be secondary to iatrogenic dehydration from \nher fluid restriction. She had evidence of dehydration on exam. \nShe was given 1L IVF prior to discharge and had repeat labs \nwhich showed a stable creatinine. She had her fluid restriction \nlifted and will have labs rechecked in ___ days.\n\n# Metabolic encephalopathy:\nShe had confusion. This improve with treatment of the above \nissues. At the time of discharge she was at her baseline mental \nstatus.\n\n# Hypertension, benign: \nShe had multiple episodes of hypertension. Upon presentation to \nICU it was systolic 200s. On the floor her blood pressure range \nwas 140-170s. She was continued on her home verapamil. Upon \nreview of outpatient blood pressures, she tends to run slightly \nhigh. Given her age and chronic hypertension no adjustments were \nmade to her blood pressure regimen. Further management deferred \nto PCP.\n\nTransitional issues:\nordered for labs on ___ or ___\nPCP appointment on ___\ncxr to eval for underlying mass\nblood pressure control per PCP\n\n___ was full code\n\nPatient and family informed of warning signs and symptoms. The \nfamily was comfortable and requesting discharge on oral \nantibiotics.'}}
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{'final_diagnoses': ['pneumonia', 'hyponatremia'], 'procedures': ['Chest Tube'], 'visit_summary': '___ who presents with severe multifocal pneumonia.\n\n# Pneumonia:\n# Hypoxic respiratory distress:\nShe presented with respiratory distress and pneumonia. She was \nstarted on antibiotics and was transfered to the ICU. She was \nstarted on cefepime, vancomycin, levofloxacin. Lasix was \nattempted with minimal improvement. IP was consulted and \ninserted a chest tube for a parapneumonic effusion (culture \nnegative). The regimen was changed to vancomycin and zosyn. She \nimproved and was eventually on room air and symptom free. Her \nCXR still appeared to have significant opacities but she was \nsymptom free. The plan was to give 14 days of IV antibiotics \ngiven the severity of her infection. However, the patient and \nfamily wanted to go home and were unwilling to do IV \nantibiotics. She received over 8 days of IV antibiotics. She was \nswitched to PO levofloxacin for 6 more days for a total course \nof 14 days. She was warned that this coverage was not as good \nand to represent with any worsening symptoms. In addition, she \nwill have very close follow up with labs and PCP. She should \nhave a repeat CXR to make sure there is no underlying mass \n(although not demonstrated by CT).\n\n# Hyponatremia:\nShe presented with hyponatremia. This was due to SIADH. She was \nfluid restricted with eventual improvement. Her nadir was 116. \nAt discharge her sodium had normalized. Her fluid restriction \nwas lifted at the time of discharge. She will have follow up \nlabs a few days after discharge.\n\n# Acute renal failure:\nThis was thought to be secondary to iatrogenic dehydration from \nher fluid restriction. She had evidence of dehydration on exam. \nShe was given 1L IVF prior to discharge and had repeat labs \nwhich showed a stable creatinine. She had her fluid restriction \nlifted and will have labs rechecked in ___ days.\n\n# Metabolic encephalopathy:\nShe had confusion. This improve with treatment of the above \nissues. At the time of discharge she was at her baseline mental \nstatus.\n\n# Hypertension, benign: \nShe had multiple episodes of hypertension. Upon presentation to \nICU it was systolic 200s. On the floor her blood pressure range \nwas 140-170s. She was continued on her home verapamil. Upon \nreview of outpatient blood pressures, she tends to run slightly \nhigh. Given her age and chronic hypertension no adjustments were \nmade to her blood pressure regimen. Further management deferred \nto PCP.\n\nTransitional issues:\nordered for labs on ___ or ___\nPCP appointment on ___\ncxr to eval for underlying mass\nblood pressure control per PCP\n\n___ was full code\n\nPatient and family informed of warning signs and symptoms. The \nfamily was comfortable and requesting discharge on oral \nantibiotics.', 'medications_prescribed': ['Acetaminophen 325-650 mg PO Q6H:PRN pain, fever ', 'Aspirin 81 mg PO DAILY ', 'Verapamil SR 300 mg PO QHS ', 'Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath or \nwheeze \nRX *albuterol sulfate 90 mcg 2 puffs oral every ___ hours Disp \n#*1 Inhaler Refills:*0', 'Docusate Sodium 100 mg PO BID \nRX *docusate sodium [Colace] 100 mg 1 capsule(s) by mouth twice \nper day Disp #*60 Capsule Refills:*0', 'Levofloxacin 500 mg PO DAILY Duration: 6 Days \nRX *levofloxacin [Levaquin] 500 mg 1 tablet(s) by mouth daily \nDisp #*6 Tablet Refills:*0', 'Senna 1 TAB PO BID:PRN constipation \nRX *sennosides [senna] 8.6 mg 1 tab by mouth twice per day Disp \n#*60 Tablet Refills:*0', 'Outpatient Lab Work\nDiagnosis: hyponatremia, acure renal failure\nLabs: CBC, sodium, potassium, chloride, bicarb, bun, creatinine\nDate: ___ or ___\nFax results to ___ at ___ ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 24, 'gender': 'F', 'symptoms': 'aphasia, inability to walk, worsening confusion', 'medical_history': ['hyperparathyroidism s/p parathyroidectomy', 'T2 Diabetes', 'Mastectomy in the ___', 'remote right radius fracture with plate and screws', 'hypertension', 'falls', 'syncope'], 'family_history': 'Father: ___ Disease; Tuberculosis\nMother: ___ leukemia; dementia in ___', 'present_illness': "___ year old female with hyperparathyroidism s/p \nparathyroidectomy, T2DM, hypertension, and recent precipitous \ndecline in mental functioning over the last 2.5 months, who \npresents with language impairment, worsening confusion, and \ninability to walk over the last 24 hours.\n\nDaughter at bedside, speaks in ___ with mother.\n\nDaughter reports that prior to 2.5 months ago, patient was \nliving independently. Per discharge summary from ___, \npatient was indeed living independently, although there was some \nconcern about her memory, falling, and safety. Over the last 2.5 \nmonths, daughter reports a precipitous decline in mental status. \nCurrently lives with her daughter (sister of the daughter at the \nbedside) and a hired helper, and she needs assistance with all \nADLs. Prior to last night, she did speak in simple sentences in \n___, walk independently, and feed herself with supervision.\n\nLast night, family noticed that patient seemed to be more \nconfused. She stopped having sensical speech, and she had \ndifficulty recognizing her family members. She also was no \nlonger able to walk by herself, requiring her daughter to carry \nher. She went to bed, but woke up with similar issues with \nlanguage, confusion, and gait this morning. Given on-going \nsymptoms, came to the ED.\n\nPer daughter, patient was recently diagnosed with Alzheimer's, \nalthough per recent neuropsych evaluation, vascular dementia was \nalso considered a likely diagnosis. Patient was supposed to have \nan out-patient EEG today as part of her work-up for dementia. \nFollowed by a neurologist at ___.\n\nDaughter not aware of any fevers or infectious symptoms \nrecently.", 'medications': [{'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'amitriptyline', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Betamethasone Dipro 0.05% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone (Rectal) 2.5% Cream', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', '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': 'carbamazepine', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sertraline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Topiramate (Topamax)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', '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': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'OxyCODONE--Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Miconazole Nitrate (Combo Pack)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'VG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Topiramate (Topamax)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'carbamazepine', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QAM', '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Lidocaine Jelly 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrOXYzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'omeprazole', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benzoyl Peroxide Gel 10%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'topiramate', 'proc_type': 'Non-Formulary', 'status': 'Discontinued via patient discharge', 'route': 'ORAL', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CarBAMazepine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Readi-Cat 2 (Barium Sulfate 2% Suspension)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Maalox/Diphenhydramine/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, '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': '91', 'valuenum': 91.0, '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': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.9', 'valuenum': 44.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '11', 'valuenum': 11.0, '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': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', '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': 0.4, '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 >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': 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': '0', 'valuenum': 0.0, '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': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, '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': '11.8', 'valuenum': 11.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': 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': '5', 'valuenum': 5.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'TR*.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.021', 'valuenum': 1.021, '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': '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': 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': '2.36', 'valuenum': 2.36, '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': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.0', 'valuenum': 39.0, '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': '23.0', 'valuenum': 23.0, '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': '32.6', 'valuenum': 32.6, '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': '6.8', 'valuenum': 6.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '69.4', 'valuenum': 69.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, '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': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.43', 'valuenum': 4.43, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, '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': '0.03', 'valuenum': 0.03, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.70', 'valuenum': 0.7, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.11', 'valuenum': 7.11, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '83', 'valuenum': 83.0, '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': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.2', 'valuenum': 0.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.8', 'valuenum': 5.8, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '56', 'valuenum': 56.0, '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': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.0, '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': 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': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEGATIVE. FOR QUANTITATION OF POSITIVES, SEND SERUM FOR HCG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'ug/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 12.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.9', 'valuenum': 10.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26.9', 'valuenum': 26.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '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': '91', 'valuenum': 91.0, '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': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, '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': '47.7', 'valuenum': 47.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '109', 'valuenum': 109.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '___', 'valuenum': 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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, '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': '92', 'valuenum': 92.0, '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': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '48.1', 'valuenum': 48.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '6', 'valuenum': 6.0, '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, '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': 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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '39.1', 'valuenum': 39.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.9', 'valuenum': 28.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '199', 'valuenum': 199.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '47.1', 'valuenum': 47.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'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': '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 25.0, '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': 'NEG. Positive Tricyclic results represent potentially toxic levels. Therapeutic Tricyclic levels will typically have Negative results.'}, {'value': '15', 'valuenum': 15.0, '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': '-39', 'valuenum': -39.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION\nVitals: T: 97.0 HR: 66 BP: 188/94 RR: 16 SaO2: 98%\nGeneral: NAD\nHEENT: NCAT\n___: warm and well-perfused\nPulmonary: breathing comfortably in room air\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental status: Awake, alert. Oriented to name. Per daughter,\nspeaking gibberish overall. At one point did speak to daughter \nin\na coherent sentence asking to go to the bathroom (in ___. Mimicked, did not follow commands in ___.\n\n- Cranial Nerves: Tracked phone well, with intact extra-ocular\nmovement with saccadic breakdown of smooth pursuit. Seemed to\nrespond to stimuli in all visual fields. No facial movement\nasymmetry. Tongue midline.\n\n- Motor: Normal bulk. Did not participate in confrontational\ntesting, but pushing away vigorously with both arms and waving\nthem anti-gravity. Kicking both legs anti-gravity and \nwithdrawing\nbriskly to Babinski. \n\n- Reflexes: 1+ patellar, toes down.\n\n- Sensory: Responded to touch in all extremities.\n\n- Coordination: Unable to participate, but no overt dysmetria on\nreaching for objects.\n\n===============\nDISCHARGE\nGeneral: Awake and alert this morning, laying in bed \nHEENT: NCAT. \n___: warm and well-perfused\nPulmonary: breathing comfortably in room air\nExtremities: Warm, no edema\n\nNeurologic Examination:\n- Mental status: awake and alert, oriented to hospital but not\ndate or month, knows that we are her doctors, able to repeat \nwithout paraphasic errors Follows axial and appendicular \ncommands in ___ briskly. Able to follow more complex \nmultistep commands \n\n- Cranial Nerves: Pupils 3->2, brisk. Face symmetric, tongue\nmidline, EOMI \n\n- Motor/Sensory: spontaneous and antigravity in bilateral upper\nextremities and lower extremities. Difficult to do \nconfrontational testing but able in upper extremities is ___ in \nbiceps and triceps bilaterally, ___ IP bilaterally and \ndorsiflexion. no rigidity or cogwheeling noted with or\nwithout augmentation \n\n- Reflexes: deferred \n\n- Coordination: deferred\n\n-Gait: deferred ', 'diagnoses': [{'icd_code': 'G4089', 'desc': 'Other seizures'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z87820', 'desc': 'Personal history of traumatic brain injury'}, {'icd_code': 'F4310', 'desc': 'Post-traumatic stress disorder, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'J45909', 'desc': 'Unspecified asthma, uncomplicated'}, {'icd_code': 'Z91410', 'desc': 'Personal history of adult physical and sexual abuse'}, {'icd_code': 'K581', 'desc': 'Irritable bowel syndrome with constipation'}, {'icd_code': 'R109', 'desc': 'Unspecified abdominal pain'}, {'icd_code': 'G43909', 'desc': 'Migraine, unspecified, not intractable, without status migrainosus'}, {'icd_code': 'L738', 'desc': 'Other specified follicular disorders'}, {'icd_code': 'L720', 'desc': 'Epidermal cyst'}], 'summary': "Admission Labs:\n================\n___ 05:05PM BLOOD WBC-9.7 RBC-4.84 Hgb-13.9 Hct-40.8 MCV-84 \nMCH-28.7 MCHC-34.1 RDW-13.2 RDWSD-40.7 Plt ___\n___ 05:05PM BLOOD Neuts-50.2 ___ Monos-11.7 Eos-1.1 \nBaso-0.6 Im ___ AbsNeut-4.86 AbsLymp-3.50 AbsMono-1.13* \nAbsEos-0.11 AbsBaso-0.06\n___ 05:05PM BLOOD ___ PTT-26.7 ___\n___ 05:05PM BLOOD Plt ___\n___ 05:05PM BLOOD Glucose-96 UreaN-16 Creat-1.0 Na-135 \nK-4.4 Cl-99 HCO3-23 AnGap-13\n___ 05:05PM BLOOD ALT-24 AST-31 AlkPhos-72 TotBili-0.5\n___ 05:05PM BLOOD Lipase-46\n___ 05:05PM BLOOD cTropnT-<0.01\n___ 05:05PM BLOOD Albumin-4.4 Calcium-11.6* Phos-3.1 Mg-2.1\n___ 05:05PM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nTricycl-NEG\n___ 05:13PM BLOOD Lactate-1.6 Creat-0.9\n\nPertinent Labs:\n================\n___ 05:45AM BLOOD VitB12-716 Folate-7\n___ 09:00AM BLOOD %HbA1c-5.1 eAG-100\n___ 09:00AM BLOOD Triglyc-111 HDL-41 CHOL/HD-3.1 LDLcalc-64\n___ 09:00AM BLOOD TSH-2.6\n\nCSF:\n================\n___ 02:52PM CEREBROSPINAL FLUID (CSF) TNC-0 RBC-1 Polys-1 \n___ ___ 02:52PM CEREBROSPINAL FLUID (CSF) TotProt-62* \nGlucose-73\n \n-Tau/A Beta 42: Pending \n\nDischarge Labs:\n================\n___ 05:50AM BLOOD WBC-7.2 RBC-3.95 Hgb-11.4 Hct-32.9* \nMCV-83 MCH-28.9 MCHC-34.7 RDW-13.2 RDWSD-40.0 Plt ___\n___ 05:50AM BLOOD Glucose-173* UreaN-12 Creat-0.9 Na-139 \nK-4.1 Cl-103 HCO3-26 AnGap-10\n\n___ year old right-handed female with hyperparathyroidism s/p \nparathyroidectomy, T2DM, hypertension, and recent precipitous \ndecline in mental functioning over the last 2.5 months, who \npresents with language impairment, worsening confusion, and \ninability to walk over the last 24 hours.\n\n# Acute on Subacute cognitive and functional decline\n# Epileptic encephalopathy iso vascular dementia \nPatient has had a decline in mental status over the last few \nmonths at home with acute worsening in the day prior to \npresentation. Exam notable for speaking in gibberish in ___ \n(per daughter) with poor receptive language as well. CT was \nnegative for any acute process, including ventriculomegaly. EEG \nshowed bi-frontal GPEDs, polymorphic delta slowing and \nattenuation during sleep, which are consistent with decreased \nseizure threshold. She was loaded with keppra and started on a \nmaintenance dose of 500mg BID, but due to somnolence was \nswitched to lacosamide. No clear etiology found in basic \nmetabolic-toxic-infectious work-up, but she does have extensive \nwhite matter disease. LP not consistent with infection or other \ninflammatory process. Thought this was not a high volume tap \nthere was no noticeable improvement in symptoms after LP. MRI \nfew days prior to admission reviewed with radiology and felt \nconsistent with extensive white matter disease causing vascular \ndementia. Acute decline day prior to admission felt to be due to \nepileptic encephalopathy iso vascular dementia causing the \nsubacute decline. Tau and ABeta42 from ___ sent. Continued on \nhome citalopram. Home donepezil was stopped due to possibility \nof worsening orthostatic hypotension. Risk factors were notable \nfor HgbA1C 5.1, LDL 64. She was stared on aspirin 81mg. \n\n#Difficulty walking: \nGait disordered consistent with vascular dementia with \nleukoareosis and diffuse white matter disease on MRI. Also \npossibly gait disorder exacerbated by unrecognized orthostatic \nhypotension at home. \n\n#T2DM \nHome lantus was decreased to 5 units due to poor PO intake \ninitially. Increased to 7 units at night with sliding scale when \nPO intake increased. \n\n#HTN \n#Autonomic Instability \nContinued on home losartan. Initially while patient was confused \nand laying in bed most of the day her BP remained quite elevated \nin SBP 180-200s and carvedilol was started and up titrated. Once \nshe improved and was out of bed and up working with ___ it was \nnoted that she had significant orthostatic hypotension with \nsignificant nocturnal hypertension suggestive of autonomic \ninstability. Her carvedilol was stopped but losartan was \ncontinued as she was still hypertensive with sitting. For her \nnocturnal hypertension she was started on labetalol 100mg QHS. \nPatient should sleep with wedge at night and wear compression \nstocking above the knee. Fluid intake was encouraged. Called \noutpatient Neurologist and suggested referral to Autonomic \nspecialist for tilt table testing. \n\n#Urinary retention: Patient's foley was removed but she required \nbladder scans and PRN straight catheterizations."}}
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{'final_diagnoses': ['Epileptic encephalopathy in setting of vascular dementia', 'Autonomic Instability'], 'procedures': ['Lumbar Puncture'], 'visit_summary': "___ year old right-handed female with hyperparathyroidism s/p \nparathyroidectomy, T2DM, hypertension, and recent precipitous \ndecline in mental functioning over the last 2.5 months, who \npresents with language impairment, worsening confusion, and \ninability to walk over the last 24 hours.\n\n# Acute on Subacute cognitive and functional decline\n# Epileptic encephalopathy iso vascular dementia \nPatient has had a decline in mental status over the last few \nmonths at home with acute worsening in the day prior to \npresentation. Exam notable for speaking in gibberish in ___ \n(per daughter) with poor receptive language as well. CT was \nnegative for any acute process, including ventriculomegaly. EEG \nshowed bi-frontal GPEDs, polymorphic delta slowing and \nattenuation during sleep, which are consistent with decreased \nseizure threshold. She was loaded with keppra and started on a \nmaintenance dose of 500mg BID, but due to somnolence was \nswitched to lacosamide. No clear etiology found in basic \nmetabolic-toxic-infectious work-up, but she does have extensive \nwhite matter disease. LP not consistent with infection or other \ninflammatory process. Thought this was not a high volume tap \nthere was no noticeable improvement in symptoms after LP. MRI \nfew days prior to admission reviewed with radiology and felt \nconsistent with extensive white matter disease causing vascular \ndementia. Acute decline day prior to admission felt to be due to \nepileptic encephalopathy iso vascular dementia causing the \nsubacute decline. Tau and ABeta42 from ___ sent. Continued on \nhome citalopram. Home donepezil was stopped due to possibility \nof worsening orthostatic hypotension. Risk factors were notable \nfor HgbA1C 5.1, LDL 64. She was stared on aspirin 81mg. \n\n#Difficulty walking: \nGait disordered consistent with vascular dementia with \nleukoareosis and diffuse white matter disease on MRI. Also \npossibly gait disorder exacerbated by unrecognized orthostatic \nhypotension at home. \n\n#T2DM \nHome lantus was decreased to 5 units due to poor PO intake \ninitially. Increased to 7 units at night with sliding scale when \nPO intake increased. \n\n#HTN \n#Autonomic Instability \nContinued on home losartan. Initially while patient was confused \nand laying in bed most of the day her BP remained quite elevated \nin SBP 180-200s and carvedilol was started and up titrated. Once \nshe improved and was out of bed and up working with ___ it was \nnoted that she had significant orthostatic hypotension with \nsignificant nocturnal hypertension suggestive of autonomic \ninstability. Her carvedilol was stopped but losartan was \ncontinued as she was still hypertensive with sitting. For her \nnocturnal hypertension she was started on labetalol 100mg QHS. \nPatient should sleep with wedge at night and wear compression \nstocking above the knee. Fluid intake was encouraged. Called \noutpatient Neurologist and suggested referral to Autonomic \nspecialist for tilt table testing. \n\n#Urinary retention: Patient's foley was removed but she required \nbladder scans and PRN straight catheterizations.", 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Labetalol 100 mg PO QHS', 'LACOSamide 100 mg PO BID \nRX *lacosamide [Vimpat] 100 mg 1 tablet(s) by mouth twice a day \nDisp #*60 Tablet Refills:*0', 'Multivitamins W/minerals Chewable 1 TAB PO DAILY', 'Glargine 7 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'Citalopram 10 mg PO DAILY', 'Losartan Potassium 50 mg PO DAILY', 'Ramelteon 8 mg PO QHS:PRN insomnia']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 24, 'gender': 'M', 'symptoms': 'chest pain, HTN urgency', 'medical_history': ['HTN', 'Compression Fracture of thoracic vertebra', 'atrial fibrillation', 'history of ischemic colitis', 'DJD-spine', 'osteoporosis', 'CHF-mild', 'sick sinus syndrome', 's/p hip fracture'], 'family_history': 'No family history of early MI, arrhythmia, cardiomyopathies, or \nsudden cardiac death; otherwise non-contributory.', 'present_illness': "Ms. ___, ___ predominantly ___ speaking female \nwith hx of longstanding HTN, atrial fibrillation, h/o PCM for \nSSS, who was brought into ED by daughter for asymptomatic HTN to \n220s/117 at home. No c/o headaches, vision changes, but some c/o \ndizziness on arival to ED which lasted less than 5 minutes per \ndaughter and were at rest. In the ED, patient also had a \nfleeting episode of substernal chest pressure lasting less than \n<15 seconds while sitting at rest. EKG showed TWIs in leads \nV1-V4 which was similar to priors, no overt new ST depressions \nor elevations. A-pacing noted with HR 70. Slight trop elevattion \nto .02, CKs flat. \n. \nUnfortunately, patient is a poor historian and daughter is also \nlimited with her mother's PMH. Both were unclear as to why \npatient stopped taking her usual 40mg daily lisinopril about 1.5 \nmonths ago. Patient's daughter states that her sister stopped \nthis medication because her BP was better controlled. \n. \nIn the ED, initial vitals were T 98.3F, BP 216/94, HR 70, RR 16, \n100% RA. She was given an extra dose of home atenolol 50mg PO in \nED and BPs improved to 170/85 range. Home Coumadin is for \nhistory of atrial fibrillation to prevent CVAs per daughter. She \nwas also given 325mg ASA in ED and sent to floor for ___ and \nadditional BP control. \n. \n. \nOn review of systems, she denies any prior history of stroke, \nTIA, deep venous thrombosis, pulmonary embolism, bleeding at the \ntime of surgery, myalgias, cough, hemoptysis, black stools or \nred stools. She denies recent fevers, chills or rigors. All of \nthe other review of systems were negative with exception of some \nminimal dysuria ( UA neg in ED). Cardiac review of systems is \nnotable for absence of dyspnea on exertion, paroxysmal nocturnal \ndyspnea, orthopnea, ankle edema, palpitations, syncope or \npresyncope. She c/o mild chest pressure as outlined in HPI above \nin ED. \nOn arrival to the floor she was in no apparent distress, denied \nHA, dizziness, CP had resolved. Vitals were: T ___, BP 193/98, \nHR 71, RR 18, 97% RA.", 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Cepacol (Menthol)', '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': '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Chloraseptic Throat Spray', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluconazole', 'proc_type': 'IV Piggyback', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', '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': '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': '4.4', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '29.6', 'valuenum': 29.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '232', 'valuenum': 232.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.8', 'valuenum': 29.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '229', 'valuenum': 229.0, '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': '4.50', 'valuenum': 4.5, '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}], 'exams': 'Vital Signs: T ___, BP 193/98, HR 71, RR 18, 97% RA. \nGENERAL: NAD. frail appearing, very HOH, Oriented x3. Mood, \naffect appropriate. Speaks limited ___. \nHEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthalesma. \n\nNECK: Supple with JVP of 7-cm. no LAD \nCARDIAC: RRR, normal S1, S2. No m/r/g. No thrills, lifts. No \nS3/S4. \nLUNGS: Moderate kyphosis. Resp were unlabored, no accessory \nmuscle use. CTAB, no crackles, wheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: No c/c/e. No femoral bruits. \nSKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \nPULSES: \nRight: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+ \nLeft: Carotid 2+ Femoral 2+ Popliteal 2+ DP 2+ ___ 2+', 'diagnoses': [{'icd_code': '53110', 'desc': 'Acute gastric ulcer with perforation, without mention of obstruction'}, {'icd_code': 'E9359', 'desc': 'Unspecified analgesic and antipyretic causing adverse effects in therapeutic use'}], 'summary': '___ 07:45PM BLOOD WBC-5.8 RBC-4.30 Hgb-11.8* Hct-36.7 \nMCV-85 MCH-27.4 MCHC-32.1 RDW-15.0 Plt ___\n___ 02:58AM BLOOD WBC-6.2 RBC-4.08* Hgb-11.3* Hct-33.6* \nMCV-82 MCH-27.7 MCHC-33.6 RDW-15.5 Plt ___\n___ 07:45PM BLOOD Neuts-57.2 ___ Monos-7.6 Eos-4.3* \nBaso-0.4\n___ 02:58AM BLOOD ___ PTT-30.0 ___\n___ 07:45PM BLOOD ___ PTT-29.3 ___\n___ 02:58AM BLOOD Glucose-105 UreaN-12 Creat-0.7 Na-136 \nK-3.9 Cl-100 HCO3-29 AnGap-11\n___ 07:45PM BLOOD Glucose-96 UreaN-12 Creat-0.8 Na-134 \nK-3.8 Cl-97 HCO3-29 AnGap-12\n___ 07:45PM BLOOD CK(CPK)-30\n___ 02:58AM BLOOD CK(CPK)-26\n___ 07:45PM BLOOD CK-MB-NotDone cTropnT-0.02*\n___ 02:58AM BLOOD CK-MB-NotDone cTropnT-0.02*\n___ 10:55AM BLOOD CK-MB-2 cTropnT-0.01\n___ 02:58AM BLOOD Calcium-9.7 Phos-3.5 Mg-1.7\n___ 05:45AM BLOOD Cholest-153\n___ 05:45AM BLOOD Triglyc-107 HDL-44 CHOL/HD-3.5 LDLcalc-88\n___ 08:20PM URINE Color-Straw Appear-Clear Sp ___\n___ 08:20PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-8.0 Leuks-NEG\n\n___ 8:20 pm URINE Site: CLEAN CATCH\n\n URINE CULTURE (Preliminary): \n GRAM NEGATIVE ROD(S). 10,000-100,000 ORGANISMS/ML..\n\n___ 02:58AM BLOOD WBC-6.2 RBC-4.08* Hgb-11.3* Hct-33.6* \nMCV-82 MCH-27.7 MCHC-33.6 RDW-15.5 Plt ___\n___ 02:58AM BLOOD ___ PTT-30.0 ___\n___ 02:58AM BLOOD Glucose-105 UreaN-12 Creat-0.7 Na-136 \nK-3.9 Cl-100 HCO3-29 AnGap-11\n___ 02:58AM BLOOD CK(CPK)-26\n___ 10:55AM BLOOD CK(CPK)-28\n___ 02:58AM BLOOD CK-MB-NotDone cTropnT-0.02*\n___ 10:55AM BLOOD CK-MB-2 cTropnT-0.01\n___ 02:58AM BLOOD Calcium-9.7 Phos-3.5 Mg-1.7\n___ 05:45AM BLOOD Cholest-153\n___ 05:45AM BLOOD Triglyc-107 HDL-44 CHOL/HD-3.5 LDLcalc-88\n#HTN urgency: Patient presented elevated BP up to 216/94 and \ncomplaints of dizziness and ~15 sec of substernal CP. She denied \nheadaches or vision changes. After given 50mg PO atenolol in ED, \nSBPs improved to 170s range. Per history, patient had been \ntaking 40mg PO lisinopril daily up until ___ months ago when she \nwas told to stop as it was not helping lower her BP. No focal \nneuro findings were noted on neuro exam. She was restarted on \nlisinopril 20mg and her BP normalized. It was 140s/70s on \ndischarge. She was instructed to take lisinopril 10mg BID as an \noutpatient. \n. \n#CORONARIES: No prior MIs or CVAs in past but had a fleeting \nepisode of SSCP at rest in ED that lasted ~15 sec. EKG showed \nTWIs in lateral leads that was similar to prior studies. She was \nruled out for MI with 3 sets of (-) cardiac biomarkers. A lipid \npanel was done which was WNL. \n. \n#RHYTHM : NSR with a-pacing on telemetry and on EKG. Currently \nnot in atrial fibrillation but known history of afib. EKG did \nshow prolonged PR interval. She was continued on her home dose \nmedications. \n. \n#PUMP: No prior TTE records here at ___ notable for "mild \nCHF". No fluid overload or edema on CXR or physical exam. \n. \n#Osteoporosis/back pains - Patient had no issues w/ this during \nher hospitalization.'}}
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{'final_diagnoses': ['Hypertensive urgency', 'CHF', 'Sick Sinus Syndrome s/p Pace ___', 'Atrial Fibrillation'], 'procedures': ['none'], 'visit_summary': '#HTN urgency: Patient presented elevated BP up to 216/94 and \ncomplaints of dizziness and ~15 sec of substernal CP. She denied \nheadaches or vision changes. After given 50mg PO atenolol in ED, \nSBPs improved to 170s range. Per history, patient had been \ntaking 40mg PO lisinopril daily up until ___ months ago when she \nwas told to stop as it was not helping lower her BP. No focal \nneuro findings were noted on neuro exam. She was restarted on \nlisinopril 20mg and her BP normalized. It was 140s/70s on \ndischarge. She was instructed to take lisinopril 10mg BID as an \noutpatient. \n. \n#CORONARIES: No prior MIs or CVAs in past but had a fleeting \nepisode of SSCP at rest in ED that lasted ~15 sec. EKG showed \nTWIs in lateral leads that was similar to prior studies. She was \nruled out for MI with 3 sets of (-) cardiac biomarkers. A lipid \npanel was done which was WNL. \n. \n#RHYTHM : NSR with a-pacing on telemetry and on EKG. Currently \nnot in atrial fibrillation but known history of afib. EKG did \nshow prolonged PR interval. She was continued on her home dose \nmedications. \n. \n#PUMP: No prior TTE records here at ___ notable for "mild \nCHF". No fluid overload or edema on CXR or physical exam. \n. \n#Osteoporosis/back pains - Patient had no issues w/ this during \nher hospitalization.', 'medications_prescribed': ['Atenolol 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Digoxin 125 mcg Tablet Sig: One (1) Tablet PO DAILY (Daily).', 'Warfarin 2 mg Tablet Sig: Two (2) Tablet PO Once Daily at 4 \n___. ', 'Lisinopril 10 mg Tablet Sig: One (1) Tablet PO twice a day.\nDisp:*60 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': 76, 'gender': 'M', 'symptoms': 'Chest Pain', 'medical_history': ['hypertension', 'hyperlipidemia', 'peripheral neuropathy', 'total left knee replacement', 'kidney neoplasm', 'varicose veins', 'osteoarthritis'], 'family_history': 'Father: MI at age ___\nMother: CHF age ___\n___: HTN', 'present_illness': 'Patient is a ___ with a PMHx of HTN and HLD who presented to \n___ ___ with chest discomfort with radiation to the \njaw and left arm, shortness of breath, and nausea. EKG showed \nTWI V1-V3. Troponins were uptrending: neg, then 0.52, then 1.19 \nprior to transfer. She was treated with 325mg ASA, lovenox 80mg \nBID, nitropaste, metop tartrate 12.5mg BID, 60mg prednosone and \nzantac. Prednisone and zantac were given for contrast allergy. \nShe was transferred to ___ for cath intervention. \nShe was initially admitted to ___ ___ on the NP service. She \nrecalled chest pain occurring the past several months and\nincreasing in frequency and severity over the past 5 wks. \n\nPt was initially treated with cardiac cath, found to have \nstenosis of RCA, treated unsuccessfully with POBA, thought to be \nheavily calcified. The plan was to further assess the lesion \nwith repeat cath in the future. However, after completion of \ncatheterization, pt found to have recurrence of chest pain. ECG \nat that time showed STE in inferior leads. Pt was taken back to \nthe cath lab, where, per report, was found to have complete \nstenosis of proximal RCA and dissection at the site of prior \nPOBA in mid-RCA. Both areas treated with DES. \n\nDecision was made to admit to CCU for monitoring after \nprocedure. \nVitals on transfer were: HR 84, BP 97/47, RR 14, O2 97% on 2L,\n\nIn the unit, the patient reports she is now pain free. Denies \ndyspnea, NVD, abdominal pain, ___ edema, PND, orthopnea \n\nREVIEW OF SYSTEMS: \n(+) per HPI, all other ROS otherwise negative.', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'TraZODone', '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': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Tamsulosin', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 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': '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': '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': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': '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': '27.3', 'valuenum': 27.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '132', 'valuenum': 132.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.44', 'valuenum': 4.44, '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': '46.5', 'valuenum': 46.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'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': '39', 'valuenum': 39.0, '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': '20', 'valuenum': 20.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, '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': '1.9', 'valuenum': 1.9, '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 1.9,. Estimated GFR = 35 if non African-American (mL/min/1.73 m2). Estimated GFR = 42 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': 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': '158', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '48', 'valuenum': 48.0, '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': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '96', 'valuenum': 96.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '120', 'valuenum': 120.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '46.2', 'valuenum': 46.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, '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': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS: T NR, HR 84, BP 97/47, RR 14, O2 97% on 2L \nWeight: 78kg \nTele: NSR, no alarms since transfer\nGEN: well appearing, no acute distress \nHEENT: no LAD \nNECK: no JVD visualized \nCV: RRR, nl S1 S2, no murmurs/rubs/gallops\nLUNGS: clear to auscultation b/l in anterior lung fields \nABD: soft, NT, ND, NABS, no appreciable HSM \nEXT: WWP, no edema, DP 2+ b/l. Hardened mass around right groin, \nmost palpable anteriorly and laterally without ecchymosis; \nsheath in place with sero-sang drainage around dressing; TR band \nin place on right wrist \nSKIN: pneumoboots in place, erythematous patches on b/l ___\nNEURO: CN ___ grossly intact, moving all extremities \nspontaneously\n\nDISCHARGE PHYSICAL EXAM:\nVS: T NR, HR 84, BP 97/47, RR 14, O2 97% on 2L \nWeight: 78kg \nTele: NSR, no alarms since transfer\nGEN: well appearing, no acute distress \nHEENT: no LAD \nNECK: no JVD visualized \nCV: RRR, nl S1 S2, no murmurs/rubs/gallops\nLUNGS: clear to auscultation b/l in anterior lung fields \nABD: soft, NT, ND, NABS, no appreciable HSM \nEXT: WWP, no edema, DP 2+ b/l. Hardened mass around right groin, \nmost palpable anteriorly and laterally without ecchymosis; \nsheath in place with sero-sang drainage around dressing; TR band \nin place on right wrist \nSKIN: pneumoboots in place, erythematous patches on b/l ___\nNEURO: CN ___ grossly intact, moving all extremities \nspontaneously', 'diagnoses': [{'icd_code': 'A047', 'desc': 'Enterocolitis due to Clostridium difficile'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, 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': 'N183', 'desc': 'Chronic kidney disease, stage 3 (moderate)'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'M109', 'desc': 'Gout, unspecified'}], 'summary': 'ADMISSION LABS:\n\n___ 11:06PM BLOOD WBC-11.6* RBC-4.26 Hgb-14.0 Hct-40.7 \nMCV-96 MCH-32.9* MCHC-34.4 RDW-12.2 RDWSD-42.4 Plt ___\n___ 11:06PM BLOOD ___ PTT-150* ___\n___ 11:06PM BLOOD Glucose-169* UreaN-19 Creat-0.8 Na-137 \nK-4.1 Cl-100 HCO3-23 AnGap-18\n___ 11:06PM BLOOD ALT-33 AST-56* CK(CPK)-347* AlkPhos-57 \nTotBili-0.3\n___ 11:06PM BLOOD Calcium-8.9 Phos-3.6 Mg-2.0\n\nPERTINENT INTERVAL LABS:\n\n___ 06:45PM BLOOD cTropnT-0.35*\n___ 11:06PM BLOOD CK-MB-33* MB Indx-9.5* cTropnT-0.56*\n___ 05:00AM BLOOD CK-MB-45* cTropnT-0.96*\n___ 03:01PM BLOOD CK-MB-25* cTropnT-0.62*\n\nIMAGING/STUDIES:\nCARDIAC CATH ___: LCMA normal, LAD with proximal 30% stenosis \nand mid-40% stenosis. LCX with 20% stenosis, RCA ___ mid \n40% stenosis and mid ___ stenosis \nImpression: Severe RCA stenosis with calcification, resistant to \nPTCA, non ST segment elevation MI\n\nCARDIAC CATH ___: RCA proximal 100% occlusion noted with no \nflow beyond the occlusion of the RCA. \nImpression: Acute inferior ST elevation MI, s/p \neverolimus-eluting stent placement in the mid and proximal right \ncoronary artery. Percutaneous transluminal coronary angioplasty \nwas performed earlier with plan for post-hoc rotational \natherectomy and stenting. The patient however, had symptom \nrecurrence in the holding area with ST segment elevation \nprompting emergent coronary arteriography \n\nRepeat cardiac catheterization ___ showed dissection, report \npending at time of discharge, see OMR.\n\nTTE ___\nThe left atrium is normal in size. No atrial septal defect is \nseen by 2D or color Doppler. Left ventricular wall thickness, \ncavity size, and global systolic function are normal (LVEF>55%). \nDue to suboptimal technical quality, a focal wall motion \nabnormality cannot be fully excluded. There is no ventricular \nseptal defect. Right ventricular chamber size and free wall \nmotion are normal. The diameters of aorta at the sinus, \nascending and arch levels are normal. The aortic valve leaflets \n(3) appear structurally normal with good leaflet excursion and \nno aortic stenosis or aortic regurgitation. The mitral valve \nappears structurally normal with trivial mitral regurgitation. \nThe estimated pulmonary artery systolic pressure is normal. \nThere is no pericardial effusion. \n\nCXR ___\nNo previous images. The cardiac silhouette is at the upper \nlimits of normal or mildly enlarged and there is tortuosity of \nthe aorta. No evidence of vascular congestion, pleural \neffusion, or acute focal pneumonia. \n\nDISCHARGE LABS:\n___ 04:35AM BLOOD WBC-12.2* RBC-3.96 Hgb-13.0 Hct-39.0 \nMCV-99* MCH-32.8* MCHC-33.3 RDW-12.5 RDWSD-45.2 Plt ___\n___ 04:35AM BLOOD ___ PTT-27.4 ___\n___ 04:35AM BLOOD Plt ___\n___ 04:35AM BLOOD Glucose-75 UreaN-25* Creat-0.7 Na-142 \nK-4.2 Cl-104 HCO3-27 AnGap-15\n___ 04:35AM BLOOD Calcium-9.1 Phos-3.3 Mg-2.___\nRIEF SUMMARY:\nMs. ___ is a ___ with PMH of HTN, HLD, peripheral \nneuropathy, OA s/TKR, kidney neoplasm who presented to OSH with \nchest pain, found to have RCA lesion on cath treated with POBA, \nsubsequently developed STE in inferior leads, found to have \nproximal RCA occlusion and mid-RCA dissection (at site of \nprevious POBA), both treated with DES.\n\n# ACS/NSTEMI followed by STEMI: Pt with h/o progressive anginal \ntype symptoms who presented to OSH with NSTEMI with TWI in V1-V3 \nand up-trending troponins. Initial cardiac cath showed narrowing \nwith calcification in mid-RCA, which was treated with POBA. Pt \npresented with chest pain post-procedure, found to have STE in \ninferior leads, and proximal occlusion of RCA as well as \ndissection in mid-RCA. Proximal RCA occlusion likely Type 1 MI \nsecondary to plaque rupture. Dissection at mid-RCA likely \nrepresents Type 4 MI. Now s/p DES to proximal and mid-RCA. Per \nreport, pt noted to also have ostial lesion that may require \nintervention. She was started on Plavix 75 mg daily for ___ year, \nmetoprolol 25 mg daily, lisinopril 20mg daily, Rosuvastatin \nCalcium 10 mg PO QPM. Her home lisinopril-hydrochlorothiazide \n___ mg oral DAILY was discontinued. \n\n# Hypertension: started lisinopril 20mg daily.\n\nTRANSITIONAL ISSUES:\n=====================\n- Started Plavix 75 mg daily for ___ year, metoprolol 25 mg daily, \nlisinopril 20mg daily, and rosuvastatin Calcium 10 mg PO QPM, \nand discontinued lisinopril-hydrochlorothiazide ___ mg oral \nDAILY\n- Patient agreed to try rosuvastatin since she had not tried \nthis particular statin in the past, however she is concerned \nthat previous statins made her neuropathy worse. She was \ninstructed to follow up with her PCP regarding whether she can \ntolerate rosuvastatin. Consider PCK9 inhibitor for management of \nher dyslipidemia if statin is not tolerated.\n- Consider referral to neurology for evaluation of neuropathy, \nif this is precluding patient from being treated with statin. \n# CONTACT: ___ (daughter) ___. This is the contact \nperson. ___ (daughter) ___. This is the HCP. \n# CODE: Full'}}
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{'final_diagnoses': ['ACS/STEMI', 'HTN', 'Hyperlipidemia', 'Varicose Veins', 'Osteopenia', 'Osteoporosis'], 'procedures': ['Cardiac catheterization ___'], 'visit_summary': 'RIEF SUMMARY:\nMs. ___ is a ___ with PMH of HTN, HLD, peripheral \nneuropathy, OA s/TKR, kidney neoplasm who presented to OSH with \nchest pain, found to have RCA lesion on cath treated with POBA, \nsubsequently developed STE in inferior leads, found to have \nproximal RCA occlusion and mid-RCA dissection (at site of \nprevious POBA), both treated with DES.\n\n# ACS/NSTEMI followed by STEMI: Pt with h/o progressive anginal \ntype symptoms who presented to OSH with NSTEMI with TWI in V1-V3 \nand up-trending troponins. Initial cardiac cath showed narrowing \nwith calcification in mid-RCA, which was treated with POBA. Pt \npresented with chest pain post-procedure, found to have STE in \ninferior leads, and proximal occlusion of RCA as well as \ndissection in mid-RCA. Proximal RCA occlusion likely Type 1 MI \nsecondary to plaque rupture. Dissection at mid-RCA likely \nrepresents Type 4 MI. Now s/p DES to proximal and mid-RCA. Per \nreport, pt noted to also have ostial lesion that may require \nintervention. She was started on Plavix 75 mg daily for ___ year, \nmetoprolol 25 mg daily, lisinopril 20mg daily, Rosuvastatin \nCalcium 10 mg PO QPM. Her home lisinopril-hydrochlorothiazide \n___ mg oral DAILY was discontinued. \n\n# Hypertension: started lisinopril 20mg daily.\n\nTRANSITIONAL ISSUES:\n=====================\n- Started Plavix 75 mg daily for ___ year, metoprolol 25 mg daily, \nlisinopril 20mg daily, and rosuvastatin Calcium 10 mg PO QPM, \nand discontinued lisinopril-hydrochlorothiazide ___ mg oral \nDAILY\n- Patient agreed to try rosuvastatin since she had not tried \nthis particular statin in the past, however she is concerned \nthat previous statins made her neuropathy worse. She was \ninstructed to follow up with her PCP regarding whether she can \ntolerate rosuvastatin. Consider PCK9 inhibitor for management of \nher dyslipidemia if statin is not tolerated.\n- Consider referral to neurology for evaluation of neuropathy, \nif this is precluding patient from being treated with statin. \n# CONTACT: ___ (daughter) ___. This is the contact \nperson. ___ (daughter) ___. This is the HCP. \n# CODE: Full', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Fish Oil (Omega 3) 1000 mg PO DAILY', 'Vitamin D 1000 UNIT PO DAILY', 'Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet(s) by mouth once a day \nDisp #*30 Tablet Refills:*3', 'Clopidogrel 75 mg PO DAILY \nRX *clopidogrel 75 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*3', 'Lisinopril 20 mg PO DAILY \nRX *lisinopril 20 mg 1 tablet(s) by mouth once a day Disp #*30 \nTablet Refills:*3', 'Rosuvastatin Calcium 10 mg PO QPM \nRX *rosuvastatin [Crestor] 10 mg 1 tablet(s) by mouth once a day \nDisp #*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': 20, 'gender': 'M', 'symptoms': 'abdominal pain', 'medical_history': ["PAST PSYCHIATRIC HISTORY:\n- Sx:PTSD, ADHD, delusional disorder, depression, borderline\npersonality traits, and dissociative identity disorder\n- Hospitalizations: ___ (6 months ago - doesn't\nremember why); ___, ___ ___ years ago\n- Current treaters and treatment: Dr. ___\n(has an intake appointment on ___ with a new one)\n- Medication and ECT trials: Geodone, Risperidone - didn't work\n- Self-injury/Suicide attempts: Self-cutting behavior (last time\n___ years ago); 2 suicide attempts (overdosing on steroids) many\nyears ago\n- Harm to others: None\n- Access to weapons: Denies\n- Spritual - Loves to read the bible.", 'PAST MEDICAL HISTORY:\nHistory Uterine Ca - in remission\nHistory of Breast CA - in remission\nHistory of Ovarian CA - in remission\nHTN\nGYN-ONC provider: Dr. ___ at ___'], 'family_history': 'BRCApos. Twin sister died at ___ of\nBRCA-associated cancer, per OMR.', 'present_illness': '___ year old female who presents with significant abdominal pain \nin the setting of fairly aggressive use of anti-diarrheals and \nlater promotility agents. Of note the patient has a history of \nbreast, uterine and ovarian cancer due to BRCA1+, s/p \nchemoradiation in ___ along with a TAHBSO and had radiation \ncolitis as a result. She notes 9 days prior to presentation she \ndeveloped significant abdominal pain which was crampy in nature, \nwhich she took "a ton" of Imodium for. She stopped taking the \nImodium 2 days prior to presentation, and restarted her mirilax \nTID. On the day of presentation she took Mg-Citrate which \nresulted in immediate severe cramping. She notes her last BM was \nsome sludge 4 days prior to presentation, and was passing gas \nthe day prior to presentation. She says she has had poor PO \nintake, and has had nausea and 3 episodes of vomiting.\n\nIn the ___ ED her initial vitals were 98.3, 91, 156/108, 20, \n99%. In the ED she underwent a CT scan of the abdomen. In \naddition she received both morphine (a total of 16mg) and \nketamine for pain control. She was also given IV FLuids, \nondansetron and Tylenol.', 'medications': [{'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', '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': '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': 'Acetaminophen', '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': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H: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': 'TID', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '45.0', 'valuenum': 45.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15.3', 'valuenum': 15.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': None, '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': '34.0', 'valuenum': 34.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, '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': '12.1', 'valuenum': 12.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.98', 'valuenum': 4.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.0', 'valuenum': 40.0, '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': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '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': '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': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, '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': '28.1', 'valuenum': 28.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ROS:\n GEN: - fevers, - Chills, - Weight Loss\n EYES: - Photophobia, - Visual Changes\n HEENT: - Oral/Gum bleeding\n CARDIAC: - Chest Pain, - Palpitations, - Edema\n GI: Nausea, + Vomiting, - Diarrhea, + Abdominal Pain, + \nConstipation, - Hematochezia\n PULM: - Dyspnea, - Cough, - Hemoptysis\n HEME: - Bleeding, - Lymphadenopathy\n GU: - Dysuria, - hematuria, - Incontinence\n SKIN: - Rash\n ENDO: - Heat/Cold Intolerance\n MSK: - Myalgia, - Arthralgia, - Back Pain\n NEURO: - Numbness, - Weakness, - Vertigo, - Headache\n Remainder of 10-point ROS negative except as HPI\n\nPHYSICAL EXAM:\n\nVSS: 98.9, 148/74, 70, 24, 99%RA\n GEN: In marked distress, crying in pain\n Pain: ___\n HEENT: EOMI, MMM, - OP Lesions\n PUL: CTA B/L\n COR: RRR, S1/S2, - MRG\n ABD: Moderate diffuse TTP, ND, +BS, - CVAT\n EXT: - CCE\n NEURO: CAOx3, Non-Focal', 'diagnoses': [{'icd_code': 'S0266XB', 'desc': 'Fracture of symphysis of mandible, initial encounter for open fracture'}, {'icd_code': 'S02642A', 'desc': 'Fracture of ramus of left mandible, initial encounter for closed fracture'}, {'icd_code': 'W500XXA', 'desc': 'Accidental hit or strike by another person, initial encounter'}, {'icd_code': 'Y929', 'desc': 'Unspecified place or not applicable'}], 'summary': '___ 03:45PM BLOOD WBC-11.6* RBC-5.01 Hgb-14.3 Hct-43.3 \nMCV-86 MCH-28.5 MCHC-33.0 RDW-13.0 RDWSD-40.4 Plt ___\n___ 03:45PM BLOOD Neuts-83.2* Lymphs-12.9* Monos-2.7* \nEos-0.3* Baso-0.5 Im ___ AbsNeut-9.68* AbsLymp-1.50 \nAbsMono-0.31 AbsEos-0.04 AbsBaso-0.06\n___ 03:45PM BLOOD Glucose-143* UreaN-8 Creat-0.9 Na-143 \nK-3.6 Cl-108 HCO3-15* AnGap-20*\n___ 03:45PM BLOOD ALT-19 AST-19 AlkPhos-126* TotBili-0.4\n___ 03:45PM BLOOD Albumin-5.1 Calcium-10.7* Phos-3.9 Mg-2.6\n___ 08:16PM BLOOD Lactate-2.1*\n___ 03:51PM BLOOD Lactate-3.1*\n___ 07:25PM URINE Color-Yellow Appear-Clear Sp ___\n___ 07:25PM URINE Blood-NEG Nitrite-NEG Protein-NEG \nGlucose-NEG Ketone-NEG Bilirub-NEG Urobiln-NEG pH-6.0 Leuks-NEG\n\n___ 7:25 pm URINE\n\n URINE CULTURE (Pending):\n\nECG Study Date of ___ 4:04:57 ___\n Intervals Axes \nRate PR QRS QT QTc (___) P QRS T \n77 154 96 ___ 30 -9 116 \n\n\nCT ABD & PELVIS WITH CONTRAST Study Date of ___ 5:48 ___ \nIMPRESSION: \n1. Most of the colon is distended, filled with fecal material \nand air, with an abrupt transition located within the sigmoid \ncolon, concerning for large bowel obstruction, possibly related \nto a mild stercoral colitis. Mild pericolonic fat stranding \nalong the distal descending colon/proximal sigmoid colon, \nproximal to the change in caliber of the colon. ___ discrete \nmass identified. \n2. Stable pulmonary nodules of the right middle lobe, measuring \nup to 2 mm. \n3. Hepatic steatosis. \n4. Other findings, as described above.\n1. Abdominal pain:\n___ female with history of radiation colitis, opiate \ninduced constipation, breast cancer and endometrial cancer \nstatus post chemoradiation\nwho comes with abdominal distention, inability to pass gas. She\nhas been taking large quantities of Imodium. A CT scan showed\nlarge bowel obstruction likely on the setting of large amount of\nstool in the colon. Her previous colonoscopy in ___ showed\nerythema and linear erosions in the rectum, sigmoid colon and\ndescending colon compatible with colitis. Biopsies were \nconsistent with radiation colitis. \n\nA Gastrografin enema was performed to relieve the obstruction on \n___ under fluoroscopy; it showed ___ evidence of strictures.She \nhad a large loose BM after and felt immediate relief. \nShe was advised to avoid narcotics if possible. For bowel \nregimen, we recommended that she continue miralax BID and mag \ncitrate as rescue therapy. We also suggested she avoid immodium \nand maintain a high fiber diet. She needs follow up with a GI \nmotility specialist. \n\n2. ___ Esophagus\n- Omeprazole\n\n3. Anxiety\n- Clonazepam BID as outpatient regimen\n- Seroquel, Topomax, Clonidine, Bupropion\n\n4. ADHD\n- Continue methylphenidate'}}
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{'final_diagnoses': ['Large bowel obstruction'], 'procedures': ['gastrograffin enema'], 'visit_summary': '1. Abdominal pain:\n___ female with history of radiation colitis, opiate \ninduced constipation, breast cancer and endometrial cancer \nstatus post chemoradiation\nwho comes with abdominal distention, inability to pass gas. She\nhas been taking large quantities of Imodium. A CT scan showed\nlarge bowel obstruction likely on the setting of large amount of\nstool in the colon. Her previous colonoscopy in ___ showed\nerythema and linear erosions in the rectum, sigmoid colon and\ndescending colon compatible with colitis. Biopsies were \nconsistent with radiation colitis. \n\nA Gastrografin enema was performed to relieve the obstruction on \n___ under fluoroscopy; it showed ___ evidence of strictures.She \nhad a large loose BM after and felt immediate relief. \nShe was advised to avoid narcotics if possible. For bowel \nregimen, we recommended that she continue miralax BID and mag \ncitrate as rescue therapy. We also suggested she avoid immodium \nand maintain a high fiber diet. She needs follow up with a GI \nmotility specialist. \n\n2. ___ Esophagus\n- Omeprazole\n\n3. Anxiety\n- Clonazepam BID as outpatient regimen\n- Seroquel, Topomax, Clonidine, Bupropion\n\n4. ADHD\n- Continue methylphenidate', 'medications_prescribed': ['BuPROPion (Sustained Release) 100 mg PO BID', 'ClonazePAM 1 mg PO BID', 'Omeprazole 20 mg PO DAILY', 'QUEtiapine Fumarate 300 mg PO QHS', 'Prazosin 1 mg PO QPM', 'Topiramate (Topamax) 12.5 mg PO BID', 'Polyethylene Glycol 17 g PO BID', 'Senna 8.6 mg PO EVERY OTHER DAY', 'CloNIDine 0.3 mg PO TID', 'Vitamin D 1000 UNIT PO DAILY', 'Vitamin D ___ UNIT PO 1X/WEEK (MO)', 'Methadone 10 mg PO TID', 'MethylPHENIDATE (Ritalin) 10 mg PO QAM', 'MethylPHENIDATE (Ritalin) 10 mg PO DAILY AT NOON', 'BuPROPion (Sustained Release) 100 mg PO BID', 'ClonazePAM 1 mg PO BID', 'Omeprazole 20 mg PO DAILY', 'QUEtiapine Fumarate 300 mg PO QHS', 'Prazosin 1 mg PO QPM', 'Topiramate (Topamax) 12.5 mg PO BID', 'Polyethylene Glycol 17 g PO BID', 'Senna 8.6 mg PO EVERY OTHER DAY', 'CloNIDine 0.3 mg PO TID', 'Vitamin D 1000 UNIT PO DAILY', 'Vitamin D ___ UNIT PO 1X/WEEK (MO)', 'Methadone 10 mg PO TID', 'MethylPHENIDATE (Ritalin) 10 mg PO QAM', 'MethylPHENIDATE (Ritalin) 10 mg PO DAILY AT NOON']}
|
Generate a treatment plan with clinical reasoning for this case:
|
{'patient_profile': {'age': 37, 'gender': 'F', 'symptoms': 'dyspnea and ___ edema likely in setting of underlying lung disease and chronic lymphedema.', 'medical_history': ['obesity', 'heart failure', 'OSA', 'chronic lymphedema', 'seizure disorder', 'gastroparesis', 'hypertension', 'recurrent cellulitis'], 'family_history': None, 'present_illness': 'Ms. ___ is a ___ with history of obesity, heart failure, \nOSA, chronic lymphedema, seizure disorder, gastroparesis, \nhypertension, recurrent cellulitis on ppx cefadroxil, who \npresents with dyspnea and ___ edema likely in setting of \nunderlying lung disease and chronic lymphedema.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Bicarbonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin Flush CRRT (5000 Units/mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'REPLACE', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Desmopressin Acetate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Phenylephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', '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': 'PENTObarbital Sodium', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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 Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'PENTObarbital Sodium', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Chlorhexidine Gluconate 0.12% Oral Rinse', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'ORAL', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Entecavir Oral Solution', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'PENTObarbital Sodium', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY: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': 'Heparin Flush (10 units/ml)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Vasopressin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acyclovir', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'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': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Expired', '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': 'DIALYS', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetylcysteine (IV)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Piperacillin-Tazobactam Na', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', '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}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'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': 'ROUTINE', 'comments': 'OCCASIONAL.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10', 'valuenum': 10.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': '36.0', 'valuenum': 36.0, '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': '17', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', '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': 'NORMAL.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '67', 'valuenum': 67.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, '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': '9.2', 'valuenum': 9.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'ug/mL', 'ref_range_lower': 5.0, 'ref_range_upper': 25.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 6375.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '118', 'valuenum': 118.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3665', 'valuenum': 3665.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 5.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '176', 'valuenum': 176.0, 'valueuom': 'IU/L', 'ref_range_lower': 26.0, 'ref_range_upper': 140.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, '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': '___'}, {'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': None, 'valuenum': None, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'value': '163', 'valuenum': 163.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'POSITIVE.'}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '___', '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': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'POSITIVE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEGATIVE.'}, {'value': '206', 'valuenum': 206.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': 'abnormal', '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': '61', 'valuenum': 61.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '311', 'valuenum': 311.0, 'valueuom': 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'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '44', 'valuenum': 44.0, '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': '3.3', 'valuenum': 3.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'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': '24.8', 'valuenum': 24.8, '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': '32.6', 'valuenum': 32.6, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46', 'valuenum': 46.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, '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': '4.3', 'valuenum': 4.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '235', 'valuenum': 235.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 24.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC.'}, {'value': '___', 'valuenum': 117.9, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.16', 'valuenum': 1.16, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '98', 'valuenum': 98.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, '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': '172', 'valuenum': 172.0, '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': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48', 'valuenum': 48.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.0', 'valuenum': 14.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.82', 'valuenum': 2.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '214', 'valuenum': 214.0, 'valueuom': 'mg/dL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, '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': '23.9', 'valuenum': 23.9, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '89.4', 'valuenum': 89.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2085', 'valuenum': 2085.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '992', 'valuenum': 992.0, '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': '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': '11.8', 'valuenum': 11.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', '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': '4.6', 'valuenum': 4.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'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': '0', 'valuenum': 0.0, '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': '1.09', 'valuenum': 1.09, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '99', 'valuenum': 99.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '26', 'valuenum': 26.0, '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': '178', 'valuenum': 178.0, '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': '___'}], 'exams': 'On exam, JVP not elevated - \nfurther examined with US probe, JVP small and collapsible, not \nfilled with fluid.', 'diagnoses': [{'icd_code': '07020', 'desc': 'Viral hepatitis B with hepatic coma, acute or unspecified, without mention of hepatitis delta'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '51881', 'desc': 'Acute respiratory failure'}, {'icd_code': '2762', 'desc': 'Acidosis'}, {'icd_code': '2763', 'desc': 'Alkalosis'}, {'icd_code': '7885', 'desc': 'Oliguria and anuria'}, {'icd_code': '2768', 'desc': 'Hypopotassemia'}, {'icd_code': '79029', 'desc': 'Other abnormal glucose'}, {'icd_code': '30000', 'desc': 'Anxiety state, unspecified'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "ADMISSION LABS:\n===============\n___ 03:15PM BLOOD WBC-14.8* RBC-4.46 Hgb-10.2* Hct-35.5 \nMCV-80* MCH-22.9* MCHC-28.7* RDW-18.6* RDWSD-53.6* Plt ___\n___ 03:15PM BLOOD UreaN-36* Creat-1.5* Na-140 K-3.5 Cl-98 \nHCO3-25 AnGap-17\n___ 03:15PM BLOOD ALT-14 AST-13 AlkPhos-105 TotBili-<0.2\n___ 03:15PM BLOOD Lipase-44\n___ 03:15PM BLOOD cTropnT-<0.01 proBNP-182\n___ 03:15PM BLOOD Phos-3.2 Mg-2.4\n\nCXR ___\nThere is a right upper extremity PICC which terminates in the \ncavoatrial \njunction. There is no focal consolidation, pleural effusion or \npneumothorax. The cardiomediastinal silhouette is within normal \nlimits. Mild multilevel degenerative changes of the thoracic \nspine are noted. No acute osseous abnormalities are identified. \n\n___ 06:50AM BLOOD WBC-13.9* RBC-4.53 Hgb-10.4* Hct-36.1 \nMCV-80* MCH-23.0* MCHC-28.8* RDW-18.6* RDWSD-52.9* Plt ___\n___ 12:30PM BLOOD Glucose-121* UreaN-43* Creat-1.8* Na-140 \nK-3.9 Cl-94* HCO3-29 AnGap-17\n___ 12:30PM BLOOD Calcium-9.6 Phos-4.1 Mg-2.3\nTRANSITIONAL ISSUES:\n=====================\nDischarge weight: 341 lb\nDischarge creatinine: 1.8\nDischarge diuretic: Torsemide 100mg BID\n\nCARDIOLOGY\n[] Only gave 1 dose of torsemide on ___. Pt to skip Torsemide \nand spironolactone on ___ and take only 2 doses of potassium. \nOn ___ can resume 100mg BID torsemide. \n[] Please follow-up chemistry panel, pt with slight ___ to 1.8 \non discharge in setting of receiving metolazone.\n\nPCP\n[] Please obtain PFTs as outpatient for further work-up of \nunderlying lung disease\n\n___\n[] Please check labs ___. \n\n\nBRIEF HOSPITAL COURSE: \n===================== \nMs. ___ is a ___ with history of obesity, heart failure, \nOSA, chronic lymphedema, seizure disorder, gastroparesis, \nhypertension, recurrent cellulitis on ppx cefadroxil, who \npresents with dyspnea and ___ edema likely in setting of \nunderlying lung disease and chronic lymphedema.\n\nCORONARIES: unk \nPUMP: TTE ___: limited study, normal EF, normal RV function, no\neval of valves or TR gradient \nRHYTHM: sinus \n\n===============\nACTIVE ISSUES: \n===============\n#? Volume overload, HFpEF\n Concern for volume overload on admission related to HF but \nafter review of echo and detailed exam, unlikely to be a HF \nexacerbation. Suspect dyspnea and ___ edema/weight gain not \ncardiogenic (see below). No evidence of pulmonary edema on CXR \nwith normal BNP and lung exam. On exam, JVP not elevated - \nfurther examined with US probe, JVP small and collapsible, not \nfilled with fluid. Pt was continued on home diuretic (100mg \ntorsemide BID) with goal net\neven.\n- Preload: Torsemide 100mg BID. Consider CardioMEMS as \noutpatient\nto avoid unnecessary diuretics and subsequent ___. \n- GDMT: Continued spironolactone 100mg \n-replete K+ >4, Mg >2\n\n#Chronic lymphedema\nPatient has a history of chronic lymphedema with significant\nhistory of cellulitis and 1 week of chills with leukocytosis on\nadmission to 14. On exam however, LEs with symmetric erythema \nand swelling without warmth, ulcerations or purulence. Pt \nafebrile, did not appear c/w cellulitis. Continued on \ncefpodoxime while inpatient, may resume home Cefadroxil on \ndischarge. \n In terms of worsening lymphedema, pt with compression boots\nat home but does not wear. Wrapped legs in ACE wraps while \ninpatient and encouraged patient to wear her compression boots \nwhen she returns home.\n\n___ on CKD\nBaseline Cr of 1.4, 1.5 on admission. Of note, patient received \n2.5mg metolazone and 200mg IV Lasix on admission for c/f HF \nexacerbation with subsequent increase in Cr to 1.8 - suspect iso \noverdiuresis.\n- Will arrange for chem panel check on ___. \n\n\n#Dyspnea\nAs above, suspect that current dyspnea is not ___ HF \nexacerbation. Given morbid obesity, patient likely has \nrestrictive component. Additionally patient with wheezing on \nexam, may have underlying asthma/COPD. Pt also has sleep apnea \nand is not using her CPAP due to claustrophobia.\n- Treated with duonebs while inpatient. Will give prescription \nfor albuterol on discharge\n- TI - plan for PFTs as outpatient\n\n#Coping\nPatient homebound and mother recently placed on hospice. Social \nwork saw patient to discuss coping and support.\n\n#Back/leg pain\nSuspect worsening leg pain in setting of increasing ___ edema.\nContinued on home oxy/dilaudid and lidocaine patch. Added \nTylenol \n\n================\nCHRONIC ISSUES: \n================\n#History of DVT/PE\nDVT/PE in distant past on lifelong warfarin. Goal INR ___, \nwarfarin dosed daily on ___ mg.\n ___ - INR 2.4 - Gave 6mg today\n ___ - INR 2.2 - Gave 7.5mg warfarin\n- Patient should have INR checked on ___ by ___. \nAnticoagulation managed by ___. \n\n#PICC Line\nPlaced ___. Originally placed for IV abx. Gets weekly lab draws\nwith ___. Patient reports that she is a hard stick and with such\nfrequency of admissions and labs, she would prefer it to stay. \nKept PICC line in place.\n\n# Seizure disorder\nPatient continued on home keppra + topiramate\n\n#HLD\nPatient continued on home ezetimibe 10mg daily\n\n#GERD\nPatient's home esomeprazole not on formulary. Therefore, started\non omeprazole while inpatient.\n\n# Hypothyroid\nPatient continued on home levothyroxine 75mcg daily\n\n# OSA\nShe has not been using CPAP at home."}}
|
{'final_diagnoses': ['Chronic HFpEF', 'Chronic lymphedema', 'Coping', 'Back/leg pain', 'CKD', 'DVT/PE'], 'procedures': ['None'], 'visit_summary': "TRANSITIONAL ISSUES:\n=====================\nDischarge weight: 341 lb\nDischarge creatinine: 1.8\nDischarge diuretic: Torsemide 100mg BID\n\nCARDIOLOGY\n[] Only gave 1 dose of torsemide on ___. Pt to skip Torsemide \nand spironolactone on ___ and take only 2 doses of potassium. \nOn ___ can resume 100mg BID torsemide. \n[] Please follow-up chemistry panel, pt with slight ___ to 1.8 \non discharge in setting of receiving metolazone.\n\nPCP\n[] Please obtain PFTs as outpatient for further work-up of \nunderlying lung disease\n\n___\n[] Please check labs ___. \n\n\nBRIEF HOSPITAL COURSE: \n===================== \nMs. ___ is a ___ with history of obesity, heart failure, \nOSA, chronic lymphedema, seizure disorder, gastroparesis, \nhypertension, recurrent cellulitis on ppx cefadroxil, who \npresents with dyspnea and ___ edema likely in setting of \nunderlying lung disease and chronic lymphedema.\n\nCORONARIES: unk \nPUMP: TTE ___: limited study, normal EF, normal RV function, no\neval of valves or TR gradient \nRHYTHM: sinus \n\n===============\nACTIVE ISSUES: \n===============\n#? Volume overload, HFpEF\n Concern for volume overload on admission related to HF but \nafter review of echo and detailed exam, unlikely to be a HF \nexacerbation. Suspect dyspnea and ___ edema/weight gain not \ncardiogenic (see below). No evidence of pulmonary edema on CXR \nwith normal BNP and lung exam. On exam, JVP not elevated - \nfurther examined with US probe, JVP small and collapsible, not \nfilled with fluid. Pt was continued on home diuretic (100mg \ntorsemide BID) with goal net\neven.\n- Preload: Torsemide 100mg BID. Consider CardioMEMS as \noutpatient\nto avoid unnecessary diuretics and subsequent ___. \n- GDMT: Continued spironolactone 100mg \n-replete K+ >4, Mg >2\n\n#Chronic lymphedema\nPatient has a history of chronic lymphedema with significant\nhistory of cellulitis and 1 week of chills with leukocytosis on\nadmission to 14. On exam however, LEs with symmetric erythema \nand swelling without warmth, ulcerations or purulence. Pt \nafebrile, did not appear c/w cellulitis. Continued on \ncefpodoxime while inpatient, may resume home Cefadroxil on \ndischarge. \n In terms of worsening lymphedema, pt with compression boots\nat home but does not wear. Wrapped legs in ACE wraps while \ninpatient and encouraged patient to wear her compression boots \nwhen she returns home.\n\n___ on CKD\nBaseline Cr of 1.4, 1.5 on admission. Of note, patient received \n2.5mg metolazone and 200mg IV Lasix on admission for c/f HF \nexacerbation with subsequent increase in Cr to 1.8 - suspect iso \noverdiuresis.\n- Will arrange for chem panel check on ___. \n\n\n#Dyspnea\nAs above, suspect that current dyspnea is not ___ HF \nexacerbation. Given morbid obesity, patient likely has \nrestrictive component. Additionally patient with wheezing on \nexam, may have underlying asthma/COPD. Pt also has sleep apnea \nand is not using her CPAP due to claustrophobia.\n- Treated with duonebs while inpatient. Will give prescription \nfor albuterol on discharge\n- TI - plan for PFTs as outpatient\n\n#Coping\nPatient homebound and mother recently placed on hospice. Social \nwork saw patient to discuss coping and support.\n\n#Back/leg pain\nSuspect worsening leg pain in setting of increasing ___ edema.\nContinued on home oxy/dilaudid and lidocaine patch. Added \nTylenol \n\n================\nCHRONIC ISSUES: \n================\n#History of DVT/PE\nDVT/PE in distant past on lifelong warfarin. Goal INR ___, \nwarfarin dosed daily on ___ mg.\n ___ - INR 2.4 - Gave 6mg today\n ___ - INR 2.2 - Gave 7.5mg warfarin\n- Patient should have INR checked on ___ by ___. \nAnticoagulation managed by ___. \n\n#PICC Line\nPlaced ___. Originally placed for IV abx. Gets weekly lab draws\nwith ___. Patient reports that she is a hard stick and with such\nfrequency of admissions and labs, she would prefer it to stay. \nKept PICC line in place.\n\n# Seizure disorder\nPatient continued on home keppra + topiramate\n\n#HLD\nPatient continued on home ezetimibe 10mg daily\n\n#GERD\nPatient's home esomeprazole not on formulary. Therefore, started\non omeprazole while inpatient.\n\n# Hypothyroid\nPatient continued on home levothyroxine 75mcg daily\n\n# OSA\nShe has not been using CPAP at home.", 'medications_prescribed': ['Albuterol Inhaler 2 PUFF IH Q4H:PRN shortness of breath \nRX *albuterol sulfate [Ventolin HFA] 90 mcg 2 puffs inhaled \nevery 4 hours as needed for shortness of breath Disp #*1 Inhaler \nRefills:*0', 'Alteplase 1mg/2mL ( Clearance ie. PICC, midline, tunneled \naccess line, PA ) 2 mg IV DAILY:PRN line obstruction \nIf catheter has multiple lumens, all lumens, should have \ninstallation of tPA', 'cefaDROXiL 500 mg oral DAILY', 'Cyclobenzaprine 10 mg PO HS:PRN muscle spasm', 'EPINEPHrine (EpiPEN) 0.3 mg IM ONCE:PRN allergic reaction', 'esomeprazole magnesium 40 mg oral DAILY', 'Ezetimibe 10 mg PO DAILY', 'Heparin Flush (10 units/ml) 10 mL IV PRN and PRN, line flush', 'HYDROmorphone (Dilaudid) ___ mg PO Q4H:PRN Pain - Moderate', 'LevETIRAcetam 1500 mg PO BID', 'Levothyroxine Sodium 75 mcg PO DAILY', 'Lidocaine 5% Patch ___ PTCH TD QAM', 'MetOLazone 2.5 mg PO PRN per cardiologist', 'Naloxone Nasal Spray 4 mg IH ONCE for over sedation', 'OxyCODONE SR (OxyCONTIN) 20 mg PO Q12H', 'Potassium Chloride 60 mEq PO TID \nHold for K >', 'Spironolactone 100 mg PO DAILY', 'Topiramate (Topamax) 200 mg PO BID', 'Torsemide 100 mg PO BID', 'Triamcinolone Acetonide 0.1% Cream 1 Appl TP TID:PRN rash', 'Warfarin 7 mg PO 3X/WEEK (___)', 'Warfarin 6 mg PO 4X/WEEK (___)']}
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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': 'Right knee osteoarthritis', 'medical_history': ['HLD', 'HTN', 'OSA', 'OA', 'UTI'], 'family_history': 'non-contributory', 'present_illness': '___ year old female with right knee osteoarthritis, failed \nconservative management now s/p R TKR.', 'medications': [{'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': 'Furosemide', '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': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Chlorothiazide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H: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': 'Allopurinol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Aspirin EC', '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': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Glycopyrrolate', '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexmedetomidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Calcium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ranitidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IH', 'frequency': 'Q4H', 'doses_per_24_hrs': 6.0}, {'medication': 'Oxycodone-Acetaminophen (5mg-325mg)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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 via patient discharge', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Xopenex Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'INHALATION', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Amiodarone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Norepinephrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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': 'Sodium Chloride 3% Inhalation Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q4H: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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amiodarone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'MR X1', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q12H', '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': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'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': 'Midazolam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '1X', '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': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IH', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Mupirocin Nasal Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen IV', 'proc_type': 'IV Piggyback', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'MR X1', 'doses_per_24_hrs': None}, {'medication': 'Meperidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'MRX1:PRN', 'doses_per_24_hrs': None}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Discontinued', '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': 'PNEUMOcoccal 23-valent polysaccharide vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Milrinone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'INFUSION', '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': 'Furosemide', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', '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': 'Phytonadione', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Nitroglycerin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (25g / 500mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '1X', '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': 'Atorvastatin', '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': 0.0}]}, 'clinical_findings': {'labs': [{'value': '34.8', 'valuenum': 34.8, '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': '33.1', 'valuenum': 33.1, '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': '105', 'valuenum': 105.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, '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': '78', 'valuenum': 78.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '112', 'valuenum': 112.0, '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': '50', 'valuenum': 50.0, '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': '0.9', 'valuenum': 0.9, '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': '1.7', 'valuenum': 1.7, '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 1.7,. 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': 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': '263', 'valuenum': 263.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', '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': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '___', 'valuenum': 5.8, 'valueuom': '%', 'ref_range_lower': 4.8, 'ref_range_upper': 5.9, 'flag': None, 'priority': 'ROUTINE', 'comments': 'ADA RECOMMENDATIONS:; <7% GOAL OF THERAPY; >8% WARRANTS THERAPEUTIC ACTION.'}, {'value': '___', 'valuenum': 120.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '30.1', 'valuenum': 30.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '3', 'valuenum': 3.0, 'valueuom': '#/lpf', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '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': '-2', 'valuenum': -2.0, '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': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, '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': '95', 'valuenum': 95.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '9.5', 'valuenum': 9.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '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': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.39', 'valuenum': 7.39, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '240', 'valuenum': 240.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, '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': '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': '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': '131', 'valuenum': 131.0, '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': '6.8', 'valuenum': 6.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '297', 'valuenum': 297.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', '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': '145', 'valuenum': 145.0, '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': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36', 'valuenum': 36.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.42', 'valuenum': 7.42, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '297', 'valuenum': 297.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '-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': '156', 'valuenum': 156.0, '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': '7.5', 'valuenum': 7.5, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '370', 'valuenum': 370.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 6.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. SPECIMEN NOT HEMOLYZED.'}, {'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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '116', 'valuenum': 116.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '1.31', 'valuenum': 1.31, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, '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': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.8', 'valuenum': 7.8, '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': None, 'valuenum': None, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'VERIFIED.'}, {'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': '7.29', 'valuenum': 7.29, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '170', 'valuenum': 170.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', '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': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '2+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, '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': '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': '24.6', 'valuenum': 24.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.6', 'valuenum': 7.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '1+.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '3+.'}, {'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': '31.0', 'valuenum': 31.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 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': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '77', 'valuenum': 77.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'LOW.'}, {'value': '17.7', 'valuenum': 17.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.41', 'valuenum': 2.41, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '205', 'valuenum': 205.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '22.4', 'valuenum': 22.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, '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': '102', 'valuenum': 102.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.3', 'valuenum': 17.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.30', 'valuenum': 3.3, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, 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'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': '127', 'valuenum': 127.0, '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': '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': '95', 'valuenum': 95.0, '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, 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'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': '124', 'valuenum': 124.0, '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': '94', 'valuenum': 94.0, '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': '7.38', 'valuenum': 7.38, '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': '36.6', 'valuenum': 36.6, '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': '___'}, {'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': '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': '122', 'valuenum': 122.0, 'valueuom': 'mg/dL', 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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': '36.6', 'valuenum': 36.6, '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': '___'}, {'value': '-4', 'valuenum': -4.0, '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': '1.14', 'valuenum': 1.14, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': 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'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': 'MIXED.'}, {'value': 'MIX.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '29.3', 'valuenum': 29.3, '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': '32.2', 'valuenum': 32.2, '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '49', 'valuenum': 49.0, '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': '3.03', 'valuenum': 3.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16.3', 'valuenum': 16.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '55', 'valuenum': 55.0, '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': '1.7', 'valuenum': 1.7, 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{'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': '4.9', 'valuenum': 4.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '40', 'valuenum': 40.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '174', 'valuenum': 174.0, 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'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '410', 'valuenum': 410.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '6.1', 'valuenum': 6.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47', 'valuenum': 47.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '17.1', 'valuenum': 17.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, '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': '12', 'valuenum': 12.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '168', 'valuenum': 168.0, '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, '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 4.6,. 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': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.7', 'valuenum': 6.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '144', 'valuenum': 144.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 111.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED - CONSISTENT WITH OTHER DATA.'}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '19.1', 'valuenum': 19.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', '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': '7.47', 'valuenum': 7.47, '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': '19', 'valuenum': 19.0, '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': '7.1', 'valuenum': 7.1, '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': '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': '___', 'valuenum': 107.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.6', 'valuenum': 5.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 2.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'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': '100', 'valuenum': 100.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, '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': '146', 'valuenum': 146.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '33.1', 'valuenum': 33.1, '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18.1', 'valuenum': 18.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, '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': '9.2', 'valuenum': 9.2, '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': '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': 136.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, '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': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 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': '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': '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': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '147', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '7.49', 'valuenum': 7.49, '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': '4', 'valuenum': 4.0, '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': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.51', 'valuenum': 7.51, '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': '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': '-3', 'valuenum': -3.0, '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': '1.17', 'valuenum': 1.17, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.0, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '53', 'valuenum': 53.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.28', 'valuenum': 7.28, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 29.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'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': '33', 'valuenum': 33.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '11.4', 'valuenum': 11.4, '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': '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': 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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 147.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ANION GAP VERIFIED.'}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, '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': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.1', 'valuenum': 30.1, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 108.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED.'}, {'value': '50', 'valuenum': 50.0, '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': '2.88', 'valuenum': 2.88, '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': '2.4', 'valuenum': 2.4, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25.2', 'valuenum': 25.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '48.5', 'valuenum': 48.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '-8', 'valuenum': -8.0, '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': '1.43', 'valuenum': 1.43, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 11.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 78.0, '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': 7.08, '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': '___', 'valuenum': 53.0, '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': '4.5', 'valuenum': 4.5, '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': '-10', 'valuenum': -10.0, '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': '1.23', 'valuenum': 1.23, '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': '___', 'valuenum': 12.6, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'value': '___', 'valuenum': 78.0, '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': '___', 'valuenum': 7.06, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 54.0, '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': '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': '-10', 'valuenum': -10.0, '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': '___', 'valuenum': 13.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED.'}, {'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': '___', 'valuenum': 7.08, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': '___', 'valuenum': 46.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': 'VERIFIED. NO CALLS MADE - SAME ABNORMALITY PREVIOUSLY NOTED TODAY.'}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}], 'exams': 'Well appearing in no acute distress \nAfebrile with stable vital signs \nPain well-controlled \nRespiratory: CTAB \nCardiovascular: RRR \nGastrointestinal: NT/ND \nGenitourinary: Voiding independently \nNeurologic: Intact with no focal deficits \nPsychiatric: Pleasant, A&O x3 \nMusculoskeletal Lower Extremity: \n* 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': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '5845', 'desc': 'Acute kidney failure with lesion of tubular necrosis'}, {'icd_code': '570', 'desc': 'Acute and subacute necrosis of liver'}, {'icd_code': '41519', 'desc': 'Other pulmonary embolism and infarction'}, {'icd_code': '51851', 'desc': 'Acute respiratory failure following trauma and surgery'}, {'icd_code': '2875', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': '5853', 'desc': 'Chronic kidney disease, Stage III (moderate)'}, {'icd_code': '7885', 'desc': 'Oliguria and anuria'}, {'icd_code': '5733', 'desc': 'Hepatitis, unspecified'}, {'icd_code': '1629', 'desc': 'Malignant neoplasm of bronchus and lung, unspecified'}, {'icd_code': '51289', 'desc': 'Other pneumothorax'}, {'icd_code': '9971', 'desc': 'Cardiac complications, not elsewhere classified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '4241', 'desc': 'Aortic valve disorders'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '40390', 'desc': 'Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage I through stage IV, or unspecified'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42989', 'desc': 'Other ill-defined heart diseases'}], 'summary': "___ 06:26AM BLOOD WBC-10.7* RBC-3.12* Hgb-8.9* Hct-26.7* \nMCV-86 MCH-28.5 MCHC-33.3 RDW-13.1 RDWSD-40.4 Plt ___\n___ 06:25AM BLOOD WBC-13.2* RBC-3.69* Hgb-10.3* Hct-31.9* \nMCV-86 MCH-27.9 MCHC-32.3 RDW-13.2 RDWSD-41.1 Plt ___\n___ 06:15AM BLOOD WBC-14.4* RBC-3.66* Hgb-10.2* Hct-31.5* \nMCV-86 MCH-27.9 MCHC-32.4 RDW-13.3 RDWSD-41.3 Plt ___\n___ 06:02AM BLOOD WBC-13.1*# RBC-3.92 Hgb-10.9* Hct-33.8* \nMCV-86 MCH-27.8 MCHC-32.2 RDW-13.2 RDWSD-41.2 Plt ___\n___ 06:02AM BLOOD Glucose-137* UreaN-10 Creat-0.8 Na-136 \nK-3.9 Cl-97 HCO3-25 AnGap-14\n___ 06:02AM BLOOD Calcium-8.5 Phos-2.9 Mg-1.7\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, patient was orthostatic with ___ with BP down to ___ \nand up to 120/71 back in chair. Patient was asymptomatic and \nadministered 500ml bolus of IV fluids, which she responded to \nappropriately. Hematocrit was 33.8.\nPOD #2, hematocrit was 31.5. Patient reported dizziness while \nworking with ___ with orthostasis, SBP ___ from 110s. She was \nadministered 1 liter bolus of IV fluids and responded \nappropriately.\nPOD #3, patient was unable to clear stairs with ___ due to report \nof nausea and dizziness. BP was stable 100s/60s. Hematocrit was \n31.9. She was administered 1 liter bolus of IV fluids and \nencouraged to increase fluid PO intake. Patient declined need \nfor nausea medication and nausea resolved on its own. Holding \nparameters were placed on patient's home blood pressure meds.\nPOD #4, patient cleared ___ without being hypotensive or \northostatic.\n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Aspirin 325 mg twice \ndaily for DVT prophylaxis starting on the morning of POD#1. The \nsurgical dressing will remain on until POD#7 after surgery. The \npatient was seen daily by physical therapy. Labs were checked \nthroughout the hospital course and repleted accordingly. At the \ntime of discharge the patient was tolerating a regular diet and \nfeeling well. The patient was afebrile with stable vital signs. \n The patient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the dressing was intact. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity. \n\nMs. ___ is discharged to home with services in stable \ncondition."}}
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{'final_diagnoses': ['Right knee OA'], 'procedures': ['___: R TKR by ___, MD'], '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, patient was orthostatic with ___ with BP down to ___ \nand up to 120/71 back in chair. Patient was asymptomatic and \nadministered 500ml bolus of IV fluids, which she responded to \nappropriately. Hematocrit was 33.8.\nPOD #2, hematocrit was 31.5. Patient reported dizziness while \nworking with ___ with orthostasis, SBP ___ from 110s. She was \nadministered 1 liter bolus of IV fluids and responded \nappropriately.\nPOD #3, patient was unable to clear stairs with ___ due to report \nof nausea and dizziness. BP was stable 100s/60s. Hematocrit was \n31.9. She was administered 1 liter bolus of IV fluids and \nencouraged to increase fluid PO intake. Patient declined need \nfor nausea medication and nausea resolved on its own. Holding \nparameters were placed on patient's home blood pressure meds.\nPOD #4, patient cleared ___ without being hypotensive or \northostatic.\n\nOtherwise, pain was controlled with a combination of IV and oral \npain medications. The patient received Aspirin 325 mg twice \ndaily for DVT prophylaxis starting on the morning of POD#1. The \nsurgical dressing will remain on until POD#7 after surgery. The \npatient was seen daily by physical therapy. Labs were checked \nthroughout the hospital course and repleted accordingly. At the \ntime of discharge the patient was tolerating a regular diet and \nfeeling well. The patient was afebrile with stable vital signs. \n The patient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the dressing was intact. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity. \n\nMs. ___ is discharged to home with services in stable \ncondition.", 'medications_prescribed': ['Docusate Sodium 100 mg PO BID', 'Gabapentin 300 mg PO TID', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN Pain', 'Pantoprazole 40 mg PO Q24H', 'Senna 8.6 mg PO BID', 'Acetaminophen 1000 mg PO Q8H', 'Aspirin 325 mg PO BID', 'Hydrochlorothiazide 25 mg PO DAILY', 'Losartan Potassium 50 mg PO BID', 'HELD- Ibuprofen 400 mg PO Q8H:PRN Pain - Mild This \nmedication was held. Do not restart Ibuprofen until you complete \nyour course of Aspirin x 28 days']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 51, 'gender': 'M', 'symptoms': 'Slurred speech', 'medical_history': ['HTN: on amlodipine and captopril, unclear baseline hypertension', 'DM: on insulin, unclear A1c'], 'family_history': 'unknown', 'present_illness': 'Mr. ___ is a ___ M with HTN/HL who presents as a \ntransfer in the setting of acute "tongue swelling" and \ndifficulty speaking on a background of HTN, HL. \n\nHistory is limited at this time given that patient is intubated. \nHistory is obtained from a combination ___ records and \ndaughter in law. He was apparently at his baseline up until \nyesterday evening. During the day he did not complain of \nheadache, neck stiffness, or any infectious symptoms. In fact, \nby all accounts he had a normal day. \n \nThis morning his wife woke up around 6am and found that he was \nhaving difficulty speaking and that his tongue was swollen. His \ncomprehension and ability to interact purposefully during this \ntime was maintained. He had apparently woken up before his wife, \n(with whom he lives) and there was a concern that he had taken \nsomething, either a medication or other ?substance but this was \nnever exactly clarified. At that time, he did not have any\ndifficulty walking and could gesticulate answers to other \npeople\'s questions. \n \nHis wife and daughter in law accompanied him to ___. On \ninitial presentation, given the concern for allergic reaction, \nhe was taken benadryl and epinephrine. Labs revealed WBC 23.5 \n(80%N) and he was given 2g Ceftriaxone/1g Vancomycin. Vitals \nat ___ were: Afbrile, HR ___, sBP 150s. On exam, he was \nnoted to have a right pronator drift and right facial droop with \ndifficulty swallowing. He was intubated for airway protection \nand\ntransfered to ___. \n\nOn arrival his VS were: 98.4; 62; 150/61; 18; 100% ETT. He was \nswitched to propofol which was held for the exam.', 'medications': [{'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H: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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H:PRN', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '41.9', 'valuenum': 41.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, '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': '4.50', 'valuenum': 4.5, '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': '625', 'valuenum': 625.0, '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': '138', 'valuenum': 138.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '269', 'valuenum': 269.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '213', 'valuenum': 213.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '524', 'valuenum': 524.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '149', 'valuenum': 149.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '201', 'valuenum': 201.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '5.7', 'valuenum': 5.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 75.0, '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': '38', 'valuenum': 38.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41.8', 'valuenum': 41.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.45', 'valuenum': 4.45, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Vitals: 98.4 62 150/61 18 100% \nGeneral: NAD\nHEENT: no nuchal rigidity,\nCV: RRR S1S2\nLungs: CTA b/l\nExtremities: warm, wp, 2+ pulses.\n\nNeuro\nMS: alert, oriented X3 (using head shaking yes/no questions),\nable to follow commands including showing both thumbs and \nshowing\ntwo fingers, attempted to articulate/mouth words although ETT in\nplace. \nCN: pupils equal reaction 2-->1mm b/l, conjugate gaze, no ptosis\nor gaze deviation, \n\nFace symmetric (although difficult to assess with ETT), facial\nsensation grossly intact to light touch over the face (denies \nany\ndifference)\n\nMotor: Difficult to formally test but at least antigravity in \nthe\nleft arm, right arm has more pronounced difficulty with\nmaintaining antigravity (although no pronator drift seen), nl\nbulk, tone slightly decreased in the right arm but increased in\nthe lower extremities bilaterally. No adventitious movements\nSensory: moves all limbs to tactile stimulation\nReflexes (R/L): ___ achilles; ___ patella; ___ biceps;\nCoordination/Gait: defered\n\nDISCHARGE EXAM: \nExpired after made Comfort Measures Only by HCP', 'diagnoses': [{'icd_code': '86802', 'desc': 'Injury to other intra-abdominal organs without mention of open wound into cavity, bile duct and gallbladder'}, {'icd_code': '99741', 'desc': 'Retained cholelithiasis following cholecystectomy'}, {'icd_code': '5718', 'desc': 'Other chronic nonalcoholic liver disease'}, {'icd_code': '57451', 'desc': 'Calculus of bile duct without mention of cholecystitis, with obstruction'}, {'icd_code': '7824', 'desc': 'Jaundice, unspecified, not of newborn'}, {'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': '78906', 'desc': 'Abdominal pain, epigastric'}, {'icd_code': '78901', 'desc': 'Abdominal pain, right upper quadrant'}, {'icd_code': '7904', 'desc': 'Nonspecific elevation of levels of transaminase or lactic acid dehydrogenase [LDH]'}], 'summary': "___ 06:51PM CEREBROSPINAL FLUID (CSF) PROTEIN-57* \nGLUCOSE-76\n___ 06:51PM CEREBROSPINAL FLUID (CSF) WBC-1 RBC-2* \nPOLYS-14 ___ ___ 04:50PM TYPE-ART PO2-504* PCO2-32* PH-7.43 TOTAL \nCO2-22 BASE XS--1\n___ 04:50PM LACTATE-1.8\n___ 04:45PM GLUCOSE-144* UREA N-20 CREAT-1.3* SODIUM-139 \nPOTASSIUM-4.1 CHLORIDE-107 TOTAL CO2-19* ANION GAP-17\n___ 04:45PM estGFR-Using this\n___ 04:45PM ALT(SGPT)-14 AST(SGOT)-23 LD(LDH)-326* ALK \nPHOS-51 TOT BILI-0.4\n___ 04:45PM ALBUMIN-3.3* CALCIUM-8.1* PHOSPHATE-3.4 \nMAGNESIUM-1.8 CHOLEST-178\n___ 04:45PM %HbA1c-7.0* eAG-154*\n___ 04:45PM TRIGLYCER-73 HDL CHOL-52 CHOL/HDL-3.4 \nLDL(CALC)-111\n___ 04:45PM WBC-21.6* RBC-4.09* HGB-12.6* HCT-40.4 \nMCV-99* MCH-31.0 MCHC-31.3 RDW-12.1\n___ 04:45PM PLT COUNT-285\n___ 04:45PM ___ PTT-34.5 ___\n___ 01:25PM URINE COLOR-Straw APPEAR-Clear SP ___\n___ 01:25PM URINE BLOOD-SM NITRITE-NEG PROTEIN-100 \nGLUCOSE-TR KETONE-NEG BILIRUBIN-NEG UROBILNGN-NEG PH-6.0 \nLEUK-NEG\n___ 01:25PM URINE RBC-1 WBC-2 BACTERIA-FEW YEAST-NONE \nEPI-<1\n___ 01:25PM URINE HYALINE-1*\n___ 01:25PM URINE MUCOUS-RARE\n\nMRI ___:\nFindings in the right cerebral hemisphere indicate subacute to \nchronic infarcts. There is no definite acute infarct seen in \nthe left \ncerebral hemisphere or in the brainstem or cerebellum. Brain \nand medial \ntemporal atrophy. \n\nCT/CTA head and neck:\n1. Head CT shows no hemorrhage or loss of gray-white matter \ndifferentiation. Brain atrophy and medial temporal atrophy \nseen. \n2. CT angiography of the neck demonstrates no evidence of \nhigh-grade \nstenosis, but calcifications seen in the aorta and at both \nvertebral artery origins. No stenosis seen in the neck. \n3. Intracranial CTA shows atherosclerotic disease of both \nsupraclinoid \ninternal carotid arteries and distal vertebral arteries, right \ngreater than left side. However, no high-grade stenosis is seen \nor an aneurysm greater than 3 mm in size noted. \n\nRight Shoulder Xray:\nSingle AP view of the right shoulder demonstrates severe \ndegenerative change of the AC joint with prominent osteophytes \nand joint calcifications likely chondrocalcinosis. The \nglenohumeral joint also \ndemonstrates degenerative changes and there is a faint \ncalcification within the axillary pouch, which may represent a \nloose body or capsular \ncalcification. No acute fractures are seen. Soft tissues are \nwithin normal limits. The visualized right lung apex appears \nclear. There are \ncalcifications of the thoracic aorta. \n\nECHO IMPRESSION: The left atrium is normal in size. No atrial \nseptal defect is seen by 2D or color Doppler. Left ventricular \nwall thicknesses are normal. The left ventricular cavity size is \nnormal. Left ventricular systolic function is hyperdynamic (EF \n75%). Tissue Doppler imaging suggests an increased left \nventricular filling pressure (PCWP>18mmHg). Right ventricular \nchamber size and free wall motion are normal. The aortic valve \nleaflets (3) are mildly thickened but aortic stenosis is not \npresent. The mitral valve leaflets are mildly thickened. Trivial \nmitral regurgitation is seen. There is moderate pulmonary artery \nsystolic hypertension. There is no pericardial effusion. No \nobvious cardiac source of embolus seen (best excluded by TEE).\n___ with HTN and DM who presented with dysarthria, right arm \nweakness, right facial droop and possible tongue bite. Found to \nhave a small subacute stroke in the right parietal lobe on MRI \nand weakness of right arm consistent with a C5-C6 distribution \n(possibly due to injury from recent fall). Of note, the patient \npresented with elevated WBC, ESR, CRP which is concerning for \nperhaps an underlying malignancy. \n\n# NEURO: \nThe patient was admitted to the neuro ICU. He was able to be \nextubated soon after admission. He had an MRI which did show a \nsmall area of subacute infarct in the right parietal lobe but \nthis was not conisistent with any clinical findings. His arm \nweakness was felt to be peripheral in a C5-C6 distribution. \nGiven the recent fall a flexion/extension xray of the neck was \nobtained which showed no acute fracture, just findings \nconsistent with degenerative change. \n\nDue to reports of a fall and perhaps a tongue bite an EEG was \nobtained which preliminarily did not show any seizure activity. \n\n# MSK: \nThe patient complained of right shoulder pain and recent fall on \nthat side. Right Shoulder x-ray was obtained and showed severe \ndegenerative change of the AC joint with prominent osteophytes \nand joint calcifications likely chondrocalcinosis, but no acute \nfracture.\n\n# CARDS:\nThe patient was maintained on Norvasc 10mg, and not continued on \nCaptopril for concerns that he has had issues with allergy to \nthis medication for which Azathioprine for the associated rash \nwas continued in house. Imdur was added for better BP control \nin setting of normal heart rate.\n\n# F/E/N:\nTube feeds via NGT were administered as the patient failed his \nspeech and swallow previously; and subsequent swallow \nevaluations demonstrated inability to tolerate PO without \naspiration\n\n# ID: \nPatient found to have CXR consistent with consolidation likely \n___ aspiration. ABX started, but due to clinical decline \npatient's HCP requested CMO\n\n# DISPOSITION:\nExpired after made Comfort Measures Only by HCP"}}
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{'final_diagnoses': ['Primary:', '- Sub-acute ischemic stroke', '- Aspiration Pneumonia', '- Cardiopulmonary Failure', 'Secondary:', '- Hypertension', '- Hyperlipidemia', '- Diabetes Mellitus'], 'procedures': ['- Lumbar Puncture', '- NG Tube Placement'], 'visit_summary': "___ with HTN and DM who presented with dysarthria, right arm \nweakness, right facial droop and possible tongue bite. Found to \nhave a small subacute stroke in the right parietal lobe on MRI \nand weakness of right arm consistent with a C5-C6 distribution \n(possibly due to injury from recent fall). Of note, the patient \npresented with elevated WBC, ESR, CRP which is concerning for \nperhaps an underlying malignancy. \n\n# NEURO: \nThe patient was admitted to the neuro ICU. He was able to be \nextubated soon after admission. He had an MRI which did show a \nsmall area of subacute infarct in the right parietal lobe but \nthis was not conisistent with any clinical findings. His arm \nweakness was felt to be peripheral in a C5-C6 distribution. \nGiven the recent fall a flexion/extension xray of the neck was \nobtained which showed no acute fracture, just findings \nconsistent with degenerative change. \n\nDue to reports of a fall and perhaps a tongue bite an EEG was \nobtained which preliminarily did not show any seizure activity. \n\n# MSK: \nThe patient complained of right shoulder pain and recent fall on \nthat side. Right Shoulder x-ray was obtained and showed severe \ndegenerative change of the AC joint with prominent osteophytes \nand joint calcifications likely chondrocalcinosis, but no acute \nfracture.\n\n# CARDS:\nThe patient was maintained on Norvasc 10mg, and not continued on \nCaptopril for concerns that he has had issues with allergy to \nthis medication for which Azathioprine for the associated rash \nwas continued in house. Imdur was added for better BP control \nin setting of normal heart rate.\n\n# F/E/N:\nTube feeds via NGT were administered as the patient failed his \nspeech and swallow previously; and subsequent swallow \nevaluations demonstrated inability to tolerate PO without \naspiration\n\n# ID: \nPatient found to have CXR consistent with consolidation likely \n___ aspiration. ABX started, but due to clinical decline \npatient's HCP requested CMO\n\n# DISPOSITION:\nExpired after made Comfort Measures Only by HCP", 'medications_prescribed': ['Expired after made Comfort Measures Only by HCP']}
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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': 'Chest pain, shortness of breath', 'medical_history': ['1. HTN', '2. DM2 on insulin', '3. CAD s/p MI in ___, s/p CABG in ___, s/p RCA stent in ___, \ns/p cardiac catheterization in ___ without any interventions \nbut resulting in right femoral artery pseudoaneurysm, s/p \ncatheterization at ___ approximately ___ years ago \nwhich evidently did not show any obstructive coronary artery \ndisease.', '4. CHF -- ___ echo with EF >55%,mild LVH, 1+ MR, 1+ TR', '5. CRI -- baseline cr 1.7-2.0', '6. Anemia secondary to underproduction erythropoietin from \nchronic renal failure, on Aranesp with baseline hct ___', '7. Peripheral Vascular Disease, S/P right femoral-tibial peronal \ntrunk bypass ___, S/P cutting balloon PTA ___ S/P repair \nright femoral artery pseudoaneurysm ___. Obesity', '9. Hypercholesterolemia', '10. GERD', '11. Hiatal hernia', '12. Glaucoma'], 'family_history': 'Her mother died of rectal cancer at ___, her brother had an MI in \nhis early ___.', 'present_illness': 'Ms. ___ is an ___ yo ___ Speaking female with hx of CAD \ns/p MI (00) s/p CABG (01) s/p several cath including \nintervention to RCA ___, HTN, DM2, CRI with baseline 1.7-2, \nPVD, Diastolic CHF, who presents to the hospital with sudden \nonset SSCP at 830pm on ___. The patient was in her usual \nstate of health, sitting down talking on the phone when she \nsuddenly "felt bad". She felt a lump in her chest and pain with \ninspiration. She had never experienced this before. There was no \nradiation of the pain and no associated symptoms. She took 2 NTG \nwith no improvement in symptoms. She also took her daily \naspirin. She also tried oxygen with no improvement. She went to \nlie down but the pain and shortness of breath persisted so she \npresented to the ED. At baseline she is minimally active noting \nthat even with making the bed she requires resting afterwards. \n. \nOf note, she tells me that her anginal equivalent is burning in \nthe back of her throat. She denies any recent fevers, chills, \ncough, nausea, vomiting, radiating pain or palpiations. She \ndenies any recent heavy lifting. She reports no change in \nappetite - eats little overall. \n. \nIn ___ she fell and broke her hip and underwent repair. \nShe spent some time in rehab following surgery. She had been \ndoing well from this perspective but today notes some discomfort \nin her right hip as well as some discomfort in her right \nshoulder also an old injury from a fall. She denies any recent \nfalls. She ambulates with a walker at baseline. \n. \nThe patient was admitted in ___ with left sided chest pain \nand ruled out for ACS. She refused a stress test at the time and \ntells me today that she is afraid of having another stress test. \n\n. \nIn the ED, initial vitals were T 97.3, BP 140/60, HR 88, O2sat \n99% on RA. CXR was performed and showed no acute process. \nD-dimer was done out of concern for PE and was found to be \nslightly elevated. CTA was not performed ___ CRI so she was \nstarted on Heparin gtt for presumed PE and admitted to medicine. \nShe was also given morphine 2mg x1. VQ scan was also done and is \npending. \n. \nOn arrival to the floor, the chest pain is improved and \nbreathing is more comfortable. She continues to have pain with \ndeep breaths, none at rest.', 'medications': [{'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': 'Multivitamins W/minerals', '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': 'CloNIDine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cyclobenzaprine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propranolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Diazepam - CIWA protocol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'FoLIC Acid', '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}]}, 'clinical_findings': {'labs': [{'value': '224', 'valuenum': 224.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '76', 'valuenum': 76.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '379', 'valuenum': 379.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.8', 'valuenum': 37.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '33.1', 'valuenum': 33.1, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '131', 'valuenum': 131.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.81', 'valuenum': 3.81, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '50.4', 'valuenum': 50.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.87', 'valuenum': 3.87, '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': '49.6', 'valuenum': 49.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 70.0, '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': '102', 'valuenum': 102.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, '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': 'Hemolysis falsely elevates this test. 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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', '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': '30.8', 'valuenum': 30.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '17', 'valuenum': 17.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '___', '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': 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': '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': '36.9', 'valuenum': 36.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 98.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'LOW*.'}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.65', 'valuenum': 3.65, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, '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': '49.7', 'valuenum': 49.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}], 'exams': 'VS: T=96.6 BP= 144/70 HR= 85 RR= 20 O2 sat= 96% on 2L \nGENERAL: WDWN female in NAD. Oriented x3. Mood, affect \nappropriate. \nHEENT: NCAT. Sclera anicteric. EOMI. Conjunctiva were pink, no \npallor or cyanosis of the oral mucosa. \nNECK: Supple with JVP of 5-6 cm. \nCARDIAC: PMI located in ___ intercostal space, midclavicular \nline. RR, normal S1, S2. No m/r/g. \nLUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. CTAB, no crackles, \nwheezes or rhonchi. \nABDOMEN: Soft, NTND. No HSM or tenderness. \nEXTREMITIES: 2+ nonpitting edema on right ___, well healing \nsurgical scar. No edema on left. \nSKIN: Scattered ecchymoses. \nGuaiac: Negative', 'diagnoses': [{'icd_code': 'S36113A', 'desc': 'Laceration of liver, unspecified degree, initial encounter'}, {'icd_code': 'Z7289', 'desc': 'Other problems related to lifestyle'}, {'icd_code': 'J449', 'desc': 'Chronic obstructive pulmonary disease, unspecified'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'F419', 'desc': 'Anxiety disorder, unspecified'}, {'icd_code': 'M810', 'desc': 'Age-related osteoporosis without current pathological fracture'}, {'icd_code': 'W06XXXA', 'desc': 'Fall from bed, initial encounter'}, {'icd_code': 'Y92003', 'desc': 'Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external cause'}, {'icd_code': 'Z9181', 'desc': 'History of falling'}, {'icd_code': 'Z86718', 'desc': 'Personal history of other venous thrombosis and embolism'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': "Labs on admission:\n___ 12:25AM BLOOD WBC-12.4*# RBC-4.36 Hgb-12.8 Hct-37.6 \nMCV-86 MCH-29.4 MCHC-34.0 RDW-14.8 Plt ___\n___ 12:25AM BLOOD Neuts-82.3* Lymphs-11.5* Monos-4.2 \nEos-1.6 Baso-0.4\n___ 12:25AM BLOOD ___ PTT-24.1 ___\n___ 12:25AM BLOOD Plt ___\n___ 12:25AM BLOOD Glucose-235* UreaN-35* Creat-2.0* Na-138 \nK-3.8 Cl-103 HCO3-21* AnGap-18\n___ 12:25AM BLOOD CK(CPK)-51\n___ 08:40AM BLOOD CK(CPK)-48\n___ 05:05PM BLOOD CK(CPK)-54\n___ 12:25AM BLOOD cTropnT-<0.01\n___ 08:40AM BLOOD CK-MB-NotDone cTropnT-0.01\n___ 05:05PM BLOOD CK-MB-NotDone cTropnT-0.02*\n___ 08:40AM BLOOD Calcium-8.6 Phos-3.5 Mg-2.1\n___ 12:25AM BLOOD D-Dimer-659*\n___ 08:40AM BLOOD %HbA1c-7.7*\n\nStudies:\n___ Echo: The left atrium is elongated. The estimated right \natrial pressure is ___ mmHg. There is mild symmetric left \nventricular hypertrophy with normal cavity size and \nregional/global systolic function (LVEF>55%). The estimated \ncardiac index is normal (>=2.5L/min/m2). Right ventricular \nchamber size and free wall motion are normal. The aortic root is \nmildly dilated at the sinus level. The aortic valve leaflets (3) \nare mildly thickened but aortic stenosis is not present. No \naortic regurgitation is seen. The mitral valve leaflets are \nmildly thickened. Trivial mitral regurgitation is seen. There is \nmild pulmonary artery systolic hypertension. There is no \npericardial effusion. \nCompared with the prior study (images reviewed) of ___, the \ndetected severity of pulmonary artery systolic hypertension has \ndecreased. \n\n___ VQ scan: IMPRESSION: No perfusion defects identified. No \nchange from ___. Normal lung scan rules out recent \npulmonary embolism. \n\n___ ___ US: IMPRESSION: No evidence of right lower extremity \nDVT.\n\n___ CXR: CHEST, UPRIGHT PORTABLE VIEW: The patient is \nsignificantly rotated, which largely obscures the right hilum. \nNo airspace consolidation is seen. There is no evidence of \npulmonary edema. Atherosclerotic calcifications and median \nsternotomy wires are unchanged. Cardiomegaly is unchanged. \nIMPRESSION: No acute abnormality.\n___ yo female with CAD s/p CABG, CHF, HTN, DM, CRI presenting \nwith sudden onset pleuritic CP and found to be in atrial \nfibrillation. \n. \nAtrial fibrillation: On the morning prior to planned discharge \nthe patient developed atrial fibrillation with rapid ventricular \nresponse. She was treated with IV diltiazem and started on a \nheparin gtt. Her beta blocker was then titrated up to a final \ndose of 150mg daily for better rate control. An echocardiogram \nwas done which showed an elongated left atrium, otherwise \nunremarkable. Nifedipine was discontinued in order to make room \nfor increased beta blocker. After a discussion with her \ncardiologist Dr. ___ was decided that she would \nbenefit from coumadin. Her aspirin was decreased to 81g daily, \nplavix was discontinued. INRs will be followed by Dr. \n___. A standing order was placed in OMR.\n. \n# Chest pain: Differential includes PE vs ACS vs MSK vs PNA vs \ncostochondritis. Patient presents with signs and symptoms \nconcerning for pulmonary embolus given sudden onset of pleuritic \nchest pain, constant and associated with SOB. CT scan was \ndeferred in the ED given poor baseline renal function and she \nwas started on Heparin gtt out of concern for PE. VQ scan on \n___ was negative for PE and heparin was discontinued. EKG was \nunchanged and three sets of cardiac enzymes were negative. \nPatient remained chest pain free. Beta blocker was titrated up \nas above and aspirin was changed to 81mg daily. \n. \n# CAD: Patient is s/p MI, CABG and multiple c.cath. Chest pain \nis pleuritic and different from prior episodes of angina. No \nrelief with NTG. EKG unchanged, negative enzymes. CP free. \nContinued on home Metoprolol, ASA, Imdur, Statin, Plavix \n. \n# CHF, compensated: History of Diastolic CHF, remains euvolemic \non exam. Continued on home furosemide. \n. \n# DM2: A1c 7.7%. Continued home regimen. FSBG QID \n. \n# HTN: Well controlled this admission. Continued on metoprolol, \ntitrated up. D/c'd nifedipine.\n. \n# GERD: Continued home PPI \n. \n# Anemia: Hct baseline is 36-37. Attributed to CKD in past. \nGuaiac negative in the ED. Stable."}}
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{'final_diagnoses': ['Atypical chest pain, NOS', 'Atrial fibrillation', 'CAD s/p CABG', 'Hypertension', 'Hyperlipidemia', 'Diabetes mellitus, type 2'], 'procedures': ['None.'], 'visit_summary': "___ yo female with CAD s/p CABG, CHF, HTN, DM, CRI presenting \nwith sudden onset pleuritic CP and found to be in atrial \nfibrillation. \n. \nAtrial fibrillation: On the morning prior to planned discharge \nthe patient developed atrial fibrillation with rapid ventricular \nresponse. She was treated with IV diltiazem and started on a \nheparin gtt. Her beta blocker was then titrated up to a final \ndose of 150mg daily for better rate control. An echocardiogram \nwas done which showed an elongated left atrium, otherwise \nunremarkable. Nifedipine was discontinued in order to make room \nfor increased beta blocker. After a discussion with her \ncardiologist Dr. ___ was decided that she would \nbenefit from coumadin. Her aspirin was decreased to 81g daily, \nplavix was discontinued. INRs will be followed by Dr. \n___. A standing order was placed in OMR.\n. \n# Chest pain: Differential includes PE vs ACS vs MSK vs PNA vs \ncostochondritis. Patient presents with signs and symptoms \nconcerning for pulmonary embolus given sudden onset of pleuritic \nchest pain, constant and associated with SOB. CT scan was \ndeferred in the ED given poor baseline renal function and she \nwas started on Heparin gtt out of concern for PE. VQ scan on \n___ was negative for PE and heparin was discontinued. EKG was \nunchanged and three sets of cardiac enzymes were negative. \nPatient remained chest pain free. Beta blocker was titrated up \nas above and aspirin was changed to 81mg daily. \n. \n# CAD: Patient is s/p MI, CABG and multiple c.cath. Chest pain \nis pleuritic and different from prior episodes of angina. No \nrelief with NTG. EKG unchanged, negative enzymes. CP free. \nContinued on home Metoprolol, ASA, Imdur, Statin, Plavix \n. \n# CHF, compensated: History of Diastolic CHF, remains euvolemic \non exam. Continued on home furosemide. \n. \n# DM2: A1c 7.7%. Continued home regimen. FSBG QID \n. \n# HTN: Well controlled this admission. Continued on metoprolol, \ntitrated up. D/c'd nifedipine.\n. \n# GERD: Continued home PPI \n. \n# Anemia: Hct baseline is 36-37. Attributed to CKD in past. \nGuaiac negative in the ED. Stable.", 'medications_prescribed': ['1. Furosemide 20 mg Tablet Sig: Three (3) Tablet PO BID (2 times \na day).', '2. Nexium 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day.', '3. Dorzolamide 2 % Drops Sig: One (1) Drop Ophthalmic TID (3 \ntimes a day).', '4. Ferrous Sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily).', '5. Brimonidine 0.15 % Drops Sig: One (1) Drop Ophthalmic BID (2 \ntimes a day).', '6. Cholecalciferol (Vitamin D3) 400 unit Tablet Sig: One (1) \nTablet PO BID (2 times a day).', '7. Calcium Carbonate 500 mg Tablet, Chewable Sig: One (1) \nTablet, Chewable PO TID (3 times a day).', '8. Atorvastatin 40 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', '9. Oxybutynin Chloride 5 mg Tablet Sig: 0.5 Tablet PO BID (2 \ntimes a day).', '10. Isosorbide Mononitrate 60 mg Tablet Sustained Release 24 hr \nSig: One (1) Tablet Sustained Release 24 hr PO DAILY (Daily).', '11. Magnesium Hydroxide 400 mg/5 mL Suspension Sig: Thirty (30) \nML PO Q6H (every 6 hours) as needed.', '12. Multivitamin Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', '13. Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: ___ \nDrops Ophthalmic PRN (as needed).', '14. Folic Acid 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '15. Ranolazine 500 mg Tablet Sustained Release 12 hr Sig: One \n(1) Tablet Sustained Release 12 hr PO BID (2 times a day).', '16. Please continue with Novolin 70/30 at 8 units twice daily.', '17. Aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO once a day.', '18. Toprol XL 100 mg Tablet Sustained Release 24 hr Sig: 1.5 \nTablet Sustained Release 24 hrs PO once a day.\nDisp:*45 Tablet Sustained Release 24 hr(s)* Refills:*2*', '19. Coumadin 2 mg Tablet Sig: 1.5 Tablets PO once a day: Please \ntake as directed by Dr. ___. \nDisp:*45 Tablet(s)* Refills:*2*', '20. Outpatient Lab Work\nPlease check INR on ___ and on ___. Please fax results to Dr. \n___ office at ___.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 59, 'gender': 'F', 'symptoms': 'hematuria', 'medical_history': ['- T4a, N1, M0, stage ___ squamous cell carcinoma of the \noropharynx s/p\nradiation to ___ Gy ___ with concurrent Erbitux', '- Ruptured right iliac artery aneurysm status post repair/stent\non ___. This was complicated by a retroperitoneal\nbleed requiring transfer to the ICU and transfusion of 10 units\nof packed red blood cells and development of acute renal \nfailure,\nwhich was thought to be due initially to volume loss. He\ndeveloped right hydronephrosis requiring a right PCN. He also\ndeveloped a GI bleed requiring embolization of the left gastric\nartery on ___. He also had PEA cardiac arrest and \na non-ST elevation MI shortly afterward at ___.', '- Right Hydronephrosis status post right ureteral stent on \n___.', '- HTN/HLD', '- Alcohol abuse with withdrawal seizures in the past, sober \nsince ___', '- Fatty liver seen on CT scan ___', '- Diverticulosis', '- Depression of superior endplate of T10 and compression \ndeformity of L1, with 50% loss of anterior height', '- Atypical chest pain ___, stress Echo (___) w/ no \nischemia, cath (___) clean coronary arteries ', '- Cholelithiasis', '- Anemia s/p colonic polyp removal ___', '- h/o PEA arrest ', '- h/o esophagitis/GIB (sp gastric artery embolization ___', '- CKD 4: secondary to ___, obstructive uropathy', '- Monoclonal Gammopathy '], 'family_history': 'No FH cancers, DM, HTN, HLD', 'present_illness': 'Pt is a ___ M with a complicated medical history including\nlaryngeal SCC S/P chemoradiation in ___, PEA arrest in\nsetting of retroperitoneal bleed, CKD stage 4, monoclonal\ngammopathy, gout, malnutrition, s/p PEG, and R iliac artery\naneurysm s/p repair with stent ___ c/b endoleak outside the\nstent s/p ___ embolization ___, and fistula between the\nendoleak sac and R ureter requiring permanent R nephrostomy \ntube.\nThe pt was recently admitted for syncope and hypotension; during\nthis admission he was found to have a pericardial effusion and\ncardiac tamponade and a multi-drug resistant UTI. ___ Cx from \n___ grew MDR EColi. At this time the pt was inpatient; ID was\nconsulted and recommended meropenem -> ertapenem 2 wk course\n(___).\n\nToday, the skilled nursing facility where patient resides\ncontacted ___ stating that patient had hematuria in his\nnephrostomy tube 4d ago, which they watched over the weekend. He\nhas not been hypotensive or lightheaded. Today he had frank \nblood\ndraining into his nephrostomy tube, roughly 100 cc, thus ___\nrecommended he present to the ED for evaluation. On the ED,\npatient had an abdominal CT scan done for evaluation of\nnephrostomy tube and incidentally he was found to have\npneumatosis around the cecum. ACS was consulted for evaluation.\nHe was not complaining of any abdominal pain, only pain and\ntenderness in right flank around PCN tube insertion site. He\ndenies nausea, vomit, fever, chills, diarrhea or constipation.', 'medications': [{'medication': 'Ciprofloxacin', 'proc_type': 'IV Piggyback', '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': 'Labetalol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'DAILY', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Miconazole Powder 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV BOLUS', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Alteplase', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV BOLUS', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', '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': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Docusate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CefazoLIN', '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': 'Mannitol', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV BOLUS', 'frequency': 'ONCE MR2', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen (Liquid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Succinylcholine', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Etomidate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Vecuronium Bromide', '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': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID', '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': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Artificial Tear Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}, {'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Succinylcholine', 'proc_type': 'Unit Dose', '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': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Potassium Chloride (Powder)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Tobramycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Scopolamine Patch', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', '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': 'Famotidine', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albuterol Inhaler', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE Liquid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', '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': 'Hydrochlorothiazide', '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 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': 'Citalopram', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '9.4', 'valuenum': 9.4, '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': '3.9', 'valuenum': 3.9, 'valueuom': 'Ratio', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '219', 'valuenum': 219.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 199.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '308', 'valuenum': 308.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 91.0, '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 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'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': '363', 'valuenum': 363.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6', 'valuenum': 6.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, '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': '43.7', 'valuenum': 43.7, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '2.3', 'valuenum': 2.3, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '82.4', 'valuenum': 82.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '393', 'valuenum': 393.0, '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': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, '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': 'STAT', 'comments': None}, {'value': '297', 'valuenum': 297.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, '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': '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': 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3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '148', 'valuenum': 148.0, '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': 'HOLD. 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'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}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, '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': '338', 'valuenum': 338.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 'INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '40', 'valuenum': 40.0, 'valueuom': '%', 'ref_range_lower': 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'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': '137', 'valuenum': 137.0, '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': '6', 'valuenum': 6.0, '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': '1.26', 'valuenum': 1.26, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, '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': '7.44', 'valuenum': 7.44, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': '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': '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': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 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': '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': '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': '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'LG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.018', 'valuenum': 1.018, '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': 'Red.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NEG.'}, {'value': '35.1', 'valuenum': 35.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.7', 'valuenum': 11.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '515', 'valuenum': 515.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.18', 'valuenum': 1.18, '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': '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': '40', 'valuenum': 40.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.46', 'valuenum': 7.46, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', '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': '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': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 145.0, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, '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': '30.7', 'valuenum': 30.7, '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '549', 'valuenum': 549.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.62', 'valuenum': 3.62, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, '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': '34.7', 'valuenum': 34.7, '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': '564', 'valuenum': 564.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.61', 'valuenum': 3.61, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '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': 186.0, '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': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 174.0, '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': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35', 'valuenum': 35.0, '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': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '667', 'valuenum': 667.0, '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': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.2', 'valuenum': 15.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.8', 'valuenum': 33.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '780', 'valuenum': 780.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.71', 'valuenum': 3.71, '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': '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': '9.9', 'valuenum': 9.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '4.1', 'valuenum': 4.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.4', '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': '42', 'valuenum': 42.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'ug/mL', 'ref_range_lower': 6.0, 'ref_range_upper': 10.0, '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': '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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 232.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'ug/mL', 'ref_range_lower': 6.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '725', 'valuenum': 725.0, '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': '3.88', 'valuenum': 3.88, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '772', 'valuenum': 772.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '16.7', 'valuenum': 16.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, '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': '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': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 201.0, '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '43', 'valuenum': 43.0, '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': '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': '31.5', 'valuenum': 31.5, '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': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '766', 'valuenum': 766.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, '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 = 74 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': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '138', 'valuenum': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '45', 'valuenum': 45.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'L/min', 'ref_range_lower': None, 'ref_range_upper': None, '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': '37', 'valuenum': 37.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 139.0, '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': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33', 'valuenum': 33.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.4', 'valuenum': 31.4, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '744', 'valuenum': 744.0, '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': '3.95', 'valuenum': 3.95, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.1', 'valuenum': 28.1, 'valueuom': 'sec', 'ref_range_lower': 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'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, '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': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '537', 'valuenum': 537.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '491', 'valuenum': 491.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '3.50', 'valuenum': 3.5, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, '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': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '91', 'valuenum': 91.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 50-59 is 93 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '1.9', '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': '4.9', 'valuenum': 4.9, '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, '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': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '483', 'valuenum': 483.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.54', 'valuenum': 3.54, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.3', 'valuenum': 7.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': '90', 'valuenum': 90.0, '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': 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': '5.0', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '270', 'valuenum': 270.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.5', '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': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'HOLD. SPECIMEN TO BE HELD 48 HOURS AND DISCARDED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '111', 'valuenum': 111.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '616', 'valuenum': 616.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '779', 'valuenum': 779.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '418', 'valuenum': 418.0, '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': '3.47', 'valuenum': 3.47, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.8', 'valuenum': 6.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '9.8', 'valuenum': 9.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', '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': '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '92', 'valuenum': 92.0, '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': 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': '1.8', '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': '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': '22', 'valuenum': 22.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.2', 'valuenum': 31.2, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.1', 'valuenum': 11.1, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '89', 'valuenum': 89.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '438', 'valuenum': 438.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.53', 'valuenum': 3.53, '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': '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': '27.1', 'valuenum': 27.1, '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': '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': '92', 'valuenum': 92.0, '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': 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': '1.6', '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': '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': '128', 'valuenum': 128.0, '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': '29.9', 'valuenum': 29.9, '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': '30.9', 'valuenum': 30.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '363', 'valuenum': 363.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, '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': 4.2, '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': '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': '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': '86', 'valuenum': 86.0, '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': 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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '29.2', 'valuenum': 29.2, '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': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '367', 'valuenum': 367.0, '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': '3.37', 'valuenum': 3.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '29.3', 'valuenum': 29.3, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '351', 'valuenum': 351.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.31', 'valuenum': 3.31, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '12', 'valuenum': 12.0, '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': '9.7', 'valuenum': 9.7, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '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': 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': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, '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': '125', 'valuenum': 125.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'Admission Exam: \n===============\n VITAL SIGNS: T: 98.1F HR:90 BP:114/63 RR:18 O2 sat:97% RA\n GENERAL: AAOx3 NAD\n HEENT: NCAT, EOMI, PERRLA, mucosa moist, no LAD\n CARDIOVASCULAR: R/R/R, S1/S2, NO M/R/G\n PULMONARY: CTA ___, No crackles or rhonchi\n GASTROINTESTINAL: soft, non-tender, non-distended. No guarding,\nrebound, or peritoneal signs. +BSx4. Flank: R percutaneous\nnephrostomy tube with dark bloody urine in bag\n EXT/MS/SKIN: No C/C/E; Feet warm. Good perfusion.\n NEUROLOGICAL: Reflexes, strength, and sensation grossly intact\n\nDischarge Exam:\nVITAL SIGNS: T:97.98 F HR: 102 BP: 158/78 RR:16 O2 sat:98% RA\n GENERAL: AAOx3 NAD\n HEENT: NCAT, EOMI, PERRLA, mucosa moist, no LAD\n CARDIOVASCULAR: R/R/R, S1/S2, NO M/R/G\n PULMONARY: CTA ___, No crackles or rhonchi\n GASTROINTESTINAL: soft, non-tender, non-distended. No guarding,\nrebound, or peritoneal signs. +BSx4. Flank: R percutaneous\nnephrostomy tube draining clear urine. No hematuria. \n EXT/MS/SKIN: No C/C/E; Feet warm. Good perfusion.\n NEUROLOGICAL: Reflexes, strength, and sensation grossly intact', 'diagnoses': [{'icd_code': '431', 'desc': 'Intracerebral hemorrhage'}, {'icd_code': '3485', 'desc': 'Cerebral edema'}, {'icd_code': '99731', 'desc': 'Ventilator associated pneumonia'}, {'icd_code': '3314', 'desc': 'Obstructive hydrocephalus'}, {'icd_code': '99675', 'desc': 'Other complications due to nervous system device, implant, and graft'}, {'icd_code': '34202', 'desc': 'Flaccid hemiplegia and hemiparesis affecting nondominant side'}, {'icd_code': '2536', 'desc': 'Other disorders of neurohypophysis'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '0417', 'desc': 'Pseudomonas infection in conditions classified elsewhere and of unspecified site'}, {'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': '4786', 'desc': 'Edema of larynx'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '78451', 'desc': 'Dysarthria'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': '59971', 'desc': 'Gross hematuria'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}], 'summary': "Admission Labs: \n===============\n\n___ 03:27PM BLOOD WBC-9.5 RBC-2.64* Hgb-7.7* Hct-23.9* \nMCV-91 MCH-29.2 MCHC-32.2 RDW-13.9 RDWSD-45.5 Plt ___\n___ 10:14PM BLOOD Neuts-70.4 Lymphs-10.7* Monos-6.8 \nEos-11.6* Baso-0.2 Im ___ AbsNeut-6.85* AbsLymp-1.04* \nAbsMono-0.66 AbsEos-1.13* AbsBaso-0.02\n___ 03:56PM BLOOD ___ PTT-28.2 ___\n___ 03:27PM BLOOD Glucose-73 UreaN-64* Creat-2.0* Na-140 \nK-4.1 Cl-93* HCO3-34* AnGap-13\n___ 04:45AM BLOOD Calcium-8.6 Phos-3.5 Mg-2.1\n___ 11:46PM BLOOD Lactate-0.7\n\nDischarge Labs:\n===============\n\n___ 04:38AM BLOOD WBC-5.9 RBC-2.56* Hgb-7.5* Hct-23.2* \nMCV-91 MCH-29.3 MCHC-32.3 RDW-14.0 RDWSD-45.3 Plt ___\n___ 04:38AM BLOOD Plt ___\n___ 04:38AM BLOOD ___ PTT-31.5 ___\n___ 04:38AM BLOOD Glucose-121* UreaN-40* Creat-1.4* Na-145 \nK-3.5 Cl-107 HCO3-27 AnGap-11\n\nImaging: \n========\n___ CHEST (SINGLE VIEW):\nRight PICC tip in the upper SVC. Unchanged small left pleural \neffusion and left basilar opacity, likely compressive \natelectasis. \n\n___ CT ABD & PELVIS W/O CONTRAST:\n1. Pneumatosis involving the cecum, with a small amount \npneumoperitoneum \nadjacent to the cecum and in the right upper quadrant. Findings \nare worrisome for ischemic bowel, or possibly typhlitis if the \npatient is immunocompromised, and clinical correlation is \nneeded. No portal venous or mesenteric venous gas is present. \nSurgical consultation is recommended. \n2. Migration of the right nephrostomy tube, now within a renal \ncalyx, with \ninterval development of moderate hydroureter. A locule of air is \nalso noted within the right kidney collecting system, similar to \nprior, likely due to the presence of the indwelling nephrostomy \ncatheter. Mild ureteral wall thickening may relate to the \npatient's ongoing urinary tract infection. \n3. No significant change in moderate left pleural effusion with \ncompressive atelectasis. Resolution of right pleural effusion. \n4. Stable size and appearance of right internal iliac artery \naneurysm, status post embolization, with streak artifact \nlimiting assessment. \n5. Small pericardial effusion, similar to most recent chest CT, \nand decreased in size from the prior CT abdomen pelvis. \n6. Cholelithiasis. \n\n___ EXCHANGE NEPRHOSTOMY TUBE:\n1. Initial right antegrade nephrostogram shows nephrostomy tube \npigtail \nmalpositioned within a renal calyx. The right proximal ureter \nis patent. \n2. Appropriate final position of right 10 ___ nephrostomy \ntube. \nMr. ___ is a ___ yo M c a complicated PMH including \nlaryngeal SCC s/p chemoradiation therapy in ___, permanent \nright nephrostomy tube and UTI with MDR E. coli. The right \nnephrostomy tube had been placed after the repair of a right \niliac artery aneurysm with stent in ___ had been \ncomplicated by an endoleak with fistula formation between the \nendoleak sac and the right ureter. He now presented from his \nskilled nursing facility after he had frank blood draining from \nhis right nephrostomy tube. \n\nThe patient's hemoglobin was stable. A CT of the abdomen and \npelvis revealed migration of the right nephrostomy tube into a \nrenal calyx complicated by right-sided hydroureter. An antegrade \nnephrostogram confirmed that the nephrostomy tube pigtail was \nmalpositioned in a renal calyx. The tube was exchanged for a \nnephrostomy tube of the same size ___ F) on ___. The hematuria \nsubsequently resolved.\n\nOn admission to the hospital Mr. ___ was in ___ with serum \ncreatinine up to 2 in the setting of a right malpositioned \nnephrostomy tube c/b hydroureter. The ___ resolved with exchange \nof the nephrostomy tube (discharge serum creatinine 1.4). \n\nA CT of the abdomen and pelvis on admission showed pneumatosis \nof the cecum. Mr. ___ did not experience any abdominal \npain and serial exams were reassuring for no signs of \nperitonitis. Serum lactate on admission was normal. No surgical \nintervention was indicated. \n\nOn 2 occasions during his admission Mr. ___ was noted to \nexpectorate a blood tinged sputum. Our Medicine service was \nconsulted. Outpatient follow-up with ENT and Respirology is \nrecommended. \n\nAn appointment for an exchange of the nephrostomy tube in 3 \nmonths should be scheduled with our Department of Radiology \n(___). "}}
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{'final_diagnoses': ['malpositioned nephrostomy tube complicated by hematuria', 'blood-tinged sputum', 'post-renal acute kidney injury'], 'procedures': ['___: EXCHANGE NEPHROSTOMY CATHETER'], 'visit_summary': "Mr. ___ is a ___ yo M c a complicated PMH including \nlaryngeal SCC s/p chemoradiation therapy in ___, permanent \nright nephrostomy tube and UTI with MDR E. coli. The right \nnephrostomy tube had been placed after the repair of a right \niliac artery aneurysm with stent in ___ had been \ncomplicated by an endoleak with fistula formation between the \nendoleak sac and the right ureter. He now presented from his \nskilled nursing facility after he had frank blood draining from \nhis right nephrostomy tube. \n\nThe patient's hemoglobin was stable. A CT of the abdomen and \npelvis revealed migration of the right nephrostomy tube into a \nrenal calyx complicated by right-sided hydroureter. An antegrade \nnephrostogram confirmed that the nephrostomy tube pigtail was \nmalpositioned in a renal calyx. The tube was exchanged for a \nnephrostomy tube of the same size ___ F) on ___. The hematuria \nsubsequently resolved.\n\nOn admission to the hospital Mr. ___ was in ___ with serum \ncreatinine up to 2 in the setting of a right malpositioned \nnephrostomy tube c/b hydroureter. The ___ resolved with exchange \nof the nephrostomy tube (discharge serum creatinine 1.4). \n\nA CT of the abdomen and pelvis on admission showed pneumatosis \nof the cecum. Mr. ___ did not experience any abdominal \npain and serial exams were reassuring for no signs of \nperitonitis. Serum lactate on admission was normal. No surgical \nintervention was indicated. \n\nOn 2 occasions during his admission Mr. ___ was noted to \nexpectorate a blood tinged sputum. Our Medicine service was \nconsulted. Outpatient follow-up with ENT and Respirology is \nrecommended. \n\nAn appointment for an exchange of the nephrostomy tube in 3 \nmonths should be scheduled with our Department of Radiology \n(___). ", 'medications_prescribed': ['1. Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line \nflush ', '2. Acetaminophen 650 mg NG Q6H:PRN Pain - Mild ', '3. Allopurinol ___ mg NG DAILY ', '4. amLODIPine 5 mg NG DAILY ', '5. Aspirin 81 mg NG DAILY ', '6. Bisacodyl ___AILY:PRN constipation ', '7. Docusate Sodium 100 mg PO DAILY ', '8. Fleet Enema (Saline) 1 Enema PR ONCE A DAY EVERY 3 DAYS ', '9. FoLIC Acid 1 mg NG DAILY ', '10. Lidocaine 5% Patch 1 PTCH TD DAILY ', '11. melatonin 9 mg oral QHS ', '12. Milk of Magnesia 30 mL PO ONCE A DAY: PRN constipation ', '13. Ondansetron 4 mg PO BID ', '14. Ondansetron 4 mg PO ONCE:PRN nausea ', '15. pantoprazole 40 mg NG BID ', '16. Senna 8.6 mg NG BID:PRN constipation ', '17. Senna 8.6 mg PO DAILY ', '18. Thiamine 100 mg NG DAILY ', '19. TraMADol 50 mg PO BID ', '20. Vitamin D ___ UNIT NG DAILY ']}
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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': 'Elective ERCP', 'medical_history': ['AIDS- diagnosed in ___', 'Phernergan addiction and abuse', 'Heroin abuse', 'Cocaine abuse', 'Benzodiapine', 'H/o alcohol abuse', 'Homeless at one time'], 'family_history': None, 'present_illness': '___ M was recently d/c\x92d from ___ on ___ s/p \nsphincterotomy and stenting. He had to return today for removal \nof the stent. However during ERCP found to have many stones \n(more than prior) requiring replacement of stent. Was admitted \novernight for monitoring and IV antibiotics, pain control. \nPlease refer to D/C note in ___ for previous admission details.\n.', 'medications': [{'medication': 'HYDROmorphone (Dilaudid)', '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': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IVPCA', 'frequency': 'ASDIR', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Maalox/Diphenhydramine/Lidocaine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QID: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': 'Metoprolol Succinate XL', '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': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q2H: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': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'TP', 'frequency': 'ONCE NOW', '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': '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': 'Olanzapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', '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': 'Expired', 'route': 'IV', 'frequency': 'ONCE', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Olanzapine (Disintegrating Tablet)', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H: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': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV DRIP', 'frequency': 'INFUSION', 'doses_per_24_hrs': None}, {'medication': 'Diltiazem', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Polystyrene Sulfonate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IVPCA', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q3H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Furosemide', 'proc_type': 'Unit Dose', 'status': '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}]}, 'clinical_findings': {'labs': [{'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': '___', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 31.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '5.6', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '___', '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': '87', 'valuenum': 87.0, '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': 'STAT', 'comments': 'HOLD.'}, {'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': 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': 'MOD.'}, {'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': None, 'ref_range_upper': None, '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': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'TR.'}, {'value': '3', 'valuenum': 3.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '1.014', 'valuenum': 1.014, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, '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': 'Hazy.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Yellow.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, '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': '___', 'valuenum': 1.9, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '53', 'valuenum': 53.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '42', 'valuenum': 42.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4', 'valuenum': 4.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1200', 'valuenum': 1200.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '125', 'valuenum': 125.0, 'valueuom': '#/uL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '144', 'valuenum': 144.0, 'valueuom': 'IU/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'g/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '15.0', 'valuenum': 15.0, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72', 'valuenum': 72.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '159', 'valuenum': 159.0, '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': '87', 'valuenum': 87.0, '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': '19.9', 'valuenum': 19.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 28.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '624', 'valuenum': 624.0, 'valueuom': 'ng/mL', 'ref_range_lower': 30.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '77', 'valuenum': 77.0, 'valueuom': 'ug/dL', 'ref_range_lower': 45.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '199', 'valuenum': 199.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '5.6', 'valuenum': 5.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '153', 'valuenum': 153.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, 'flag': 'abnormal', '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': '89', 'valuenum': 89.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '26.5', 'valuenum': 26.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '460', 'valuenum': 460.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, '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': '___', 'valuenum': 5.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'VERIFIED BY SMEAR.'}, {'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': 'NOT INTUBATED.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '3', 'valuenum': 3.0, 'valueuom': 'L/min', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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': '7.40', 'valuenum': 7.4, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '68', 'valuenum': 68.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '36.4', 'valuenum': 36.4, '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': '___', 'valuenum': 158.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY INCREASES THIS RESULT. 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': '___', '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': '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': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'value': '___', 'valuenum': 112.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': 'abnormal', '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': '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': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.0', 'valuenum': 29.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, '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': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '527', 'valuenum': 527.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.6', 'valuenum': 21.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.98', 'valuenum': 2.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}, {'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': '___', 'valuenum': 15.7, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'ICTERIC, MODERATELY.'}, {'value': '35.2', 'valuenum': 35.2, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.5', 'valuenum': 29.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '493', 'valuenum': 493.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.03', 'valuenum': 3.03, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED. CHECKED FOR NRBC.'}, {'value': '105', 'valuenum': 105.0, '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': '143', 'valuenum': 143.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '126', 'valuenum': 126.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '20.3', 'valuenum': 20.3, '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': '___', 'valuenum': 34.0, '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': '2', 'valuenum': 2.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED BY DILUTION.'}, {'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': '207', 'valuenum': 207.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, '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': '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': '4.6', 'valuenum': 4.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '135', 'valuenum': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '96', 'valuenum': 96.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', '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': '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': '159', 'valuenum': 159.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.9', 'valuenum': 22.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM:\nVS: 100.3, 140/70, 76, 16, 99%/RA\nGEN: comfortable\nPain: ___\nHEENT: EOMI, MMM, - OP Lesions\nPUL: CTA B/L\nCOR: RRR, S1/S2, - MRG\nABD: NT/ND, +BS, - CVAT\nEXT: - CCE\nNEURO: CAOx3, Non-Focal', 'diagnoses': [{'icd_code': '1550', 'desc': 'Malignant neoplasm of liver, primary'}, {'icd_code': '452', 'desc': 'Portal vein thrombosis'}, {'icd_code': '5849', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': '42732', 'desc': 'Atrial flutter'}, {'icd_code': '78959', 'desc': 'Other ascites'}, {'icd_code': '5723', 'desc': 'Portal hypertension'}, {'icd_code': '45621', 'desc': 'Esophageal varices in diseases classified elsewhere, without mention of bleeding'}, {'icd_code': '5119', 'desc': 'Unspecified pleural effusion'}, {'icd_code': '51189', 'desc': 'Other specified forms of effusion, except tuberculous'}, {'icd_code': '51882', 'desc': 'Other pulmonary insufficiency, not elsewhere classified'}, {'icd_code': '07070', 'desc': 'Unspecified viral hepatitis C without hepatic coma'}, {'icd_code': '5715', 'desc': 'Cirrhosis of liver without mention of alcohol'}, {'icd_code': '4019', 'desc': 'Unspecified essential hypertension'}, {'icd_code': '33819', 'desc': 'Other acute pain'}, {'icd_code': '4778', 'desc': 'Allergic rhinitis due to other allergen'}, {'icd_code': '3569', 'desc': 'Unspecified hereditary and idiopathic peripheral neuropathy'}, {'icd_code': '33829', 'desc': 'Other chronic pain'}, {'icd_code': '28522', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': 'V1302', 'desc': 'Personal history, urinary (tract) infection'}], 'summary': "___ 11:50AM UREA N-22* CREAT-1.1\n___ 11:50AM ALT(SGPT)-56* AST(SGOT)-103* ALK PHOS-627* \nAMYLASE-111* TOT BILI-1.3 DIR BILI-0.8* INDIR BIL-0.5\n___ 11:50AM LIPASE-30\n___ 11:50AM WBC-6.3 RBC-4.14* HGB-12.9* HCT-38.1* MCV-92 \nMCH-31.2 MCHC-33.9 RDW-16.0*\n___ 11:50AM NEUTS-77.9* LYMPHS-15.1* MONOS-6.1 EOS-0.5 \nBASOS-0.6\n___ 11:50AM PLT COUNT-424\n___ 11:50AM ___\n.\nERCP on ___\n- A plastic stent placed in the biliary duct was found in the \nmajor papilla. A plastic stent was removed\n- Evidence of a previous sphincterotomy was noted in the major \npapilla\n- Many round pigment stones ranging in size from 5mm to 12mm \nthat were causing partial obstruction were seen at the main \nduct, common hepatic duct, left main hepatic duct and right main \nhepatic duct\n- A 12 mm CRE balloon was introduced for dilation in the ampulla \nsuccessfully for sphincteroplasty\n- 5 stones were partially extracted using a 11mm/15 mm balloon. \n5 stones were partially extracted using a ___ lithotriptor\n- A 5cm by ___ double pig tail biliary stent was placed \nsuccessfully using a Oasis ___ stent introducer kit considering \nthe possibility of retained stones and to facilitate adequate \nbiliary drainage\n.\n# Choledocholithiasis: s/p ERCP\n- Ciprofloxacin 500mg BID for 5 days \n- NPO overnight and diet was advance the next day. \n- Will repeat ERCP after 6 weeks with stent pull and to remove \nthe retained stones\n- Referred to Dr. ___ for cholecystectomy and surgery will \narrange outpatient follow-up\n.\n# Hemolytic Anemia: possibility raised by ERCP team for \nrecurrent stones, indirect bili low \n- check hapto pending at time of discharge\n- may need outpt w/u if high suspicion\n.\n# HIV: contined HIV meds\n.\n# h/o narcotic addiction:'\nPatient was continued on methadone 140mg/day. This dose was \nconfirmed with his ___ clinic ___ (___ Substance \n___ in ___. \nPh: ___\n.\n# Hyponatremia: chronic, mild.\n.\n# Ppx - Azithro, Bactrim\n."}}
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{'final_diagnoses': ['Choledocholithiasis'], 'procedures': ['ERCP s/p stent placement'], 'visit_summary': "# Choledocholithiasis: s/p ERCP\n- Ciprofloxacin 500mg BID for 5 days \n- NPO overnight and diet was advance the next day. \n- Will repeat ERCP after 6 weeks with stent pull and to remove \nthe retained stones\n- Referred to Dr. ___ for cholecystectomy and surgery will \narrange outpatient follow-up\n.\n# Hemolytic Anemia: possibility raised by ERCP team for \nrecurrent stones, indirect bili low \n- check hapto pending at time of discharge\n- may need outpt w/u if high suspicion\n.\n# HIV: contined HIV meds\n.\n# h/o narcotic addiction:'\nPatient was continued on methadone 140mg/day. This dose was \nconfirmed with his ___ clinic ___ (___ Substance \n___ in ___. \nPh: ___\n.\n# Hyponatremia: chronic, mild.\n.\n# Ppx - Azithro, Bactrim\n.", 'medications_prescribed': ['- Trimethoprim-Sulfamethoxazole 160-800 mg Tablet PO DAILY (Daily)', '- Azithromycin 600 mg Tablet Sig: Two (2) Tablet PO 1X/WEEK (FR)', '- Multivitamin Tablet Sig: One (1) Tablet PO DAILY (Daily): ', '- Methadone 10 mg Tablet Sig: Fourteen (14) Tablet PO DAILY ', '- Lopinavir-Ritonavir 200-50 mg Tablet Sig: Two (2) Tablet PO BID (2 times a day)', '- Emtricitabine-Tenofovir 200-300 mg Tablet Sig: One (1) Tablet PO DAILY (Daily)', '- Celexa 20 mg Tablet Sig: One (1) Tablet PO as directed: Take ___ tablet (10 mg) for 7 days, then increase to a full tablet daily']}
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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': 'Right lower lobe nodule', 'medical_history': ['Ocular myasthenia ___', 'Hypertension', 'Hyperlipidemia', 'Colon CA s/p transverse colectomy in ___', 'Peripheral neuropathy', 'Tonsillectomy for OSA'], 'family_history': 'Dad with CHF, mom with DM and celiac sprue (only autoimmune dz \nin the family)', 'present_illness': 'Had been followed with imaging for right lower lobe nodule which \nwas increasing in size. A CT on ___ showed it to be a 7.5 mm \nnodule abutting the pleura without any lymphadenopathy.', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': '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': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Furosemide', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'GlipiZIDE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Brimonidine Tartrate 0.15% Ophth.', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'BOTH EYES', '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': 'Digoxin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gemfibrozil', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Phytonadione', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'MetRONIDAZOLE (FLagyl)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '7.2', 'valuenum': 7.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 64.4, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '48.4', 'valuenum': 48.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '36.7', 'valuenum': 36.7, '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': '3.4', 'valuenum': 3.4, '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': '35.9', 'valuenum': 35.9, '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': '3.1', 'valuenum': 3.1, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92.5', 'valuenum': 92.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '602', 'valuenum': 602.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '4.48', 'valuenum': 4.48, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.7', 'valuenum': 29.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', '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': None, 'valuenum': None, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '___', 'valuenum': 386.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES ALT.'}, {'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': '564', 'valuenum': 564.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, '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': '___', 'valuenum': 620.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES AST..'}, {'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': '1.2', 'valuenum': 1.2, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.9', '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': 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': '___', 'valuenum': 4.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': 'HEMOLYSIS FALSELY ELEVATES K..'}, {'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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 6.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '62.5', 'valuenum': 62.5, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '50.7', 'valuenum': 50.7, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '535', 'valuenum': 535.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '339', 'valuenum': 339.0, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': '0.6', 'valuenum': 0.6, 'valueuom': 'ng/mL', 'ref_range_lower': 0.9, 'ref_range_upper': 2.0, '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': '12', 'valuenum': 12.0, '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': '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.8', 'valuenum': 28.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, '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': '633', 'valuenum': 633.0, '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': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.0', 'valuenum': 28.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '34.2', 'valuenum': 34.2, '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': '28.1', 'valuenum': 28.1, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '82', 'valuenum': 82.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '655', 'valuenum': 655.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.18', 'valuenum': 4.18, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.3', 'valuenum': 26.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '187', 'valuenum': 187.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '417', 'valuenum': 417.0, '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': '137', 'valuenum': 137.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 155.0, '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': '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': '3.9', 'valuenum': 3.9, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.0', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '696', 'valuenum': 696.0, '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': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '20.7', 'valuenum': 20.7, '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': '15.6', 'valuenum': 15.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.4', 'valuenum': 27.4, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, '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': 'SM .'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, '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': 'NEG.'}, {'value': '5.5', 'valuenum': 5.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': None, 'valuenum': None, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'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': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RARE.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '13', 'valuenum': 13.0, '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': '15.3', 'valuenum': 15.3, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, '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': '35.3', 'valuenum': 35.3, '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': '671', 'valuenum': 671.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.17', 'valuenum': 4.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '18.7', 'valuenum': 18.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '162', 'valuenum': 162.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '342', 'valuenum': 342.0, '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': '102', 'valuenum': 102.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, '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': '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': 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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '27.0', 'valuenum': 27.0, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '101', 'valuenum': 101.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '298', 'valuenum': 298.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': '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': '36.2', 'valuenum': 36.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '28.7', 'valuenum': 28.7, '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': '83', 'valuenum': 83.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '759', 'valuenum': 759.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': 'abnormal', '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': '4.39', 'valuenum': 4.39, '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}], 'exams': 'VS:\nGeneral: ___ year-old male in no apparent distress\nHEENT: normocephalic, mucus membranes moist\nNeck: supple, no lymphadenopathy\nCard: regular/irregular\nResp:\nGI: bowel sounds positive abdomen soft non-tender/non-distended\nExtr: warm no edema\nIncision: Right VATs clean/dry/intact\nNeuro: non-focal', 'diagnoses': [{'icd_code': '5750', 'desc': 'Acute cholecystitis'}, {'icd_code': '5754', 'desc': 'Perforation of gallbladder'}, {'icd_code': '4280', 'desc': 'Congestive heart failure, unspecified'}, {'icd_code': '42731', 'desc': 'Atrial fibrillation'}, {'icd_code': 'V4976', 'desc': 'Above knee amputation status'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '41401', 'desc': 'Coronary atherosclerosis of native coronary artery'}, {'icd_code': '3694', 'desc': 'Legal blindness, as defined in U.S.A.'}, {'icd_code': '79092', 'desc': 'Abnormal coagulation profile'}], 'summary': "His pathology report came back positive for 0.7 x 0.6 x 0.6 cm \nsquamous cell carcinoma. All lymph nodes were negative for \ncarcinoma. He does not have any evidence of known metastasis, \nwhich gives him a diagnosis of Stage 1a squamous cell carcinoma \nof the lung.\nMr. ___ was admitted to the floor after his VATS and right \nlower lobectomy on ___. Intraoperatively his only issue was \nepisodic supraventricular tachycardia followed by bradycardia, \nwhich did not continue in the PACU. Cardiology was consulted but \nwas unable to view any intraoperative rhythm strips and \ntherefore could not determine the exact nature of the \narrhythmia. They recommended resuming his home medications and \nusing beta blockers for rate control given that the patient had \na history of paroxysmal atrial fibrillation. \nHe had a right chest drain to waterseal. A PCA was provided for \npain control. His diet was clears to be advanced as tolerated to \nregular. A foley catheter was in place.\nOn POD 1, his chest drain had put out a large volume of \nserosanginous fluid and a small air leak was present.\n \nOn POD 2, his foley catheter was discontinued and he was able to \nvoid without difficulty. He was transitioned from the PCA onto \noral medications. The chest drain was left to waterseal. Serial \nchest xrays had demonstrated no pneumothorax. \n\nOn POD 3, he was triggered for atrial fibrillation with rapid \nventricular rate to the 140's which responded promptly to IV \nlopressor. His dose of PO Toprol XL was increased after \nconsultation with cardiology. He converted to sinus rhythm.\n\nOn POD 4, the dose of Toprol XL was again increased after he \nwent back into AF with RVR. He converted back into sinus rhythm.\n\nOn POD 5, the chest drain was discontinued after he was found to \nhave no air leak. He was placed on bulb suction. He continued \nto have various cardiac dysrhythmias, namely, ventricular \nbigeminy, Afib/Flutter and episodes of non-sustained VT. \nCardiology was consulted again for improved rhythym control that \nwere not controlled with the BID toprol XL. The patient \ncontinued to have dyspnea with ambulation. \nstarted in Sotalol and dose titrated for rate control- initially \nTID then decreased to BID d/t bradycardia. Started on coumadin \nfor persistant atrial dysrhythmia.\n\n___ ___ drain d/c'd on POD#6 w/ stable CXR.\nRemained in hospital per recommendation of cardiology to monitor \neffects of sotalol on QTC. QTC stable. Pt d/c'd to home w/ ___ \nservices. Dr. ___ follow INR."}}
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{'final_diagnoses': ['Right lower lobe nodule', 'Paroxysmal atrial fibrillation', 'Ocular myasthenia', 'Hypertension/Hyperlipidemia', 'Peripheral Neuropathy', 'Colon cancer s/p transverse colectomy'], 'procedures': ['Flexible bronchoscopy', 'video-assisted thoracoscopic right lower lobe wedge resection', 'video-assisted thoracoscopic right lower lobectomy', 'thoracic lymphadenectomy'], 'visit_summary': "Mr. ___ was admitted to the floor after his VATS and right \nlower lobectomy on ___. Intraoperatively his only issue was \nepisodic supraventricular tachycardia followed by bradycardia, \nwhich did not continue in the PACU. Cardiology was consulted but \nwas unable to view any intraoperative rhythm strips and \ntherefore could not determine the exact nature of the \narrhythmia. They recommended resuming his home medications and \nusing beta blockers for rate control given that the patient had \na history of paroxysmal atrial fibrillation. \nHe had a right chest drain to waterseal. A PCA was provided for \npain control. His diet was clears to be advanced as tolerated to \nregular. A foley catheter was in place.\nOn POD 1, his chest drain had put out a large volume of \nserosanginous fluid and a small air leak was present.\n \nOn POD 2, his foley catheter was discontinued and he was able to \nvoid without difficulty. He was transitioned from the PCA onto \noral medications. The chest drain was left to waterseal. Serial \nchest xrays had demonstrated no pneumothorax. \n\nOn POD 3, he was triggered for atrial fibrillation with rapid \nventricular rate to the 140's which responded promptly to IV \nlopressor. His dose of PO Toprol XL was increased after \nconsultation with cardiology. He converted to sinus rhythm.\n\nOn POD 4, the dose of Toprol XL was again increased after he \nwent back into AF with RVR. He converted back into sinus rhythm.\n\nOn POD 5, the chest drain was discontinued after he was found to \nhave no air leak. He was placed on bulb suction. He continued \nto have various cardiac dysrhythmias, namely, ventricular \nbigeminy, Afib/Flutter and episodes of non-sustained VT. \nCardiology was consulted again for improved rhythym control that \nwere not controlled with the BID toprol XL. The patient \ncontinued to have dyspnea with ambulation. \nstarted in Sotalol and dose titrated for rate control- initially \nTID then decreased to BID d/t bradycardia. Started on coumadin \nfor persistant atrial dysrhythmia.\n\n___ ___ drain d/c'd on POD#6 w/ stable CXR.\nRemained in hospital per recommendation of cardiology to monitor \neffects of sotalol on QTC. QTC stable. Pt d/c'd to home w/ ___ \nservices. Dr. ___ follow INR.", 'medications_prescribed': ['1. Outpatient Lab Work\n___ 2 week. Next INR check ___\nresults fax to Dr. ___ ___ for coumadin titration. \nGoal INR ___.\n\n2. Doxazosin 1 mg Tablet Sig: Two (2) Tablet PO HS (at bedtime). \n \n3. Pravastatin 20 mg Tablet Sig: Two (2) Tablet PO HS (at \nbedtime). \n4. Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day). \n5. Senna 8.6 mg Tablet Sig: One (1) Tablet PO HS (at bedtime). \n6. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed.\nDisp:*75 Tablet(s)* Refills:*0*\n7. Amlodipine 5 mg Tablet Sig: One (1) Tablet PO once a day: ___ \nyour usual dose. \n8. Lisinopril 20 mg Tablet Sig: One (1) Tablet PO DAILY (Daily). \n \n9. Allopurinol ___ mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). \n10. Aspirin 81 mg Tablet, Chewable Sig: One (1) Tablet, Chewable \nPO DAILY (Daily). \n11. Sotalol 80 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday).\nDisp:*60 Tablet(s)* Refills:*2*\n12. Coumadin 2 mg Tablet Sig: Two (2) Tablet PO once a day: Dr. \n___ call with dosing instructions.\nDisp:*60 Tablet(s)* Refills:*2*\n13. Hydrochlorothiazide 12.5 mg Tablet Sig: One (1) Tablet PO \nonce a day.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 85, 'gender': 'M', 'symptoms': 'Weakness/ Gait instability', 'medical_history': ['GERD', 'C5-6 disc herniation', 'C6-7 ACDF (Dr. ___ ___', 'Cervical spinal cord stimulator (Dr. ___ ___'], 'family_history': 'nc', 'present_illness': 'Mr. ___ is a ___ male w/h/o c6-7 ACDF with Dr.\n___ ___ for herniated disc s/p work injury, c/b CRPS LUE \ns/p\ncervical spinal cord stimulator by Dr. ___ ___. He reports\nleft side weakness over the past months, worse over the past 3\nweeks. He also c/o burning pain/numbness around his mid torso\ndown. He has difficulty walking, now requiring a cane and \nfalling\n20 times over the last week.', 'medications': [{'medication': 'Lidocaine Jelly 2% (Urojet)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'TP', 'frequency': '1X', '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': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Famotidine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', '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': 'OxycoDONE (Immediate Release) ', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Albuterol 0.083% Neb Soln', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IH', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}, {'medication': 'LeVETiracetam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 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', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Virus Vaccine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': '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': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pneumococcal Vac Polyvalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', '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': 'CefazoLIN', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}]}, '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': '19', 'valuenum': 19.0, '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': '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': 4320.0, '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': '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 = 38 if non African-American (mL/min/1.73 m2). Estimated GFR = 46 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 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': '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': '142', 'valuenum': 142.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.4', 'valuenum': 40.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.6', 'valuenum': 33.6, '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': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '95.4', 'valuenum': 95.4, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '289', 'valuenum': 289.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, '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': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '114', 'valuenum': 114.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 5363.0, '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': '26', 'valuenum': 26.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.6', 'valuenum': 1.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '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': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '34', 'valuenum': 34.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '37.4', 'valuenum': 37.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '234', 'valuenum': 234.0, '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': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 6.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 4728.0, 'valueuom': 'IU/L', 'ref_range_lower': 47.0, 'ref_range_upper': 322.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'VERIFIED BY DILUTION. 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': '21', 'valuenum': 21.0, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.2', 'valuenum': 8.2, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '111', 'valuenum': 111.0, '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': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, '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': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': '37.2', 'valuenum': 37.2, '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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.8', 'valuenum': 31.8, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, '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': '12.3', 'valuenum': 12.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.84', 'valuenum': 3.84, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '-10', 'valuenum': -10.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', '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': '94', 'valuenum': 94.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '34', 'valuenum': 34.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, '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': '39', 'valuenum': 39.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '___', 'valuenum': 7.23, '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': '244', 'valuenum': 244.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, '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': '142', 'valuenum': 142.0, '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': '0.9', 'valuenum': 0.9, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.2', 'valuenum': 10.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.5', 'valuenum': 30.5, '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': 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': '31.6', 'valuenum': 31.6, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, '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': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.29', 'valuenum': 3.29, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': 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': 10.3, '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': '___', 'valuenum': 1590.0, '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': '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': 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': '1.9', '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': 3.3, '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '2.8', 'valuenum': 2.8, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, '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': '20', 'valuenum': 20.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '110', 'valuenum': 110.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1007.0, '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': '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': 114.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.7', 'valuenum': 1.7, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.8', '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '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': '33.3', 'valuenum': 33.3, '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': '214', 'valuenum': 214.0, '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': '3.31', 'valuenum': 3.31, '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': '10', 'valuenum': 10.0, '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': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.3', 'valuenum': 1.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 106.0, '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': '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': '27', 'valuenum': 27.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 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': '31.1', 'valuenum': 31.1, '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': '213', 'valuenum': 213.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.27', 'valuenum': 3.27, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.9', 'valuenum': 4.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '34.2', 'valuenum': 34.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': '=================\nOn Admission\n=================\nPHYSICAL EXAM:\nO: T: 99.7 BP: 124/81 HR: 90 R: 18 O2Sats: 100%RA\nGen: WD/WN, in mild distress from pain\n\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nMotor:\n D B T WE WF G IP Q H AT ___ G\nR 5 5 5 ___ 5 5 5 5 5 5\nL 5 5 5 ___ 4 4+ 4 0 4+ 4 \n\nSensation: decreased sensation to pinprick from ~ c6 on left and\n~T8 on right. \n\n+ Bilateral Hoffmans L>R\n+ Bilateral Clonus \n\n_____________\nON DISCHARGE: \nO: T: 98.2 BP: 131/81 HR: 89 R: 20 O2Sats: 95%RA\nGen: WD/WN, NAD\nExtrem: Warm and well-perfused.\nNeuro:\nMental status: Awake and alert, cooperative with exam, normal\naffect.\nOrientation: Oriented to person, place, and date.\nMotor:\n D B T WE WF G IP Q H AT ___ G\nR 5 5 5 ___ 5 5 5 5 5 5\nL 5 5 5 ___ 5 5 5 4+ 5 5 \n\nSensation: Intact to light touch throughout, mild tingling \naround hips only\n\n+ Bilateral Hoffmans L>R\n+ LLE clonus', 'diagnoses': [{'icd_code': '85221', 'desc': 'Subdural hemorrhage following injury without mention of open intracranial wound, with no loss of consciousness'}, {'icd_code': '72888', 'desc': 'Rhabdomyolysis'}, {'icd_code': '496', 'desc': 'Chronic airway obstruction, not elsewhere classified'}, {'icd_code': '7140', 'desc': 'Rheumatoid arthritis'}, {'icd_code': 'E8889'}, {'icd_code': '7812', 'desc': 'Abnormality of gait'}], 'summary': 'Please see OMR for imaging reports and lab results\nMr. ___ was admitted to the Neurosurgery service for pain \ncontrol and further workup for his pain and weakness.\n\n#Pain, gait instability\nA CT of the spine was done confirming lead placement level with \nno major hemorrhage or fracture noted. Patient was admitted for \npain control and to discuss surgical options. The patient \nexpressed wanting to have the spinal cord stimulator removed. \nPhysical therapy saw the patient and felt a home discharge was \nnot safe secondary to gait instability. After discussion with \nDr. ___ was planned for ___. He went to the OR on \n___ for spinal cord stimulator removal. Please see operative \nnote for details.\n\nPostoperatively he recovered well and reported significant \nimprovement in symptoms and strength. The postoperative MRI \nshowed decreased flattening of the cord at C4-5 but residual \nspondylotic changes of the cervical spine at C5-C6. He was \nevaluated and cleared by the physical therapy team to go home \nwith a walker. At the time of discharge he was voiding without \nproblems, tolerating regular diet, having bowel movements, and \nhaving adequate pain control.'}}
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{'final_diagnoses': ['Chronic Pain', 'Cervical myopathy', 'Gait instability'], 'procedures': ['___ Removal of the spinal cord stimulator'], 'visit_summary': 'Mr. ___ was admitted to the Neurosurgery service for pain \ncontrol and further workup for his pain and weakness.\n\n#Pain, gait instability\nA CT of the spine was done confirming lead placement level with \nno major hemorrhage or fracture noted. Patient was admitted for \npain control and to discuss surgical options. The patient \nexpressed wanting to have the spinal cord stimulator removed. \nPhysical therapy saw the patient and felt a home discharge was \nnot safe secondary to gait instability. After discussion with \nDr. ___ was planned for ___. He went to the OR on \n___ for spinal cord stimulator removal. Please see operative \nnote for details.\n\nPostoperatively he recovered well and reported significant \nimprovement in symptoms and strength. The postoperative MRI \nshowed decreased flattening of the cord at C4-5 but residual \nspondylotic changes of the cervical spine at C5-C6. He was \nevaluated and cleared by the physical therapy team to go home \nwith a walker. At the time of discharge he was voiding without \nproblems, tolerating regular diet, having bowel movements, and \nhaving adequate pain control.', 'medications_prescribed': ['Acetaminophen 325-650 mg PO Q6H:PRN for fever or pain', 'Docusate Sodium 100 mg PO BID', 'OxyCODONE (Immediate Release) ___ mg PO Q4H:PRN pain \nRX *oxycodone 5 mg ___ tablet(s) by mouth every ___ hours as \nneeded Disp #*30 Tablet Refills:*0', 'Tizanidine 4 mg PO Q8H:PRN Muscle Spasm \nRX *tizanidine 4 mg 1 capsule(s) by mouth every 8 hours as \nneeded Disp #*40 Capsule Refills:*2', 'ALPRAZolam 1 mg PO BID:PRN Anxiety']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 65, 'gender': 'M', 'symptoms': 'gestational hypertension\nT1DM', 'medical_history': ['T1DM', 'heart murmur', 'migraines', 'anxiety'], 'family_history': 'non contributory', 'present_illness': " ___ G1P0 at 35w3d with h/o T1DM sent from routine OB visit\nfor elevated blood pressures and headache. \n\nToday at routine OB visit was noted to have mild range BP.\nPatient also states that she wasn't feeling like her self. She\nhad a ___ headache that is frontal in nature. She had spots in\nher vision prior to her appointment that resolved spontaneously. \n\n\nShe denies ctx, VB, LOF. +FM.", 'medications': [{'medication': 'Potassium Chloride Replacement (Critical Care and Oncology) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Aspirin', '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', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QAM', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': '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': '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': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'Q12H', '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': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Lisinopril', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/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': 'Magnesium Sulfate Replacement (Critical Care and Oncology)', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Lisinopril', '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': 'Discontinued via patient discharge', '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': 'Magnesium Oxide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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': 'Clopidogrel', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Aquaphor Ointment', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TP', 'frequency': 'TID: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': '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': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Warfarin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY16', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': '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': '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': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', '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': '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': '7.5', 'valuenum': 7.5, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'TR.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.027', 'valuenum': 1.027, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Yellow.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '55', 'valuenum': 55.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '41', 'valuenum': 41.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, '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': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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 = 67 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (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': 'STAT', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '315', 'valuenum': 315.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51', 'valuenum': 51.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': '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': '___', 'valuenum': 5.7, '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': 117.0, 'valueuom': 'mg/dL', 'ref_range_lower': 91.0, 'ref_range_upper': 123.0, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '37.6', 'valuenum': 37.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '___', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERIFIED. LABEL CHECKED.'}, {'value': '119', 'valuenum': 119.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.5', 'valuenum': 47.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '20.7', 'valuenum': 20.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.7', 'valuenum': 39.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '68.8', 'valuenum': 68.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '78.4', 'valuenum': 78.4, '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': '44.4', 'valuenum': 44.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '51.8', 'valuenum': 51.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '50.4', 'valuenum': 50.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'STAT', 'comments': None}, {'value': '13.2', 'valuenum': 13.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.4', 'valuenum': 49.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '49.6', 'valuenum': 49.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '67.6', 'valuenum': 67.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '41.0', 'valuenum': 41.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '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': '98', 'valuenum': 98.0, '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': '13.2', 'valuenum': 13.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '46.9', 'valuenum': 46.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, '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': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', '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': '17', 'valuenum': 17.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', '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': '75.5', 'valuenum': 75.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '62.3', 'valuenum': 62.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83.2', 'valuenum': 83.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '75.2', 'valuenum': 75.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '55.5', 'valuenum': 55.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83.2', 'valuenum': 83.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '83.5', 'valuenum': 83.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '30.3', 'valuenum': 30.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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 = 67 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 60-69 is 85 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '37.2', 'valuenum': 37.2, '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': '31.7', 'valuenum': 31.7, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.9', 'valuenum': 14.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '51.6', 'valuenum': 51.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.3', 'valuenum': 12.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.8', 'valuenum': 47.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, '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': '2.3', 'valuenum': 2.3, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '136', 'valuenum': 136.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86.7', 'valuenum': 86.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '71.6', 'valuenum': 71.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '38.1', 'valuenum': 38.1, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, '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': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '117', 'valuenum': 117.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '4.05', 'valuenum': 4.05, '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': '50.6', 'valuenum': 50.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.1', 'valuenum': 34.1, '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': '105', 'valuenum': 105.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.5', 'valuenum': 14.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.57', 'valuenum': 3.57, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '49.6', 'valuenum': 49.6, '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': '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': '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': 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': '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': '139', 'valuenum': 139.0, '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': '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': '60.1', 'valuenum': 60.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.7', 'valuenum': 31.7, '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': '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}, 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32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.7', 'valuenum': 33.7, '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': '11.8', 'valuenum': 11.8, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.2', 'valuenum': 69.2, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '130', 'valuenum': 130.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '14.2', 'valuenum': 14.2, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.17', 'valuenum': 3.17, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '0.17', 'valuenum': 0.17, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.61', 'valuenum': 0.61, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.59', 'valuenum': 3.59, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '48.1', 'valuenum': 48.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.7', 'valuenum': 30.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.3', 'valuenum': 10.3, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'On admission:\n\n___ 16:35BP: 138/79 (94)\n___ ___: 85\n___ 16:37Temp.: 97.9°F\n___ 16:40BP: 140/74 (89)\n___ ___: 78\n___ 16:50BP: 140/74 (89)\n___ ___: 77\n___ 17:40BP: 125/77 (88)\n___ ___: 77\n\nGen: A&O, comfortable\nAbd: soft, gravid, nontender\nExt: no calf tenderness, +1 swelling \n \nSVE: deferred\n\nOn discharge:\nTemp: 97.7 (Tm 97.7), BP: 118/77 (118-131/77-82), HR: 74 \n(74-81),\nRR: 20 (___), O2 sat: 98% (97-98), FHR: 150-160 (150-160)\n\nGeneral:NAD\nRespiratory: No evidence of respiratory distress, LCTAB\nAbdomen: soft, non-tender \nExtremities:bilateral lower extremities, nontender and\nnonedematous', 'diagnoses': [{'icd_code': 'I25110', 'desc': 'Atherosclerotic heart disease of native coronary artery with unstable angina pectoris'}, {'icd_code': 'I7779', 'desc': 'Dissection of other specified artery'}, {'icd_code': 'L7622', 'desc': 'Postprocedural hemorrhage of skin and subcutaneous tissue following other procedure'}, {'icd_code': 'I9788', 'desc': 'Other intraoperative complications of the circulatory system, not elsewhere classified'}, {'icd_code': 'I97410', 'desc': 'Intraoperative hemorrhage and hematoma of a circulatory system organ or structure complicating a cardiac catheterization'}, {'icd_code': 'I9751', 'desc': 'Accidental puncture and laceration of a circulatory system organ or structure during a circulatory system procedure'}, {'icd_code': 'I480', 'desc': 'Paroxysmal atrial fibrillation'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'R001', 'desc': 'Bradycardia, unspecified'}, {'icd_code': 'Z951', 'desc': 'Presence of aortocoronary bypass graft'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'Z85828', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'E119', 'desc': 'Type 2 diabetes mellitus without complications'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z6828', 'desc': 'Body mass index [BMI] 28.0-28.9, adult'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}, {'icd_code': 'I9581', 'desc': 'Postprocedural hypotension'}, {'icd_code': 'Y840', 'desc': 'Cardiac catheterization 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'}, {'icd_code': 'Z955', 'desc': 'Presence of coronary angioplasty implant and graft'}, {'icd_code': 'Z952', 'desc': 'Presence of prosthetic heart valve'}, {'icd_code': 'C44719', 'desc': 'Basal cell carcinoma of skin of left lower limb, including hip'}], 'summary': '___ 05:20PM BLOOD WBC-8.9 RBC-3.75* Hgb-12.7 Hct-37.7 \nMCV-101* MCH-33.9* MCHC-33.7 RDW-13.1 RDWSD-48.1* Plt ___\n___ 05:20PM BLOOD Neuts-67.7 ___ Monos-6.7 Eos-1.3 \nBaso-0.3 Im ___ AbsNeut-6.03 AbsLymp-2.12 AbsMono-0.60 \nAbsEos-0.12 AbsBaso-0.03\n___ 05:20PM BLOOD UreaN-9 Creat-0.5\n___ 05:20PM BLOOD ALT-8 AST-15\n___ 05:20PM BLOOD UricAcd-3.5\nMs. ___ is a ___ year old G1P0 with a history of T1DM who \nwas admitted to the antepartum service on ___ for rule out \npreeclampsia. due to headache and elevated blood pressures. \n\nHer pregnancy-induced hypertension labs, urine \nprotein:creatinine ratio, and 24-hour urine protein were all \nwithin normal limits. Her headache resolved overnight. On ___, \nshe remained asymptomatic, without severe range blood \npressures,, visual changes, chest pain, shortness of breath, or \nRUQ pain. She was given a diagnosis of gestational hypertension.\n\nRegarding her type 1 diabetes, patient was continued on her \ninsulin pump. \n\nOf note, on ___, patient had noted some vaginal spotting with \npreterm contractions. On sterile speculum exam and sterile \nvaginal exam, her cervix was long/closed/posterior. She had some \nscant pinge tinge on the examination glove. NST was reactive. \nGiven overall reassuring exam with no evidence of preterm labor \nor abruption, patient was encouraged toPO hydrate. She was Rh \npositive and thus no Rhogam was indicated. \n\nIn the evening of ___, patient continued to have normal range \nBPs and no new symptoms. She was thus discharged to home with \nclose follow up.'}}
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{'final_diagnoses': ['gestational hypertension'], 'procedures': ['none'], 'visit_summary': 'Ms. ___ is a ___ year old G1P0 with a history of T1DM who \nwas admitted to the antepartum service on ___ for rule out \npreeclampsia. due to headache and elevated blood pressures. \n\nHer pregnancy-induced hypertension labs, urine \nprotein:creatinine ratio, and 24-hour urine protein were all \nwithin normal limits. Her headache resolved overnight. On ___, \nshe remained asymptomatic, without severe range blood \npressures,, visual changes, chest pain, shortness of breath, or \nRUQ pain. She was given a diagnosis of gestational hypertension.\n\nRegarding her type 1 diabetes, patient was continued on her \ninsulin pump. \n\nOf note, on ___, patient had noted some vaginal spotting with \npreterm contractions. On sterile speculum exam and sterile \nvaginal exam, her cervix was long/closed/posterior. She had some \nscant pinge tinge on the examination glove. NST was reactive. \nGiven overall reassuring exam with no evidence of preterm labor \nor abruption, patient was encouraged toPO hydrate. She was Rh \npositive and thus no Rhogam was indicated. \n\nIn the evening of ___, patient continued to have normal range \nBPs and no new symptoms. She was thus discharged to home with \nclose follow up.', 'medications_prescribed': ['Aspirin 81 mg PO DAILY', 'Prenatal Vitamins 1 TAB 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': 'M', 'symptoms': 'Atrial Fibrillation', 'medical_history': ['-Metastatic thyroid Ca dx ___ s/p thyroidectomy and RAI', '-adenocarcinoma right SCV discovered by neck mass, unknown\nprimary- diagnosed ___ s/p XRT to neck, chemo, excision', '-PCKD followed by Dr. ___ ___ b/l enlarged kidneys\n\nwith multiple cysts (17cm and 16.8 cm) during pelvic U/S for \nmenorrhagia. +hepatic cysts', '-benign hand tremor', '-BPPV', '-morbid obesity', '-Right eye glaucoma, followed by Dr. ___.', '-Anemia with a history of blood transfusions; iron deficient in\nnature likely ___ colonic polyp removed ___', '-Right neck mass removed in ___, benign in nature', '-Chronic Kidney Disease', '-Anemia'], 'family_history': 'Her father died of prostate cancer in his ___. Mother died in \nher ___ of congestive heart failure though she was on dialysis \nand had a nephrectomy for unknown reasons. Her brother had \nkidney cysts. Her sister has hypertension. Her son has asthma \nand schizophrenia. There is no diabetes in her family. No known \nthyroid disease.', 'present_illness': ": ___ lady with PMH notable for polycystic kidney \ndisease, ESRD on HD (___), metastatic thyroid cancer s/p \nthyroidectomy and radioactive iodine therapy, hypothyroidism, \nand morbid obesity presenting with new onset atrial fibrillation \nwith RVR. Missed her dialysis Sa so was making up appointment \ntoday. Towards the end of her session, patient began to complain \nof palpatations and was found to be tachy to 160's. Brought to \nthe ED for evaluation. Received 500 cc of normal saline prior to \narrival. \n In the ED initial vitals were: ___ 20 95% RA \n EKG: irregular rhythm with rate of 154. Appearance c/w course \natrial fibrillation \n Labs/studies notable for: mild WBC of 11.4, and moderate blood \nin urine c/w known PCKD \n Patient was given: \n ___ 12:26 IV Diltiazem 20 mg ___ \n ___ 13:02 IV Diltiazem 20 mg ___ \n ___ 13:52 PO Diltiazem 30 mg ___ \n -Patient converted to NSR with Dilt \n -She initially left the ED AMA, but then returned \n -Vitals on transfer: T 98.0 HR 92 BP 162/74 RR 16 SpO2 96% RA \n On the floor, the patient denies any chest pain, palpitations, \nlightheadedness, ___ edema. She endorsed mild dyspnea and \northopnea. She remained in normal sinus rhythm with HR ___. She \nwas continued on dilt and her home medications.", 'medications': [{'medication': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Levofloxacin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Azithromycin', '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 via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS: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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H: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}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '36.5', 'valuenum': 36.5, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.6', 'valuenum': 12.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.2', 'valuenum': 32.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.5', 'valuenum': 34.5, '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': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.91', 'valuenum': 3.91, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '46.0', 'valuenum': 46.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '0', 'valuenum': 0.0, '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': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 3.3, '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': 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': '18', 'valuenum': 18.0, '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': '35.2', 'valuenum': 35.2, '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': '32.1', 'valuenum': 32.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.4', 'valuenum': 34.4, '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': '228', 'valuenum': 228.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.77', 'valuenum': 3.77, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '46.4', 'valuenum': 46.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '6', 'valuenum': 6.0, '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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': 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': '17', 'valuenum': 17.0, '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': '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': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.3', 'valuenum': 35.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.2', 'valuenum': 12.2, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '32.3', 'valuenum': 32.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '34.6', 'valuenum': 34.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '274', 'valuenum': 274.0, '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': '3.78', 'valuenum': 3.78, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '45.8', 'valuenum': 45.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM\n=============================\n VS: T 98.0 BP 158/75 HR 92 (NSR) RR 20 SpO2 93 RA \n GENERAL: NAD. Oriented x3. Mood, affect appropriate. \n HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were \npink, no pallor or cyanosis of the oral mucosa. No xanthelasma. \n\n NECK: Supple with JVP of 10 cm. \n CARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. \n LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp \nwere unlabored, no accessory muscle use. No crackles, wheezes or \nrhonchi. \n ABDOMEN: Soft, NTND. No HSM or tenderness. \n EXTREMITIES: No c/c/e. No femoral bruits. \n SKIN: No stasis dermatitis, ulcers, scars, or xanthomas. \n PULSES: Distal pulses palpable and symmetric \n\nDISCHARGE PHYSICAL EXAM\n==============================\n VS: 99 110-140s/70-80s 80-0s ___ 91-97% RA\n GENERAL: NAD. Obese\n HEENT: NCAT. Sclera anicteric. Clear oropharynx\n Neck: Supple with JVP of 10 cm. \n CARDIAC: RRR, normal S1, S2. No murmurs/rubs/gallops. \n LUNGS: Resp were unlabored. CTA b/l. No crackles, wheezes, \nrhonchi\n ABDOMEN: Soft, NTND. No HSM or tenderness. \n EXTREMITIES: LUE fistula. warm, well perfused ___. No ___ edema \n\n PULSES: Distal pulses palpable and symmetric', 'diagnoses': [{'icd_code': 'J158', 'desc': 'Pneumonia due to other specified bacteria'}, {'icd_code': 'J9601', 'desc': 'Acute respiratory failure with hypoxia'}, {'icd_code': 'E83119', 'desc': 'Hemochromatosis, unspecified'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'F411', 'desc': 'Generalized anxiety disorder'}, {'icd_code': 'F1021', 'desc': 'Alcohol dependence, in remission'}, {'icd_code': 'F17200', 'desc': 'Nicotine dependence, unspecified, uncomplicated'}, {'icd_code': 'F1290', 'desc': 'Cannabis use, unspecified, uncomplicated'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}], 'summary': 'ADMISSION LABS\n=====================\n___ 12:25PM BLOOD WBC-11.4*# RBC-4.48 Hgb-12.0 Hct-38.0 \nMCV-85 MCH-26.8 MCHC-31.6* RDW-14.8 RDWSD-45.8 Plt ___\n___ 12:25PM BLOOD ___ PTT-32.2 ___\n___ 12:25PM BLOOD Glucose-97 UreaN-21* Creat-4.6*# Na-139 \nK-4.6 Cl-98 HCO3-25 AnGap-21*\n___ 12:25PM BLOOD CK(CPK)-126\n___ 12:25PM BLOOD cTropnT-<0.01\n___ 09:30PM BLOOD cTropnT-0.02*\n___ 06:25AM BLOOD CK-MB-2 cTropnT-0.02*\n___ 12:50AM BLOOD proBNP-1659*\n___ 12:25PM BLOOD Calcium-9.2 Phos-3.5 Mg-1.9\n___ 12:50AM BLOOD TSH-<0.01*\n___ 06:25AM BLOOD T4-9.6 T3-79* Free T4-1.9*\n___ 06:25AM BLOOD Anti-Tg-LESS THAN Thyrogl-LESS THAN \n\nDISCHARGE LABS\n=======================\n___ 06:25AM BLOOD WBC-9.1 RBC-4.09 Hgb-11.0* Hct-36.0 \nMCV-88 MCH-26.9 MCHC-30.6* RDW-15.2 RDWSD-48.1* Plt ___\n___ 06:25AM BLOOD Plt ___\n___ 06:25AM BLOOD Glucose-74 UreaN-33* Creat-5.5* Na-140 \nK-5.2* Cl-97 HCO3-24 AnGap-24*\n\nCXR ___\nFINDINGS: \nLung volumes are slightly low. Cardiac silhouette size remains \nmildly \nenlarged but unchanged. The mediastinal and hilar contours are \nsimilar. \nCrowding of bronchovascular structures is present with mild \npulmonary edema. Chain sutures are again noted within the right \nupper lung field with chronic elevation of the right \nhemidiaphragm indicative of volume loss. No pleural effusion or \npneumothorax is identified. No acute osseous abnormalities \nseen. \n \nIMPRESSION: \nLow lung volumes with mild pulmonary edema. \n\nTTE: ___\nThe left atrium is elongated. The right atrium is moderately \ndilated. No atrial septal defect is seen by 2D or color Doppler. \nThere is mild symmetric left ventricular hypertrophy with normal \ncavity size and regional/global systolic function (LVEF>55%). \nThere is no ventricular septal defect. Right ventricular chamber \nsize and free wall motion are normal. The diameters of aorta at \nthe sinus, ascending and arch levels are normal. The aortic \nvalve leaflets (3) appear structurally normal with good leaflet \nexcursion and no aortic stenosis or aortic regurgitation. The \nmitral valve appears structurally normal with trivial mitral \nregurgitation. There is borderline pulmonary artery systolic \nhypertension. There is no pericardial effusion.\n___ lady with PMH notable for polycystic kidney disease, \nESRD on HD (___), metastatic thyroid cancer s/p \nthyroidectomy and radioactive iodine therapy on levothyroxine, \nand morbid obesity presenting with new onset atrial fibrillation \nwith RVR with rates in 130-150s. She was given diltiazem and \nconverted back into sinus rhythm in the ED without any further \nepisodes of afib during admission. She was noted to have \nundetectable TSH, and suspect that her afib could be related to \niatrogenic hyperthyroidism. Endocrine consulted, recommended \ndecreasing levothyroxine to 175mcg daily. Thyroglobulin and \nanti-thyroglobulin negative. She was started on metoprolol for \nrate control and recommended starting warfarin for \nanticoagulation. After lengthy discussion, patient refused to \nstart warfarin. Patient understood the risks and was discharged \nback to rehab facility\n\n# Atrial Fibrillation with RVR: New onset. No history of atrial \nfibrillation on prior EKG. Converted to NSR in ED after \nreceiving diltiazem. Uncertain etiology, but may be related to \niatrogenic hyperthyroidism given undetectable TSH. Otherwise, no \ninfectious symptoms, signs of cardiac ischemia (trops peaked at \n0.02 in setting of CKD). TTE did not reveal any new wall motion \nabnormalities with EF of 55%. Endocrine consulted, recommended \ndecreasing levothyroxine to 175mcg daily. Patient started on \nmetoprolol succinate 25mg for rate control. Patient with \nCHADS-VASC of 2 although hyperthyroid related atrial \nfibrillation have a higher risk of stroke than standard afib \npatients. Warfarin initiation was discussed with patient, but \npatient did not want to start warfarin after understanding the \nrisk and benefits. Patient monitored on telemetry and did not \nhave any further episodes of atrial fibrillation. Patient will \nfollow up with cardiology.\n\n#Thyroid disorder: Hypothryoidism due to thyroidectomy for \nthyroid cancer, on levothyroxine with undetectable TSH. Plan per \noutpt endocrinologist to be on suppressive therapy, but at \ndetectable level. Endocrine consulted, and her levothyroxine \ndose was decreased to 175mcg. Thyroglobulin and \nanti-thyroglobulin. TSH should be monitored as outpatient, and \nlevothyroxine adjusted accordingly. Patient will follow up with \noutpatient endocrinologist. \n\n#Pulmonary Edema\nMild pulmonary edema seen on chest x-ray. Likely secondary to \nafib or volume overload in setting of missing HD session. ProBNP \nelevated at 1600 but difficult to interpret in setting of CKD. \nEchocardiogram without depressed EF or obvious signs of \ndiastolic heart failure.\n\n#Troponinemia\nTroponin uptrending from <0.01 to 0.02 x2. Likely secondary to \nsupply/demand mismatch on top of poor clearance secondary to CKD\n\n CHRONIC ISSUES \n # ESRD on HD: secondary to polycystic kidney disease. On ___, \nTh, ___ schedule. \n -Continued home calcitriol, sevelamer with meals, nephrocaps. \n\n # Hyperlipidemia: continue home pravastatin, aspirin for \nprimary prevention \n\n # Iron Deficiency Anemia: continue home iron supplementation \n \n # Glaucoma: continue home latanoprost eye drops'}}
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{'final_diagnoses': ['Atrial Fibrillation', 'End stage renal Disease', 'metastatic thyroid cancer s/p thyroidectomy ', 'morbid obesity'], 'procedures': ['None'], 'visit_summary': '___ lady with PMH notable for polycystic kidney disease, \nESRD on HD (___), metastatic thyroid cancer s/p \nthyroidectomy and radioactive iodine therapy on levothyroxine, \nand morbid obesity presenting with new onset atrial fibrillation \nwith RVR with rates in 130-150s. She was given diltiazem and \nconverted back into sinus rhythm in the ED without any further \nepisodes of afib during admission. She was noted to have \nundetectable TSH, and suspect that her afib could be related to \niatrogenic hyperthyroidism. Endocrine consulted, recommended \ndecreasing levothyroxine to 175mcg daily. Thyroglobulin and \nanti-thyroglobulin negative. She was started on metoprolol for \nrate control and recommended starting warfarin for \nanticoagulation. After lengthy discussion, patient refused to \nstart warfarin. Patient understood the risks and was discharged \nback to rehab facility\n\n# Atrial Fibrillation with RVR: New onset. No history of atrial \nfibrillation on prior EKG. Converted to NSR in ED after \nreceiving diltiazem. Uncertain etiology, but may be related to \niatrogenic hyperthyroidism given undetectable TSH. Otherwise, no \ninfectious symptoms, signs of cardiac ischemia (trops peaked at \n0.02 in setting of CKD). TTE did not reveal any new wall motion \nabnormalities with EF of 55%. Endocrine consulted, recommended \ndecreasing levothyroxine to 175mcg daily. Patient started on \nmetoprolol succinate 25mg for rate control. Patient with \nCHADS-VASC of 2 although hyperthyroid related atrial \nfibrillation have a higher risk of stroke than standard afib \npatients. Warfarin initiation was discussed with patient, but \npatient did not want to start warfarin after understanding the \nrisk and benefits. Patient monitored on telemetry and did not \nhave any further episodes of atrial fibrillation. Patient will \nfollow up with cardiology.\n\n#Thyroid disorder: Hypothryoidism due to thyroidectomy for \nthyroid cancer, on levothyroxine with undetectable TSH. Plan per \noutpt endocrinologist to be on suppressive therapy, but at \ndetectable level. Endocrine consulted, and her levothyroxine \ndose was decreased to 175mcg. Thyroglobulin and \nanti-thyroglobulin. TSH should be monitored as outpatient, and \nlevothyroxine adjusted accordingly. Patient will follow up with \noutpatient endocrinologist. \n\n#Pulmonary Edema\nMild pulmonary edema seen on chest x-ray. Likely secondary to \nafib or volume overload in setting of missing HD session. ProBNP \nelevated at 1600 but difficult to interpret in setting of CKD. \nEchocardiogram without depressed EF or obvious signs of \ndiastolic heart failure.\n\n#Troponinemia\nTroponin uptrending from <0.01 to 0.02 x2. Likely secondary to \nsupply/demand mismatch on top of poor clearance secondary to CKD\n\n CHRONIC ISSUES \n # ESRD on HD: secondary to polycystic kidney disease. On ___, \nTh, ___ schedule. \n -Continued home calcitriol, sevelamer with meals, nephrocaps. \n\n # Hyperlipidemia: continue home pravastatin, aspirin for \nprimary prevention \n\n # Iron Deficiency Anemia: continue home iron supplementation \n \n # Glaucoma: continue home latanoprost eye drops', 'medications_prescribed': ['Metoprolol Succinate XL 25 mg PO DAILY \nRX *metoprolol succinate 25 mg 1 tablet(s) by mouth daily Disp \n#*30 Tablet Refills:*0', 'Levothyroxine Sodium 175 mcg PO DAILY \nRX *levothyroxine 175 mcg 1 tablet(s) by mouth daily Disp #*30 \nTablet Refills:*0', 'Acetaminophen 650 mg PO Q6H:PRN Pain - Mild/Fever', 'Aspirin 81 mg PO DAILY', 'Bisacodyl ___AILY:PRN constipation', 'Calcitriol 0.25 mcg PO 3X/WEEK (___)', 'Calcium Carbonate 500 mg PO DAILY:PRN GI upset', 'Docusate Sodium 100 mg PO BID', 'Ferrous Sulfate 325 mg PO QHS', 'Fish Oil (Omega 3) 1000 mg PO DAILY', 'GuaiFENesin ___ mL PO Q6H:PRN cough', 'Latanoprost 0.005% Ophth. Soln. 1 DROP BOTH EYES QHS', 'Loratadine 10 mg PO DAILY:PRN allergies', 'Nephrocaps 1 CAP PO DAILY', 'Polyethylene Glycol 17 g PO DAILY:PRN constipation', 'Pravastatin 40 mg PO QPM', 'Senna 8.6 mg PO BID', 'sevelamer CARBONATE 2400 mg PO TID W/MEALS']}
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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': 'Bifacial weakness', 'medical_history': ['None'], 'family_history': 'None', 'present_illness': '25RHM no significant PMH presents with bifacial weakness x\n___ days. \n\nTwo weeks ago, patient woke up with right sided neck stiffness\nthat last for 9 days. The next day he developed a fever to 102\nand a constant, achy bi-occipital headache (relieved \nw/ibuprofen)\nthat lasted about 6 days. \n\nOne week ago, he was seen at an OSH ED with persistent fever and\nHA, where he underwent a LP that was reportedly negative. \n\nTwo days after the LP ___ days ago), he developed a right \nsided\nheadache primarily located behind his right ear described as\nelectric, "almost like a toothache" sometimes shooting down to\nhis right jaw or up the side of his head. Also, occasionally\ninvolving the left side in the same location but much less\nsevere. At the same time, he developed left facial weakness.\n\nHe returned to the ED this past ___ and was diagnosed with a\nBell\'s palsy and possibly Lyme and prescribed a course of\nDoxycycline, Prednisone and Acyclovir. Due to persistent right\nsided headaches and associated jaw discomfort, patient decided \nto\ncome to ___ ED for further evaluation.\n\nROS: Left eye dryness due to incomplete closure, initially\nmetallic taste in mouth and now just lack of taste, increased\nsensitivity to sounds and difficulty chewing.\n\nDenies recent rashes or bites, sick contacts, diplopia,\ndysphagia, vertigo, numbness/tingling, weakness, bowel/bladder\nincontinence, difficulty walking, incoordination, recent falls \nor\nhead trauma.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ezetimibe', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 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': 'Ezetimibe', '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/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Docusate Sodium', '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': 'EVERY OTHER DAY', 'doses_per_24_hrs': 0.0}, {'medication': 'PredniSONE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ramelteon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Cefpodoxime Proxetil', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', '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': 'CefePIME', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Benzonatate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID', '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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Azithromycin', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QPM', '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': 'Ipratropium-Albuterol Neb', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NEB', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'QID', 'doses_per_24_hrs': 4.0}]}, 'clinical_findings': {'labs': [{'value': '0.38', 'valuenum': 0.38, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.1', 'valuenum': 0.1, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.9', 'valuenum': 39.9, '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': '2.5', 'valuenum': 2.5, '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': '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': '1.9', 'valuenum': 1.9, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '94.6', 'valuenum': 94.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 72.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'Verified by smear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'VERY LOW*.'}, {'value': '17.0', 'valuenum': 17.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '15.4', 'valuenum': 15.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.02', 'valuenum': 0.02, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.01', 'valuenum': 0.01, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.29', 'valuenum': 0.29, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.58', 'valuenum': 14.58, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.8, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.6, 'flag': 'abnormal', 'priority': 'STAT', 'comments': '___'}, {'value': '55.8', 'valuenum': 55.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '___', 'valuenum': 0.1, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '9', 'valuenum': 9.0, 'valueuom': 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': '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': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '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': 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': 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': '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, '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': '579', 'valuenum': 579.0, 'valueuom': 'mg/dL', 'ref_range_lower': 180.0, 'ref_range_upper': 400.0, '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': '12.6', 'valuenum': 12.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '23.8', 'valuenum': 23.8, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '36.1', 'valuenum': 36.1, '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': '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': '71', 'valuenum': 71.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '55.6', 'valuenum': 55.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '102', 'valuenum': 102.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '51', 'valuenum': 51.0, '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': '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': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '308', 'valuenum': 308.0, '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': '___', 'valuenum': 1629.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, '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': '18', 'valuenum': 18.0, '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': '36.4', 'valuenum': 36.4, '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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, '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': '79', 'valuenum': 79.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '16.9', 'valuenum': 16.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.89', 'valuenum': 3.89, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.1', 'valuenum': 10.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '57.4', 'valuenum': 57.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '103', 'valuenum': 103.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44', 'valuenum': 44.0, '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': '46', 'valuenum': 46.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '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': 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': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '14', 'valuenum': 14.0, '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': '38.6', 'valuenum': 38.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.5', 'valuenum': 31.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.4', 'valuenum': 33.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '94', 'valuenum': 94.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '99', 'valuenum': 99.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.10', 'valuenum': 4.1, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '57.0', 'valuenum': 57.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '406', 'valuenum': 406.0, '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': '1.5', 'valuenum': 1.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.3', 'valuenum': 3.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': 'abnormal', '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': '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '164', 'valuenum': 164.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, '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': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '75', 'valuenum': 75.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, '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': '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': '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': '93', 'valuenum': 93.0, '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': 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': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, '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': '8', 'valuenum': 8.0, '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': '37.0', 'valuenum': 37.0, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, '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': '33.5', 'valuenum': 33.5, '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': '106', 'valuenum': 106.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '3.96', 'valuenum': 3.96, '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': '55.1', 'valuenum': 55.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31', 'valuenum': 31.0, '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': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'NO MONOCLONAL IMMUNOGLOBULIN SEEN. INTERPRETED BY ___.'}, {'value': '59', 'valuenum': 59.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '252', 'valuenum': 252.0, 'valueuom': 'mg/dL', 'ref_range_lower': 700.0, 'ref_range_upper': 1600.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38', 'valuenum': 38.0, 'valueuom': 'mg/dL', 'ref_range_lower': 40.0, 'ref_range_upper': 230.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '386', 'valuenum': 386.0, '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': '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': 3.5, 'ref_range_upper': 5.4, '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': 'HYPOGAMMAGLOBULINEMIA. BASED ON IFE (SEE SEPARATE REPORT),. NO MONOCLONAL IMMUNOGLOBULIN SEEN. INTERPRETED BY ___.'}, {'value': '4.8', 'valuenum': 4.8, 'valueuom': 'g/dL', 'ref_range_lower': 6.4, 'ref_range_upper': 8.3, 'flag': 'abnormal', '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': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/L', 'ref_range_lower': 3.3, 'ref_range_upper': 19.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.81', 'valuenum': 0.81, 'valueuom': None, 'ref_range_lower': 0.26, 'ref_range_upper': 1.65, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'mg/L', 'ref_range_lower': 5.7, 'ref_range_upper': 26.3, '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': '37.9', 'valuenum': 37.9, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, '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': '33.0', 'valuenum': 33.0, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '126', 'valuenum': 126.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', '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': '4.08', 'valuenum': 4.08, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, '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': '55.0', 'valuenum': 55.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '168', 'valuenum': 168.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '58', 'valuenum': 58.0, 'valueuom': 'IU/L', 'ref_range_lower': 40.0, 'ref_range_upper': 130.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '65', 'valuenum': 65.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.1', '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': '0.8', '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': '30', 'valuenum': 30.0, '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': '437', 'valuenum': 437.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 3.5, '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': '15', 'valuenum': 15.0, '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': '36.7', 'valuenum': 36.7, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.5', 'valuenum': 12.5, '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': '34.1', 'valuenum': 34.1, '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': '129', 'valuenum': 129.0, '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': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '52.0', 'valuenum': 52.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'T- 97.2 BP- 126/74 HR- 81 RR- 18 99 O2Sat RA\nGen: Lying in bed, NAD\nHEENT: NC/AT, moist oral mucosa\nNeck: No tenderness to palpation, normal ROM, supple, no carotid\nor vertebral bruit\nBack: No point tenderness or erythema\nCV: RRR, Nl S1 and S2, no murmurs/gallops/rubs\nLung: Clear to auscultation bilaterally\naBd: +BS soft, nontender\next: no edema\nskin: diffuse redness of the skin around neck, shoulders and\nchest\n\nNeurologic examination:\nMS:\nGeneral: alert, awake, normal affect \nOrientation: oriented to person, place, date, situation\nAttention: +MOYbw. Follows simple/complex commands.\n___: fluent w/o paraphasic errors; comprehension,\nrepetition, naming and reading intact\nMemory: Registers ___ and Recalls ___ at 5 min\nL/R confusion: Touches left thumb to right ear\nPraxis: Able to brush teeth\n\nCN:\nI: not tested\nII,III: VFF to confrontation, PERRL 4mm to 2mm, fundi normal\nIII,IV,VI: EOMI, no ptosis. No nystagmus\nV: sensation intact V1-V3 to LT, pin and cold\nVII: bifacial LMN weakness L>R w/incomplete closure of left eye\nVIII: hears finger rub bilaterally\nIX,X: palate elevates symmetrically, uvula midline\nXI: SCM/trapezeii ___ bilaterally\nXII: tongue protrudes midline, no dysarthria\n\nMotor: Normal bulk and tone; no tremor, asterixis or myoclonus.\nNo pronator drift.\n\n Delt Bi Tri WE FE Grip \n C5 C6 C7 C6 C7 C8/T1 \nL 5 ___ 5 5 \nR 5 ___ 5 5 \n\n IP Quad ___ ___ PF\n L2 L3 L4-S1 L4 L5 S1/S2\nL 5 5 5 5 5 5\nR 5 5 5 5 5 5\n\nReflex: No clonus\n Bi Tri Bra Pat An Plantar\n C5 C7 C6 L4 S1 CST\nL ___ 2 2 Flexor\nR ___ 2 2 Flexor\n\nSensation: Decreased sensation to pin and cold on right \nforearm.\nOtherwise, intact to light touch, pinprick, vibration and\nproprioception throughout.\n\nCoordination: finger-nose-finger normal, heel to shin normal,\nRAMs normal.\n\nGait: Narrow based, steady.', 'diagnoses': [{'icd_code': 'J189', 'desc': 'Pneumonia, unspecified organism'}, {'icd_code': 'C9000', 'desc': 'Multiple myeloma not having achieved remission'}, {'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': 'Z96612', 'desc': 'Presence of left artificial shoulder joint'}, {'icd_code': 'Z96652', 'desc': 'Presence of left artificial knee joint'}, {'icd_code': 'D696', 'desc': 'Thrombocytopenia, unspecified'}, {'icd_code': 'R740', 'desc': 'Nonspecific elevation of levels of transaminase and lactic acid dehydrogenase [LDH]'}, {'icd_code': 'K648', 'desc': 'Other hemorrhoids'}, {'icd_code': 'E162', 'desc': 'Hypoglycemia, unspecified'}], 'summary': '___ 12:18AM BLOOD WBC-11.7* RBC-4.80 Hgb-14.1 Hct-41.2 \nMCV-86 MCH-29.4 MCHC-34.3 RDW-13.1 Plt ___\n___ 12:18AM BLOOD ___ PTT-28.2 ___\n___ 06:10PM BLOOD ESR-8\n___ 12:18AM BLOOD Glucose-102 UreaN-22* Creat-0.9 Na-142 \nK-3.9 Cl-104 HCO3-29 AnGap-13\n___ 03:50PM BLOOD ALT-163* AST-37 AlkPhos-76\n___ 12:18AM BLOOD ALT-171* AST-39 AlkPhos-68 TotBili-0.5\n___ 03:50PM BLOOD GGT-135*\n___ 12:18AM BLOOD Lipase-43\n___ 03:50PM BLOOD TotProt-7.8 Albumin-4.8 Globuln-3.0\n___ 12:18AM BLOOD Calcium-9.4 Phos-4.7* Mg-2.2\n___ 12:18AM BLOOD %HbA1c-5.1\n___ 03:50PM BLOOD ___\n___ 12:18AM BLOOD CRP-5.5*\n___ 06:10PM BLOOD ___\n___ 03:50PM BLOOD PEP-AWAITING F IgG-1157 IgA-183 IgM-228 \nIFE-PND\n___ 03:50PM BLOOD HIV Ab-NEGATIVE\n___ 12:18AM BLOOD ASA-NEG Ethanol-NEG Acetmnp-NEG \nBnzodzp-NEG Barbitr-NEG Tricycl-NEG\n___ 06:10PM BLOOD LYME BY WESTERN BLOT-PND\n___ 12:18AM BLOOD ANGIOTENSIN 1 - CONVERTING ___\n\nHead MRI (___): IMPRESSION: Questionable FLAIR \nhyperintensity of the bilateral distal internal auditory canals \nmay be related to artifact or vascular signal, although possibly \ncould reflect seventh nerve abnormality. If real, this finding \ncould reprent infectious/inflammatory( viral, lyme, sarcoid, \nSLE) or neoplastic etiology. Further evaluation with dedicated \ninternal auditory canal protocol may be helpful. The patient \nvomitted after gadolinium administration therefore, it was \ndecided not to repeat the high resolution post gadolinium study \nthrough the ___.\nPatient is a ___ y/o male with no significant PMHx who presented \nwith bifacial weakness. His exam was notable for LMN patten \nweakness, left > right only without signs of other cranial nerve \nor long tract involvment. The development of neurological \ndeficits after his headache and fever suggested a \npost-infectious process. Therefore a further work-up was \ninitiated and included testing for HIV, EBV, VZV, HSV, Lyme, \nSPEP, RPR, sarcoid/collagen vascular disease ___, ESR, CRP, \nACE) and repeat LP. His CSF showed a WBC 14, RBC 34, protein 91 \n& glucose 54. The OSH laboratory results (reported the day \nfollowing admission) were as follows: CSF - protein 50, glucose \n63, WBC 5, RBC 59; CSF culture no growth; serum Lyme titers - \nIgG present, IgM elevated (1.81). \n\nAn brain MRI showed a questionable hyperintensity of the \nbilateral distal internal auditory canals but otherwise was \nnormal. After a discussion with the Neuroradiologist, it was \nfelt that obtaining a IAC protocal MRI was low utility given his \nclinic presentation, diagnosis and history of emesis when given \ncontrast. Therefore a MRI with IAC protocal was not persued.\n\nHe was initially continued on doxycycline, prednisone and \nacyclovir at admission. Due to his CNS Lyme disease, his \ntreatment was changed to ceftriaxone 2g daily x 3 weeks per ID \nrecommendations. LFTs were also obtained and were normal given \nhis treatment with ceftriaxone.'}}
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{'final_diagnoses': ['CNS Lyme', 'None'], 'procedures': ['Lumbar Puncture on ___'], 'visit_summary': 'Patient is a ___ y/o male with no significant PMHx who presented \nwith bifacial weakness. His exam was notable for LMN patten \nweakness, left > right only without signs of other cranial nerve \nor long tract involvment. The development of neurological \ndeficits after his headache and fever suggested a \npost-infectious process. Therefore a further work-up was \ninitiated and included testing for HIV, EBV, VZV, HSV, Lyme, \nSPEP, RPR, sarcoid/collagen vascular disease ___, ESR, CRP, \nACE) and repeat LP. His CSF showed a WBC 14, RBC 34, protein 91 \n& glucose 54. The OSH laboratory results (reported the day \nfollowing admission) were as follows: CSF - protein 50, glucose \n63, WBC 5, RBC 59; CSF culture no growth; serum Lyme titers - \nIgG present, IgM elevated (1.81). \n\nAn brain MRI showed a questionable hyperintensity of the \nbilateral distal internal auditory canals but otherwise was \nnormal. After a discussion with the Neuroradiologist, it was \nfelt that obtaining a IAC protocal MRI was low utility given his \nclinic presentation, diagnosis and history of emesis when given \ncontrast. Therefore a MRI with IAC protocal was not persued.\n\nHe was initially continued on doxycycline, prednisone and \nacyclovir at admission. Due to his CNS Lyme disease, his \ntreatment was changed to ceftriaxone 2g daily x 3 weeks per ID \nrecommendations. LFTs were also obtained and were normal given \nhis treatment with ceftriaxone.', 'medications_prescribed': ['Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO Q24H (every 24 hours).\nDisp:*14 Tablet, Delayed Release (E.C.)(s)* Refills:*0*', 'Polyvinyl Alcohol-Povidone 1.4-0.6 % Dropperette Sig: ___ \nDrops Ophthalmic PRN (as needed).\nDisp:*1 * Refills:*2*', 'Artificial Tear with Lanolin 0.1-0.1 % Ointment Sig: One (1) \nAppl Ophthalmic QHS (once a day (at bedtime)): Please apply to \nboth eyes at bedtime.\nDisp:*1 * Refills:*2*', 'Ceftriaxone-Dextrose (Iso-osm) 2 gram/50 mL Piggyback Sig: \nTwo (2) gm Intravenous Q24H (every 24 hours) for 3 weeks.\nDisp:*24 gm* Refills:*0*', 'PICC line\nPICC line care (NS flushes & heparin) per ___ Home \nTherapy']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 46, 'gender': 'M', 'symptoms': 'worsening abdominal pain', 'medical_history': ['Diabetes mellitus type I c/b gastroparesis and peripheral \nneuropathy', 'Roux-en-Y gastric bypass (___) c/b anastomotic ulcer and UGIB', 'Peripheral vascular disease', 'S/P left thoracoscopy and truncal vagotomy ___', 'S/P RLE TMA for chronic osteomyelitis ___', 'S/P cholecystectomy ___', 'S/P venous access port ___', 'S/P hernia repair ___'], 'family_history': 'Mother has type ___ diabetes and atrial fibrillation. Father is \nalive and well with hypertension. She has one brother with \n___.', 'present_illness': 'Ms. ___ ___ year old female ___ type I diabetes c/o \ngastroparesis/ neuropathy, ___ bypass c/b anastomotic ulcers c/b \nn/v hematemesis and melena now s/p vagotomy on ___, PVD \npresented to ___ with worsening abdominal pain since \nreceiving EGD 3 days prior to presentation. Patient states she \nhas had poor PO intake x 3 days and vomited today. She did not \ntake her insulin today.\n\nShe has a known 1 cm anastamatoic ulcer followed by Dr ___, \n___ monthly endoscopies, last was 3 days ago by Dr ___ \n___ appeared worse compare to the most recent endoscopy. She \nwent to the ER at ___. At ___, initial vitals were \ntemp: ___ HR: 107 BP: 178/79 Resp: 20 O(2)Sat: 100. BMP Na+ \n129, K+ 5.8, glucose 728, HCO3- 12, Gap 22, Cr 1.24. UA \ndemonstrated glucose >1000/ketones 15. EKG did not show changes \nsuggestive of hyperkalemia. Stool was guiaic negative, CXR did \nnot demonstrate free air. She was given Zofran for nausea, \nstarted on IV fluids/insulin drip, given IV calcium gluconate \nfor hyperK, and transferred to ED at ___. \n\nIn the ED, initial vitals: Temp 97.9F, HR 102, BP 120/71, RR 15, \n\n97% RA. Patient was started on insulin regular @ 8 U hr with \nfingersticks every hour. Lactate 3.0. Venous blood gas w/ \npredicted ABG of pH 7.28/pCO2 31. WBC 10.0 hgb 9.7 but stable \nfrom prior. BMP significant for glucose 559, HCO3- 12, Na+134, \nCr 1.4, K+ 4.7. \n\nOn arrival to the MICU, Patient was lethargic and dozing during \ninterview. Only oriented to self. Answered all questions with \nNo.', 'medications': [{'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'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': 'Tenofovir Disoproxil (Viread)', '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': 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': 'TID W/MEALS', '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': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Dexamethasone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Gemcitabine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine SR (MS Contin)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'Aprepitant', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Senna', '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': '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'TID W/MEALS', 'doses_per_24_hrs': 3.0}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'CISplatin', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Tenofovir Disoproxil (Viread)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate IR', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H: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': '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', 'frequency': 'Q8H: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': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Prochlorperazine', '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': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Lactulose Enema', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aprepitant', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate IR', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '1.3', 'valuenum': 1.3, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': 'sec', 'ref_range_lower': 10.4, 'ref_range_upper': 13.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 22.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'HOLD.'}, {'value': '54', 'valuenum': 54.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '152', 'valuenum': 152.0, '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': '104', 'valuenum': 104.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31', 'valuenum': 31.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': 'abnormal', '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': '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 40-49 is 99 (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': '15', 'valuenum': 15.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '133', 'valuenum': 133.0, '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': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.4', 'valuenum': 0.4, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 4.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '40.2', 'valuenum': 40.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, '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': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '32.8', 'valuenum': 32.8, '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': '6.0', 'valuenum': 6.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '79.5', 'valuenum': 79.5, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '257', 'valuenum': 257.0, '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': '4.23', 'valuenum': 4.23, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, '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': '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': '53', 'valuenum': 53.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', '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': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, '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': '8.0', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 69.0, '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': '3.4', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '40.8', 'valuenum': 40.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.9', 'valuenum': 31.9, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '259', 'valuenum': 259.0, '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': '4.21', 'valuenum': 4.21, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', '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': '49', 'valuenum': 49.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '155', 'valuenum': 155.0, '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': '92', 'valuenum': 92.0, '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': '1.4', 'valuenum': 1.4, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 150.0, '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': '445', 'valuenum': 445.0, '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': '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': '4.0', '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': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '39.2', 'valuenum': 39.2, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '12.9', 'valuenum': 12.9, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', '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': '32.9', 'valuenum': 32.9, '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': '254', 'valuenum': 254.0, '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': '4.06', 'valuenum': 4.06, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.9', 'valuenum': 11.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '56', 'valuenum': 56.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '165', 'valuenum': 165.0, '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': '98', 'valuenum': 98.0, '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': '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': '8.4', 'valuenum': 8.4, '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': 217.0, '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': '540', 'valuenum': 540.0, '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': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.5', 'valuenum': 4.5, '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': '13', 'valuenum': 13.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, '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': '31.8', 'valuenum': 31.8, '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': '99', 'valuenum': 99.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.28', 'valuenum': 4.28, 'valueuom': 'm/uL', 'ref_range_lower': 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': '53', 'valuenum': 53.0, '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': '161', 'valuenum': 161.0, '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': '91', 'valuenum': 91.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, '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': '96', 'valuenum': 96.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 222.0, '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': '435', 'valuenum': 435.0, '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': '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': '4.3', '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': '17', 'valuenum': 17.0, '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': '1+.'}, {'value': '0', 'valuenum': 0.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': None, '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': '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': '41.6', 'valuenum': 41.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': None, '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': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NORMAL.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '31.3', 'valuenum': 31.3, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.6', 'valuenum': 31.6, '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': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 0.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '240', 'valuenum': 240.0, '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': '15.1', 'valuenum': 15.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.20', 'valuenum': 4.2, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': 'VERIFIED BY SMEAR.'}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVitals: ___ BP:142/78 P:88 R: 32 O2: 88-92% RA \nGENERAL: Confused, A&O1X, restless \nHEENT: Sclera anicteric, mucous membranes dry\nNECK: supple, JVP not elevated\nLUNGS: fine faint bibaslar crackles at bases bilaterally. No \nwheezes, rales, rhonchi \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 rashes \nNEURO: Moving 4 extremities with purpose, no focal neurologic \ndeficits \n\nDISCHARGE PHYSICAL EXAM\nVS: 98.6 148/74 71 18 97RA\nFGS: 103-292\nGENERAL: Laying in bed comfortably, in NAD \nHEENT: Sclera anicteric, MMM, OP clear\nNECK: supple, JVP not elevated\nLUNGS: CTAB. No wheezes or rhonchi \nCHEST: right central line in place, no erythema or tenderness, \nleft port removed without tenderness\nCV: Regular rate and rhythm, normal S1 S2, no murmurs, rubs, \ngallops \nABD: soft, mildly TTP in epigastric region, non-distended, bowel \nsounds present, firmness palpated at old hernia repair sites, no \ntenderness, no rebound tenderness or guarding, no organomegaly \nEXT: Warm, well perfused, 2+ pulses, no clubbing, cyanosis or \nedema \nSKIN: No rashes \nNEURO: CN ___ intact, A&Ox3\nACCCESS: single lumen port, no erythema or tenderness', 'diagnoses': [{'icd_code': '1550', 'desc': 'Malignant neoplasm of liver, primary'}, {'icd_code': '452', 'desc': 'Portal vein thrombosis'}, {'icd_code': '07032', 'desc': 'Chronic viral hepatitis B without mention of hepatic coma without mention of hepatitis delta'}, {'icd_code': '5780', 'desc': 'Hematemesis'}, {'icd_code': '2761', 'desc': 'Hyposmolality and/or hyponatremia'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '56409', 'desc': 'Other constipation'}], 'summary': '___ 03:15AM BLOOD WBC-10.0# RBC-3.34* Hgb-9.7* Hct-29.7* \nMCV-89 MCH-29.0 MCHC-32.7 RDW-13.3 RDWSD-43.4 Plt ___\n___ 03:15AM BLOOD Neuts-84.3* Lymphs-7.1* Monos-7.0 \nEos-0.8* Baso-0.4 Im ___ AbsNeut-8.45* AbsLymp-0.71* \nAbsMono-0.70 AbsEos-0.08 AbsBaso-0.04\n___ 03:15AM BLOOD Plt ___\n___ 05:47AM BLOOD ___ PTT-25.3 ___\n___ 05:47AM BLOOD Ret Aut-1.9 Abs Ret-0.07\n___ 03:15AM BLOOD Glucose-559* UreaN-51* Creat-1.4* Na-134 \nK-4.7 Cl-101 HCO3-12* AnGap-26*\n___ 05:47AM BLOOD Glucose-271* UreaN-49* Creat-1.4* Na-135 \nK-4.7 Cl-105 HCO3-16* AnGap-19\n___ 05:47AM BLOOD ALT-19 AST-16 LD(LDH)-200 AlkPhos-81 \nTotBili-0.3\n___ 09:30AM BLOOD Lipase-8\n___ 05:47AM BLOOD Albumin-3.5 Calcium-8.7 Phos-3.7 Mg-2.3\n___ 09:30AM BLOOD calTIBC-341 VitB12-422 Ferritn-34 TRF-262\n___ 06:17PM BLOOD Lactate-0.9\n___ 04:38AM BLOOD O2 Sat-81\n___ 12:52PM BLOOD freeCa-1.13\n___ 03:15PM URINE Color-Yellow Appear-Clear Sp ___\n___ 03:15PM URINE Blood-NEG Nitrite-NEG Protein-TR \nGlucose-1000 Ketone-10 Bilirub-NEG Urobiln-NEG pH-5.5 Leuks-NEG\n___ 03:15PM URINE RBC-2 WBC-0 Bacteri-NONE Yeast-NONE Epi-0\n\nMICRO:\n======\n___ urine culture: negative\n___ blood cultures negative\n\nIMAGING\n=======\n___ TUNNELED CENTRAL LINE PLACEMENT\n1. Successful placement of a double lumen tunneled line via the \nright internal jugular venous approach. The tip of the catheter \nterminates in the right atrium. The catheter is ready for use. \n2. Removal of left subclavian Port-A-Cath. \n\n___ Imaging CT HEAD W/O CONTRAST: 1. No significant \ninterval change since ___. No acute intracranial \nprocess. \n2. Enlarged ventricles and sulci as discussed above. Although \nquite \nnonspecific, the ventricular caliber raises a question of \ncommunicating \nhydrocephalus. \n\n___ Imaging CHEST (PORTABLE AP): Allowing for differences \nin technique, there has not been a relevant change in the \nappearance of the chest since the recent study from several hr \nearlier. \n\n___ EKG: Sinus tachycardia. Compared to the previous \ntracing of ___ the rate has increased. \n\nOTHER PERTINENT RESULTS\n=======================\n___ Mid-esophagus, biopsy:- Squamous mucosa within normal \nlimits.\n\nDISCHARGE LABS\n==============\n___ 05:03AM BLOOD WBC-5.8 RBC-2.85* Hgb-8.2* Hct-25.7* \nMCV-90 MCH-28.8 MCHC-31.9* RDW-13.1 RDWSD-43.3 Plt ___\n___ 05:03AM BLOOD Plt ___\n___ 05:03AM BLOOD Glucose-109* UreaN-34* Creat-0.7 Na-140 \nK-4.1 Cl-109* HCO3-25 AnGap-10\nPMHx T1DM (c/b gastroparesis with intractable nausea, \nneuropathy and PVD) s/p ___ bypass (c/b anastamotic ulcers c/b \nhematemesis, s/p vagotomy ___, initially admitted to the ICU \nfor DKA, which resolved quickly. Due to her malnutration, she \nunderwent tunneled double lumen central line and initiated on \nTPN ___, and her insulin regimen was adjusted accordingly.\n\nACTIVE ISSUES\n=============\n#Diabetic Ketoacidosis:\nPt presented w/ nausea and emesis and found to have DKA (with \nglucose 700s and anion gap of 22). EKG without changes related \nto hyperkalemia. VBG pH 7.29/HCO3- 32. Patient was initially \nadmitted to the medical ICU for a regular insulin gtt, with \nsubsequent gap closure and transition to subcutaneous insulin. \nPt was closely followed by ___ during admission for insulin \ntitration.\n\n#Malnutrition \nPt has malnutrition secondary to her ___ gastric bypass and \nchronic intractable nausea and vomiting due to gastroparesis. \nShe has had inability to tolerate PO and has poor nutritional \nstatus. On ___, underwent tunneled double lumen central \nline placement and initiated on TPN for nutritional \nstabilization prior to planned reversion of ___ gastric bypass. \nTPN was advanced to goal prior to discharge. Nutrition and \n___ followed the patient closely to provide adequate blood \nsugar control. Pt was discharged with a plan to continue home \nTPN, and continue cycling as able.\n\n \nCHRONIC ISSUES\n==============\n#Gastric ulcer: \nPt w/ known ulceration at ___ anastomosis of ___ gastric bypass \nthat looked worse on endoscopy on ___. Stools guaiac \nnegative in ED at ___. Patient had a few episodes of \nsmall-volume coffee ground emesis, which has happened in the \npast. Patient was started on a BID PPI. Pt remained \nhemodynamically stable during admission and did not require any \nblood transfusions. \n\n#Anemia: \nPt with chronic normocytic anemia, with a baseline hgb ___. Hgb \nduring admission slightly below baseline at ___, but she has \nremained hemodynamically stable and did required a blood \ntransfusion. Likely due to slow GI bleed. \n\n#Peripheral vascular disease: \nLikely secondary to uncontrolled type I diabetes. History of \nfoot ulcer +GBS + MSSA requiring distal amputations. Previously \ntreated with vancomycin. No concerns during admission.\n\nTRANSITIONAL ISSUES\n========================================\n1. Pt noted to have mild iron deficiency, and may benefit from \nstarting oral iron repletion as an outpatient.\n2. Pt to follow-up with Dr. ___ non-invasive \nvascular study to determine blood flow to gastric ulcers\n3. Pt to follow-up with Dr. ___ possible ___ reversion \nsurgery\n3. Pt to follow-up with ___ regarding her blood sugars and \ninsulin titration. She needs close monitoring of her blood \nsugars and adjustment of insulin regimen accordingly. She was \nseen by ___ while hospitalized for titration.\n4. Double lumen tunneled line placed for TPN. Pt to continue \nhome TPN. She will continue to cycle down her TPN to 12 hours \novernight. She was at goal on discharge. Patient to f/u with \nher outpatient providers regarding long term nutrition plan.\n5. Weekly Chem-10 to be drawn and faxed to Dr. ___ at ___ \nwho will manage her TPN.\n6. Patient started on omeprazole 40mg PO BID. \n\n# Communication: HCP: ___ (husband) ___\n# Code: Full (confirmed)'}}
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{'final_diagnoses': ['Diabetic ketoacidosis', 'Acute on chronic abdominal pain and nausea', 'Mild/moderate malnutrition', 'Diabetes mellitus type I c/b gastroparesis and peripheral \nneuropathy', 'Roux-en-Y gastric bypass (___) c/b anastomotic ulcer and UGIB', 'Peripheral vascular disease', 'S/P left thoracoscopy and truncal vagotomy ___', 'S/P RLE TMA for chronic osteomyelitis ___', 'S/P cholecystectomy ___', 'S/P venous access port ___', 'S/P hernia repair ___'], 'procedures': ['Right IJ Tunneled non-dialysis line placement', 'Left subclavian Port-A-Cath removal'], 'visit_summary': 'PMHx T1DM (c/b gastroparesis with intractable nausea, \nneuropathy and PVD) s/p ___ bypass (c/b anastamotic ulcers c/b \nhematemesis, s/p vagotomy ___, initially admitted to the ICU \nfor DKA, which resolved quickly. Due to her malnutration, she \nunderwent tunneled double lumen central line and initiated on \nTPN ___, and her insulin regimen was adjusted accordingly.\n\nACTIVE ISSUES\n=============\n#Diabetic Ketoacidosis:\nPt presented w/ nausea and emesis and found to have DKA (with \nglucose 700s and anion gap of 22). EKG without changes related \nto hyperkalemia. VBG pH 7.29/HCO3- 32. Patient was initially \nadmitted to the medical ICU for a regular insulin gtt, with \nsubsequent gap closure and transition to subcutaneous insulin. \nPt was closely followed by ___ during admission for insulin \ntitration.\n\n#Malnutrition \nPt has malnutrition secondary to her ___ gastric bypass and \nchronic intractable nausea and vomiting due to gastroparesis. \nShe has had inability to tolerate PO and has poor nutritional \nstatus. On ___, underwent tunneled double lumen central \nline placement and initiated on TPN for nutritional \nstabilization prior to planned reversion of ___ gastric bypass. \nTPN was advanced to goal prior to discharge. Nutrition and \n___ followed the patient closely to provide adequate blood \nsugar control. Pt was discharged with a plan to continue home \nTPN, and continue cycling as able.\n\n \nCHRONIC ISSUES\n==============\n#Gastric ulcer: \nPt w/ known ulceration at ___ anastomosis of ___ gastric bypass \nthat looked worse on endoscopy on ___. Stools guaiac \nnegative in ED at ___. Patient had a few episodes of \nsmall-volume coffee ground emesis, which has happened in the \npast. Patient was started on a BID PPI. Pt remained \nhemodynamically stable during admission and did not require any \nblood transfusions. \n\n#Anemia: \nPt with chronic normocytic anemia, with a baseline hgb ___. Hgb \nduring admission slightly below baseline at ___, but she has \nremained hemodynamically stable and did required a blood \ntransfusion. Likely due to slow GI bleed. \n\n#Peripheral vascular disease: \nLikely secondary to uncontrolled type I diabetes. History of \nfoot ulcer +GBS + MSSA requiring distal amputations. Previously \ntreated with vancomycin. No concerns during admission.\n\nTRANSITIONAL ISSUES\n========================================\n1. Pt noted to have mild iron deficiency, and may benefit from \nstarting oral iron repletion as an outpatient.\n2. Pt to follow-up with Dr. ___ non-invasive \nvascular study to determine blood flow to gastric ulcers\n3. Pt to follow-up with Dr. ___ possible ___ reversion \nsurgery\n3. Pt to follow-up with ___ regarding her blood sugars and \ninsulin titration. She needs close monitoring of her blood \nsugars and adjustment of insulin regimen accordingly. She was \nseen by ___ while hospitalized for titration.\n4. Double lumen tunneled line placed for TPN. Pt to continue \nhome TPN. She will continue to cycle down her TPN to 12 hours \novernight. She was at goal on discharge. Patient to f/u with \nher outpatient providers regarding long term nutrition plan.\n5. Weekly Chem-10 to be drawn and faxed to Dr. ___ at ___ \nwho will manage her TPN.\n6. Patient started on omeprazole 40mg PO BID. \n\n# Communication: HCP: ___ (husband) ___\n# Code: Full (confirmed)', 'medications_prescribed': ['Glargine 8 Units Breakfast\nGlargine 8 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'OxycoDONE Liquid 15 mg PO Q4H:PRN pain', 'Sucralfate 1 gm PO QID', 'Thiamine 100 mg PO DAILY', 'Lorazepam 1 mg PO Q6H:PRN anxiety', 'Ondansetron 8 mg PO Q8H:PRN Nausea', 'Omeprazole 40 mg PO BID \nRX *omeprazole 40 mg 1 capsule(s) by mouth twice a day Disp #*60 \nCapsule Refills:*0', 'Furosemide 80 mg PO DAILY:PRN Weight gain > 5 lbs']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 29, 'gender': 'M', 'symptoms': 'Morbid obesity', 'medical_history': ['1) hypertension', '2) obstructive sleep apnea but does not wear CPAP', '3) hyperlipidemia with elevated triglycerides (816)', '4) type 2 diabetes with hemoglobin A1c of 7.2%', '5) hepatic steatosis', '6) gastroesophageal reflux with history of ___ esophagus', '7) psoriatic arthritis', '8) dermatitis', '9) vitamin D deficiency', '10) arthritis of lower extremity joints (feet)', 'His surgical history is noted for an appendectomy in ___'], 'family_history': 'Her family history is noted for father deceased with alcoholic \ncirrhosis, arthritis; mother living with hypertension, \nhyperlipidemia; brother living with hypertension, paternal \ngrandfather deceased with prostatic CA; maternal grandmother \nwith history of diabetes. He works as a ___ \n___ for the ___ in ___ and he is \nmarried living with his wife who cares for her mother and have \nhistory of obesity s/p sleeve gastrectomy.', 'present_illness': '___ has borderline class II severe obesity with weight of 238 \npounds as of ___ with his initial screen weight of 241.3 \npounds on ___, height 68.5 inches and BMI of 35.7. His \nprevious weight loss efforts have included over-the-counter \nephedra-containing Herbalife for 6 months, over-the-counter \npancreatic lipase inhibitor orlistat (___), ___ visits and \nPCP visits losing up to 10 pounds but unable to maintain. He \nstated that his lowest weight was 165 pounds between the ages of \n___ and ___ and after he got married at age ___ his weight began to \nincrease weighing 189 pounds at age ___. He weighed 210.8 pounds \n___ years ago, 220 pounds in ___, 229 pounds in ___ and he\nweighed 237 pounds one year ago. He stated that he has been \nstruggling with weight since ___ years ago and cites as factors \ncontributing to his excess weight large portions, stressful \neating, convenience eating and lack of exercise secondary to \nphysical limitations with arthritis. He denied history of \neating disorders and he denied binge eating. He does not have a \nclinical diagnosis of depression or anxiety and he has not been \nfollowed by a therapist nor has he been hospitalized for mental \nhealth issues and he is not on any psychotropic medications.', 'medications': [{'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Risperidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Risperidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q1H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Risperidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Milk of Magnesia', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H: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': 'Nicotine Polacrilex', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Risperidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS: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': 'Haloperidol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'Q4H:PRN', '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': 'Benztropine Mesylate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Thiamine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Risperidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Aripiprazole', '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': '3.0', 'valuenum': 3.0, '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': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 129.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'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': '90', 'valuenum': 90.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 82.0, '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': 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': 20.0, 'valueuom': 'ng/mL', 'ref_range_lower': 4.0, 'ref_range_upper': 15.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'MEASURED BY ___ VERSION 2;WHICH IS LARGELY UNAFFECTED BY MACROPROLACTIN.'}], 'exams': 'Discharge Physical Exam: \n VS: 98.1, 121/76, 96, 18 93RA\n GEN: AA&O x 3, NAD, calm, cooperative. \n HEENT: (-)LAD, mucous membranes moist, trachea midline, EOMI \n CHEST: Clear to auscultation bilaterally, (-) cyanosis. \n ABDOMEN: soft, diffuse tenderness, incision sites are c/d/i \ncovered with steri-strips \n EXTREMITIES: Warm, well perfused, no edema', 'diagnoses': [{'icd_code': '29530', 'desc': 'Paranoid type schizophrenia, unspecified'}, {'icd_code': '30590', 'desc': 'Other, mixed, or unspecified drug abuse, unspecified'}, {'icd_code': '30500', 'desc': 'Alcohol abuse, unspecified'}], 'summary': "Labs:\n___ 06:50PM BLOOD WBC-12.2*# RBC-4.81 Hgb-13.3* Hct-39.7* \nMCV-83 MCH-27.7 MCHC-33.5 RDW-13.2 RDWSD-39.8 Plt ___\n___ 06:50PM BLOOD Glucose-143* UreaN-5* Creat-0.7 Na-132* \nK-3.5 Cl-92* HCO3-24 AnGap-20 06:50PM BLOOD Calcium-9.1 Phos-3.3 \nMg-1.7\n___ 04:55AM BLOOD Hct-40.8\n___ 10:47AM BLOOD Hct-38.9*\n\nImaging:\nUGI SGL CONTRAST W/ KUB: No evidence of leak or obstruction.\nThe patient presented to pre-op on ___. Pt was \nevaluated by anaesthesia and taken to the operating room for \nlaparoscopic sleeve gastrectomys. There were no adverse events \nin the operating room; please see the operative note for \ndetails. Pt was extubated, taken to the PACU until stable, then \ntransferred to the ward for observation. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA and then \ntransitioned to oral oxycodone and acetaminophen once tolerating \na stage 2 diet. \nCV: The patient had persistent hypertension throughout his \nhospitalization, which was initially managed with intravenous \nhydralazine, labetolol and enalapril. On POD1, following a \nnegative UGI series, the patient's home amlodipine and \nlisinopril dosing was resumed with normalization of blood \npressure by POD2; he will follow-up with his primary care \nprovider upon discharge. Additionally, on POD1, he was noted to \nhave mild persistent tachycardia 110s, with a brief time in the \n120s. At that time, he remained hemodynamically stable without \nchest pain, shortness of breath or abdominal pain; hematocrit \nstable throughout hospitalization. \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. \nGI/GU/FEN: The patient was initially kept NPO. A methylene blue \ndye test (intra-op) and an upper GI study (POD1) were both \nnegative for a leak, therefore, the diet was advanced \nsequentially to a Bariatric Stage 3 diet, which was well \ntolerated. Patient's intake and output were closely monitored. \nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\n\nPatient was consistently tachycardic on entire admission \n95-130s, as well as HTN for a portion of admission, max of \n160/113. Patient was started on home blood pressure medications, \nwhich he responded well to. Clinically patient looks stable on \ndischarge. CBC, Chem 10 WNL. Patient is asymptomatic and \ncomfortable. Able to ambulate and rest without discomfort. \nPatient most likely having adrenergic response to surgery. \nRecommend follow up wit PCP within next 4 weeks.\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': ['Morbid obesity', 'Hypertension'], 'procedures': ['laparoscopic sleeve gastrectomy'], 'visit_summary': "The patient presented to pre-op on ___. Pt was \nevaluated by anaesthesia and taken to the operating room for \nlaparoscopic sleeve gastrectomys. There were no adverse events \nin the operating room; please see the operative note for \ndetails. Pt was extubated, taken to the PACU until stable, then \ntransferred to the ward for observation. \n\nNeuro: The patient was alert and oriented throughout \nhospitalization; pain was initially managed with a PCA and then \ntransitioned to oral oxycodone and acetaminophen once tolerating \na stage 2 diet. \nCV: The patient had persistent hypertension throughout his \nhospitalization, which was initially managed with intravenous \nhydralazine, labetolol and enalapril. On POD1, following a \nnegative UGI series, the patient's home amlodipine and \nlisinopril dosing was resumed with normalization of blood \npressure by POD2; he will follow-up with his primary care \nprovider upon discharge. Additionally, on POD1, he was noted to \nhave mild persistent tachycardia 110s, with a brief time in the \n120s. At that time, he remained hemodynamically stable without \nchest pain, shortness of breath or abdominal pain; hematocrit \nstable throughout hospitalization. \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. \nGI/GU/FEN: The patient was initially kept NPO. A methylene blue \ndye test (intra-op) and an upper GI study (POD1) were both \nnegative for a leak, therefore, the diet was advanced \nsequentially to a Bariatric Stage 3 diet, which was well \ntolerated. Patient's intake and output were closely monitored. \nID: The patient's fever curves were closely watched for signs of \ninfection, of which there were none.\nHEME: The patient's blood counts were closely watched for signs \nof bleeding, of which there were none.\nProphylaxis: The patient received subcutaneous heparin and ___ \ndyne boots were used during this stay and was encouraged to get \nup and ambulate as early as possible.\n\nPatient was consistently tachycardic on entire admission \n95-130s, as well as HTN for a portion of admission, max of \n160/113. Patient was started on home blood pressure medications, \nwhich he responded well to. Clinically patient looks stable on \ndischarge. CBC, Chem 10 WNL. Patient is asymptomatic and \ncomfortable. Able to ambulate and rest without discomfort. \nPatient most likely having adrenergic response to surgery. \nRecommend follow up wit PCP within next 4 weeks.\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': ['1. Acetaminophen (Liquid) 650 mg PO Q6H:PRN Pain - Mild \nRX *acetaminophen 500 mg/5 mL 5 mL by mouth Q6H:PRN Refills:*0', '2. Docusate Sodium 100 mg PO BID \nRX *docusate sodium 50 mg/5 mL 5 mL by mouth twice a day \nRefills:*0', '3. OxycoDONE Liquid ___ mg PO Q4H:PRN Pain - Moderate \nRX *oxycodone 5 mg/5 mL 5 mL by mouth Q6H:PRN Refills:*0', '4. amLODIPine 10 mg PO DAILY', '5. Fenofibrate 145 mg PO DAILY', '6. Fish Oil (Omega 3) 1000 mg PO BID', '7. Ketoconazole 2% 1 Appl TP BID', '8. Lisinopril 40 mg PO DAILY', '9. Omeprazole 20 mg PO DAILY \nOpen capsule, sprinkle contents onto applesauce, swallow \ncontents whole.', '10. Vitamin D ___ UNIT PO 2X/WEEK (MO,FR)', '11. HELD- MetFORMIN XR (Glucophage XR) 500 mg PO DAILY This \nmedication was held. Do not restart MetFORMIN XR (Glucophage XR) \nuntil you discuss when to resume it with Dr. ___. This \nmedication cannot be crushed.', '12. HELD- secukinumab 150 mg/mL subcutaneous EVERY 4 WEEKS \nThis medication was held. Do not restart secukinumab until you \ndiscuss when to resume it with Dr. ___.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 74, 'gender': 'F', 'symptoms': 'R hip pain', 'medical_history': ['elevated cholesterol', 'HTN', 'GERD', 'heart murmur', 'seasonal allergies', 'non-insulin-dependent diabetes', 'osteoporosis', 'OA hip', 'anemia'], 'family_history': 'positive for cancer in five brothers, diabetes in mother and \nfather, heart disease in mother and lung disease in brother.', 'present_illness': 'R hip OA', 'medications': [{'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q3H: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': 'Triamterene-HCTZ (37.5/25)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'NOON', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'MetroNIDAZOLE', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'MetroNIDAZOLE', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', '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': 'Ciprofloxacin HCl', '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 via patient discharge', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}]}, 'clinical_findings': {'labs': [{'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.2', 'valuenum': 27.2, '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': '88', 'valuenum': 88.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '159', 'valuenum': 159.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.7', 'valuenum': 14.7, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.4', 'valuenum': 5.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '47.5', 'valuenum': 47.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 85.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.5, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '9', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, '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': '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': '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': 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': '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': '3.7', 'valuenum': 3.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '30.9', 'valuenum': 30.9, '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': '178', 'valuenum': 178.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.4', 'valuenum': 14.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.96', 'valuenum': 3.96, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '46.0', 'valuenum': 46.0, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', '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* Incision healing well with staples \n* Scant serosanguinous drainage \n* Thigh full but soft \n* No calf tenderness \n* ___ strength \n* SILT, NVI distally \n* Toes warm', 'diagnoses': [{'icd_code': 'K529', 'desc': 'Noninfective gastroenteritis and colitis, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'M1990', 'desc': 'Unspecified osteoarthritis, unspecified site'}, {'icd_code': 'N950', 'desc': 'Postmenopausal bleeding'}, {'icd_code': 'K869', 'desc': 'Disease of pancreas, unspecified'}, {'icd_code': 'Z96651', 'desc': 'Presence of right artificial knee joint'}], 'summary': "___ 07:05AM BLOOD WBC-5.7 RBC-2.83* Hgb-7.9* Hct-24.6* \nMCV-87 MCH-28.1 MCHC-32.4 RDW-13.8 Plt ___\n___ 06:40AM BLOOD WBC-6.4 RBC-2.77* Hgb-7.6* Hct-24.3* \nMCV-88 MCH-27.4 MCHC-31.2 RDW-13.5 Plt ___\n___ 07:00AM BLOOD WBC-6.8 RBC-2.87* Hgb-8.0*# Hct-25.1* \nMCV-87 MCH-27.9 MCHC-32.0 RDW-13.5 Plt ___\n___ 07:00AM BLOOD Neuts-75.8* Lymphs-15.2* Monos-7.1 \nEos-1.3 Baso-0.7\n___ 07:00AM BLOOD Glucose-79 UreaN-13 Creat-0.5 Na-141 \nK-3.8 Cl-107 HCO3-27 AnGap-11\n___ 07:00AM BLOOD Calcium-7.8* Phos-3.7 Mg-1.9\nThe patient was admitted to the orthopaedic 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\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The patient \nreceived lovenox for DVT prophylaxis starting on the morning of \nPOD#1. The foley was removed on POD#2 and the patient was \nvoiding independently thereafter. The surgical dressing was \nchanged on POD#2 and the surgical incision was found to be clean \nand intact without erythema or abnormal drainage. The patient \nwas seen daily by physical therapy. Labs were checked throughout \nthe hospital course and repleted accordingly. At the time of \ndischarge the patient was tolerating a regular diet and feeling \nwell. The patient was afebrile with stable vital signs. The \npatient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with posterior precautions. \n\n___ is discharged to rehab in stable condition."}}
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{'final_diagnoses': ['R hip osteoarthritis'], 'procedures': ['s/p right total hip replacement'], 'visit_summary': "The patient was admitted to the orthopaedic 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\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The patient \nreceived lovenox for DVT prophylaxis starting on the morning of \nPOD#1. The foley was removed on POD#2 and the patient was \nvoiding independently thereafter. The surgical dressing was \nchanged on POD#2 and the surgical incision was found to be clean \nand intact without erythema or abnormal drainage. The patient \nwas seen daily by physical therapy. Labs were checked throughout \nthe hospital course and repleted accordingly. At the time of \ndischarge the patient was tolerating a regular diet and feeling \nwell. The patient was afebrile with stable vital signs. The \npatient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with posterior precautions. \n\n___ is discharged to rehab in stable condition.", 'medications_prescribed': ['1. enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe \nSubcutaneous DAILY (Daily) for 3 weeks.\nDisp:*21 syringe* Refills:*0*', '2. aspirin, buffered 325 mg Tablet Sig: One (1) Tablet PO twice \na day for 3 weeks: Take AFTER completing Lovenox.\nDisp:*42 Tablet(s)* Refills:*0*', '3. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', '4. ferrous sulfate 325 mg (65 mg Iron) Tablet Sig: One (1) \nTablet PO DAILY (Daily) for 3 weeks.\nDisp:*21 Tablet(s)* Refills:*0*', '5. multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). ', '6. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for Constipation. ', '7. hydrochlorothiazide 12.5 mg Capsule Sig: Two (2) Capsule PO \nDAILY (Daily). ', '8. lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '9. lovastatin 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', '10. metformin 500 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', '11. omeprazole 20 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO DAILY (Daily). ', '12. hydrocodone-acetaminophen ___ mg Tablet Sig: One (1) \nTablet PO Q4H (every 4 hours) as needed for pain.\nDisp:*50 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': 60, 'gender': 'M', 'symptoms': 'Seizures, concern for status epilepticus', 'medical_history': ['DM2, non-insulin dependent', 'HTN', 'HLD', 'Seizure disorder', 'Depression'], 'family_history': 'None', 'present_illness': 'Eu Critical ___ aka ___ (DOB ___ is a ___ year old with seizure disorder (details unknown but is \nreportedly\non PHT), DM2, HTN, HLD who presents as transfer from ___ for\nstatus epilepticus. History is limited as the patient arrived\nintubated and no family present. History gathered from records\nsent from ___. \n\nPer records, patient was last known normal at 12P on ___ when \nshe\ntalked to her sister on the phone. Her sister subsequently \ncalled\nher at 3P and could not reach her. She went over to her sister\'s\nhouse around 7P and found her sister walking around and seemed\nconfused with minimal speech and garbled speech. She subsequently\ncalled EMS and she was taken to ___ around 7:50p. \n\nAt ___ she reportedly was confused but responding appropriately\nwith yes and no answers to questioning. She was able to state her\nbirth date and was following commands. She reportedly endorsed\ndizziness and difficulty with speech but otherwise a negative\nROS. Other than expressive aphasia she reportedly had a normal\nexam. She was afebrile, but was noted to have sbp up to 230s. \n\nAt around 8:45 she reportedly had a "tonic clonic seizure" noted\nby nursing (unclear what this entailed) and was given 2 mg IV\nAtivan with cessation of movements. However, she did not wake up\nafter this event and was subsequently intubated for airway\nprotection (received fentanyl 50, prop 100, vecuronium 6,\netomidate 20). She apparently had another "tonic clonic seizure"\nand was given 2 mg IV Ativan with cessation of her movements.\nUnknown duration or full semiology of these events. \n\nWork-up at ___ notable for no leukocytosis, Na 137, Glu 227,\nDilantin 1.1 and Depakote <3, LFTs normal, UA non-inflammatory\nand CXR without consolidation. NCHCT without hemorrhage or acute\ninfarct. \n\nShe was loaded with PHT 1000 mg and transferred to ___ for\nfurther management. She arrived to ___ intubated and on prop\n@20. She received 500 mg PHT x1 for a 20 mg/kg load.', 'medications': [{'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 via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'FoLIC Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'TID', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Cyanocobalamin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q 8H', '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': 'Aspirin', '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': 'Valsartan', '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': 'Vitamin D', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': 'Thiamine', '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'MetFORMIN XR (Glucophage XR)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', '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': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'Q 8H', 'doses_per_24_hrs': 3.0}]}, 'clinical_findings': {'labs': [{'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'RANDOM.'}, {'value': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NONE.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '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': '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': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1.021', 'valuenum': 1.021, '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '1', 'valuenum': 1.0, 'valueuom': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NONE', 'valuenum': None, 'valueuom': '/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 1.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': None, 'priority': None, 'comments': 'GREEN TOP.'}, {'value': '37.2', 'valuenum': 37.2, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', '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': '32.7', 'valuenum': 32.7, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '85', 'valuenum': 85.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '190', 'valuenum': 190.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.94', 'valuenum': 3.94, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '49.2', 'valuenum': 49.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '169.1', 'valuenum': 169.1, 'valueuom': 'mg/L', 'ref_range_lower': 0.0, 'ref_range_upper': 5.0, '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': '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': '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': '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': '4.4', 'valuenum': 4.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 136.0, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32', 'valuenum': 32.0, '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': '16.1', 'valuenum': 16.1, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, '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': '___', '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': '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': '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': 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': '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': '4.5', 'valuenum': 4.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'New reference range as of ___.'}, {'value': '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': '33.6', 'valuenum': 33.6, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '27.7', 'valuenum': 27.7, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '216', 'valuenum': 216.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.9', 'valuenum': 15.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.86', 'valuenum': 3.86, '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': '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 EXAMINATION\n=====================\nVitals: \n98.6 98 147/78 16 100% Intubation \nETT 7.2, 22cm @incisor. 380/16/40%/5\n___: intubated, sedation off for ~10 min, elderly lady\nHEENT: no scleral icterus noted, MMM, no lesions noted in\noropharynx (limited by ETT)\nNeck: Supple, no carotid bruits appreciated. No nuchal rigidity\nPulmonary: Normal work of breathing, rhonchorous breath sounds \nbl\nCardiac: RRR, warm, well-perfused\nAbdomen: soft, non-distended\nExtremities: No ___ edema.\nSkin: no rashes or lesions noted.\n\nNeurologic:\n\n-Mental Status: Does not eye open to noxious, does not follow\ncommands. Does forcibly try to close her eyes when I hold them\nopen. \n\n-Cranial Nerves:PERRL 3 to 2mm and brisk. Gaze conjugate.\n+corneals, +cough, +gag, Negative dolls eyes, no facial droop. \n\n-Sensory/Motor: Normal bulk, tone throughout. withdrawals\nsymmetrically and briskly with noxious applied to nail beds. Can\nget antigravity with sustained noxious.\n\n-DTRs: symmetric and brisk throughout, Toes up bilaterally, no\nclonus \n\nDISCHARGE EXAMINATION\n=====================\n___: Awake in chair, NAD\nHEENT: normocephalic, atraumatic\nLungs: Breathing comfortably in room air\nExt: Warm, well perfused\nSkin: dry and intact\n\nNeuro:\nMS: Awake, alert. Speech mildly dysarthric at baseline, but \notherwise fluent without paraphasic errors. Today able to \nrecite ___ backwards with one error with prompting. \n\nCN: PERRL. EOMI. Face symmetric. Tongue protrudes midline.\n\nMotor: No pronator drift. No asterixis, no tremor.\n\nGait: Narrow-based gait with normal stride length, walking with \none-person assistance.', 'diagnoses': [{'icd_code': 'L03116', 'desc': 'Cellulitis of left lower limb'}, {'icd_code': 'E1140', 'desc': 'Type 2 diabetes mellitus with diabetic neuropathy, unspecified'}, {'icd_code': 'E11621', 'desc': 'Type 2 diabetes mellitus with foot ulcer'}, {'icd_code': 'L97421', 'desc': 'Non-pressure chronic ulcer of left heel and midfoot limited to breakdown of skin'}, {'icd_code': 'Z6841', 'desc': 'Body mass index [BMI] 40.0-44.9, adult'}, {'icd_code': 'E11610', 'desc': 'Type 2 diabetes mellitus with diabetic neuropathic arthropathy'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I2510', 'desc': 'Atherosclerotic heart disease of native coronary artery without angina pectoris'}, {'icd_code': 'D509', 'desc': 'Iron deficiency anemia, unspecified'}, {'icd_code': 'I878', 'desc': 'Other specified disorders of veins'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}], 'summary': '___ 5:11 ___ MR HEAD W & W/O CONTRAST \n1. Examination is motion degraded. Within this confine: \n2. No acute intracranial abnormality on contrast enhanced MRI \nbrain. There is no intracranial mass, acute infarct or \nhemorrhage. \n3. No gross epileptogenic focus identified. \n4. There is an area of apparent hypoenhancement in the central \naspect of the pituitary, but this is poorly characterized due to \nmotion and may be \nartifactual. If clinically indicated a dedicated pituitary scan \nfor the \nevaluation of pituitary micro adenoma may be performed. \n5. Additional findings described above. \n\n==================\nRelevant lab work:\n==================\n___ 09:18AM BLOOD VitB12-<150* Folate-18\n___ 04:10AM BLOOD VitB12-590\n___ 04:10AM BLOOD %HbA1c-8.6* eAG-200*\nMs. ___ is a ___ left-handed woman with history notable for an unspecified seizure disorder (on phenytoin), HTN, HLD, and ___ transferred from ___ after presenting with confusion and speech disturbance, found to have two generalized tonic-clonic seizures with concern for status epilepticus, in the setting of low Dilantin levels. Following transfer to ___, Ms. ___ was admitted to the Neurosciences ICU, where she was successfully extubated on ___. She was then transferred to the Epilepsy service for further management.\n\nAcute Medical Issues:\n\n#Seizure management: \nPatient was initially started on fosphenytoin 100 mg Q8H for maintenance following her fosphenytoin loading at ___ and the ___ ED, subsequently transitioned to phenytoin ___ 100 mg Q8H following extubation. However, she had persistently sub-therapeutic levels of Dilantin (___) despite increased dosing. She was transitioned to Zonisamide, titrated up to 300 mg QHS, which she tolerated well. Dilantin was weaned off, last dose on ___. \n\nEEG monitoring did not reveal further seizures, but did show generalized sharp wave discharges suggestive of an underlying primary generalized epilepsy. Brain MRI demonstrated no focal epileptogenic lesions, though the study was motion-degraded despite administration of haloperidol for agitation.\n\n#Paranoia, agitation: \nMs. ___ family reported that she had increasingly expressed paranoid delusions (such as her family members or visiting care providers "breaking in" to her home) over the past year, which had recently been interfering with her ability to receive services at home. She had also been noted to have increasingly erratic finances, and had not been attending her physician ___. In consultation with Psychiatry, she was started on risperidone (titrated up to 1 mg QHS) for suspected dementia with psychosis vs. post-ictal psychosis following a discussion with her and her family. She was also given 25 mg Seroquel BID prn agitation, which she had not required in over one week prior to discharge. Fluoxetine was held initially, given agitation and unclear compliance at home, and was restarted and up-titrated to prior home dose before discharge. Psychiatry was consulted and provided recommendations regarding medication management. Last EKG prior to discharge was ___ with QTc 437.\n\n#Guardianship:\nGiven concerns about patient\'s ability to care for herself (see above), applications for legal guardianship, along with ___ guardianship for antipsychotic therapy, were initiated and completed during this admission.\n\n#UTI: Hospital course complicated by UTI, diagnosed ___. Urine culture with pan-sensitive E. coli. Completed course of Bactrim (___). \n\n#Discharge planning: \nPatient was evaluated by the inpatient OT and ___ teams, who recommended discharge to rehab. Anticipated stay in the rehab facility is less than 30 days.\n\nTransitional issues:\n\n#B12 deficiency: Vitamin B12 was low. Patient was started on daily repletion, with repeat level within normal limits prior to discharge.\n\n#HTN: Lisinopril was kept at half dose while she was intubated and sedated, increased back to home dose. She had been started on labetalol for BP management in the ICU, which was weaned off prior to discharge.\n\n#Diabetes: Home glimepiride/Januvia were held on admission. Maintained on standing dose of Lantus (increased to 18U) and insulin sliding scale. The ___ diabetes team was consulted during admission. Patient was discharged on metformin, glipizide, Lantus, and sliding scale insulin. Requested follow-up with ___ after discharge.'}}
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{'final_diagnoses': ['Epilepsy, symptomatic generalized', 'Intellectual disability', 'Urinary tract infection', 'Encephalopathy, toxic', 'B12 deficiency', 'Hypertension', 'Diabetes, type 2'], 'procedures': ['None'], 'visit_summary': 'Ms. ___ is a ___ left-handed woman with history notable for an unspecified seizure disorder (on phenytoin), HTN, HLD, and ___ transferred from ___ after presenting with confusion and speech disturbance, found to have two generalized tonic-clonic seizures with concern for status epilepticus, in the setting of low Dilantin levels. Following transfer to ___, Ms. ___ was admitted to the Neurosciences ICU, where she was successfully extubated on ___. She was then transferred to the Epilepsy service for further management.\n\nAcute Medical Issues:\n\n#Seizure management: \nPatient was initially started on fosphenytoin 100 mg Q8H for maintenance following her fosphenytoin loading at ___ and the ___ ED, subsequently transitioned to phenytoin ___ 100 mg Q8H following extubation. However, she had persistently sub-therapeutic levels of Dilantin (___) despite increased dosing. She was transitioned to Zonisamide, titrated up to 300 mg QHS, which she tolerated well. Dilantin was weaned off, last dose on ___. \n\nEEG monitoring did not reveal further seizures, but did show generalized sharp wave discharges suggestive of an underlying primary generalized epilepsy. Brain MRI demonstrated no focal epileptogenic lesions, though the study was motion-degraded despite administration of haloperidol for agitation.\n\n#Paranoia, agitation: \nMs. ___ family reported that she had increasingly expressed paranoid delusions (such as her family members or visiting care providers "breaking in" to her home) over the past year, which had recently been interfering with her ability to receive services at home. She had also been noted to have increasingly erratic finances, and had not been attending her physician ___. In consultation with Psychiatry, she was started on risperidone (titrated up to 1 mg QHS) for suspected dementia with psychosis vs. post-ictal psychosis following a discussion with her and her family. She was also given 25 mg Seroquel BID prn agitation, which she had not required in over one week prior to discharge. Fluoxetine was held initially, given agitation and unclear compliance at home, and was restarted and up-titrated to prior home dose before discharge. Psychiatry was consulted and provided recommendations regarding medication management. Last EKG prior to discharge was ___ with QTc 437.\n\n#Guardianship:\nGiven concerns about patient\'s ability to care for herself (see above), applications for legal guardianship, along with ___ guardianship for antipsychotic therapy, were initiated and completed during this admission.\n\n#UTI: Hospital course complicated by UTI, diagnosed ___. Urine culture with pan-sensitive E. coli. Completed course of Bactrim (___). \n\n#Discharge planning: \nPatient was evaluated by the inpatient OT and ___ teams, who recommended discharge to rehab. Anticipated stay in the rehab facility is less than 30 days.\n\nTransitional issues:\n\n#B12 deficiency: Vitamin B12 was low. Patient was started on daily repletion, with repeat level within normal limits prior to discharge.\n\n#HTN: Lisinopril was kept at half dose while she was intubated and sedated, increased back to home dose. She had been started on labetalol for BP management in the ICU, which was weaned off prior to discharge.\n\n#Diabetes: Home glimepiride/Januvia were held on admission. Maintained on standing dose of Lantus (increased to 18U) and insulin sliding scale. The ___ diabetes team was consulted during admission. Patient was discharged on metformin, glipizide, Lantus, and sliding scale insulin. Requested follow-up with ___ after discharge.', 'medications_prescribed': ['Cyanocobalamin ___ mcg PO DAILY', 'GlipiZIDE 5 mg PO BID', 'Glargine 18 Units Bedtime\nInsulin SC Sliding Scale using HUM Insulin', 'RisperiDONE 1 mg PO QHS', 'Zonisamide 300 mg PO QHS', 'MetFORMIN (Glucophage) 500 mg PO BID', 'Atorvastatin 80 mg PO QPM', 'Ezetimibe 10 mg PO DAILY', 'FLUoxetine 20 mg PO DAILY', 'Lisinopril 40 mg PO DAILY', 'Vitamin D ___ UNIT PO DAILY']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 78, 'gender': 'F', 'symptoms': 'RLE discharge, swelling, pain', 'medical_history': ['-RLE non-healing chronic venous stasis ulcers w/ recurrent \ninfections (cultures in the past have grown CoNS, MSSA, \npseduomonas, GBS, E. coil, enterobacter, VRE and bacteroides), \nulcer debridement w/ skin graft/wound vac ___, debridement \n___, STSG ___.', '-Hypereosinophilic Syndrome followed by Heme/Onc treated w/ \nprednisone, hydroxyurea, atovaquone (prophylaxis)', '-RLE DVT ___ on warfarin', '-hypertension', '-GERD', '-Osetoarthritis', '-OSA on CPAP', '-hx of eczema', '-C5-C6 fracture in ___', '-erectile dysfunction', '-Recent compressive neuropathy'], 'family_history': 'father died of MI at ___, mother had CHF. Brother prostate cancer \nat ___.', 'present_illness': "CC: wound discharge, swelling, and pain\n\nHPI: Mr. ___ is a ___ yo M w/ h/o chronic venous stasis \nulcers, cellulitis, VRE, hypereosinophilia syndrome s/p STSG \npresents w/ increased RLE swelling, serosanguinous discharge, \nand pain associated with graft. Pt c/o chronic non-healing \nvenous ulcer at RLE, s/p STSG ___ by plastics. C/o \nincreasing R shin/calf sharp pain in past 24 hrs to ___ \nseverity, non-radiating. Associated with increasing \nserosanguinous discharge starting one day PTA in the am now \nrequiring dressing changes q1hr (up from baseline daily \nchanges); denies pus-like exudate; notes increasing edema in \nsurrounding tissue as well. Pt states has had cellulitis in \npast, identical symptoms. Patient had wound culture on ___ that \ndemonstrated pseudomonas aeruginosa resistent to zosyn, \nceftazadime, sensitive to gentamycin, meropenem. Pt also had \nwound culture on ___ resulting in VRE sensitive to linezolid. \nPt was admitted on ___ for pannus cellulitis of his abdomen. \nHe was treated w/ meropenem/daptomycin w/ good effect. \n\nPatient reported episode of significant difficulty breathing on \nthe morning of admission after drinking a cup of coffee. He \nattributed it to laryngospasm and his HES. He reported chronic \nsore throat, bilateral upper and lower extremity swelling, and \nnausea. He also reported a recent episode of rhinorrhea that has \nnow resolved. He reported that sinus issues seem to be \ncorrelated with his eosinophilia. Denies fever/chills, CP, \ndyspnea, tachycardia, pleuritic chest pain. Has h/o \nhypereosinophilic syndrome requiring prednisone 20 mg qd and \nhydroxyurea 1 g TID. H/o RLE DVT on ___, on chronic warfarin. \n\n\nIn the ED, VS were T 98.1F HR 101 BP 149/57 RR 20 O2 99%. Exam \nwas significant for 3 x 5 cm non-healing venous ulcer s/p skin \ngrafting with minimal granulation tissue surrounded by 10 cm \nerythema/hyperpigmentation on all sides, no visible cellulitic \nstreaks. TTP. Labs were notable for WBC of 3.5 (baseline ~ 6.0), \nINR 2.0, lytes WNL. Pt was given IV linezolid (wound Cx's \npending). Plastics c/s: Graft failing, donor site non-healing. \nNo plan to intervene. Dressing requirements-xeroform open to air \nat donor, xeroform w/ dry gauze + ACE bandage over anterior tib.\n\nROS: per HPI. Endorsed worsening vision in the past month, \nconstipation, nausea, mild SOB. Denied fever, chills, headache, \nvision change, cough, chest pain, diarrhea, constipation, \ndysuria.", 'medications': [{'medication': 'Phenazopyridine', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Influenza Virus Vaccine', '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': 'Pravastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pilocarpine 1%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lorazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Amlodipine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ramipril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlordiazepoxide HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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': 'HydrALAzine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ramipril', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Ramipril', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Betaxolol Ophth Susp 0.25%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'LEFT EYE', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Cepacol (Menthol)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'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': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Zolpidem Tartrate', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'HS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '116', 'valuenum': 116.0, 'valueuom': 'IU/L', 'ref_range_lower': 39.0, 'ref_range_upper': 117.0, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.4', 'valuenum': 9.4, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '102', 'valuenum': 102.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 60.0, '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '143', 'valuenum': 143.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': 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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': '31.6', 'valuenum': 31.6, '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': '93', 'valuenum': 93.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '196', 'valuenum': 196.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.80', 'valuenum': 3.8, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '5.3', 'valuenum': 5.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '105', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.6', 'valuenum': 3.6, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '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': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM:\nVS: T: 97.6F BP: 142/86 HR:77 RR:20 O2: 100% RA\nGeneral: Well-appearing, obese, NAD. A/Ox3.\nHEENT: NC/AT. PER. \nLUNGS: CTAB. Nml breath sounds bilaterally. No wheezes, \nrhonchi, or crackles.\nCardiac: RRR. S1 S2. NO MRG\nAbdomen: NABS. Soft. ND/NT. No masses. No hepatosplenomegaly.\\\nExtremities: 3+ pitting-edema in lower extremities bilaterally. \nwarm.\nSkin: Scaling of web spaces on feet bilaterally w/ yellowing and \ndegradation of the nail. Scaling rash identified on the left \nhand. Eyrhtematous maculopapular rash on R arm. Unhealed ulcer \nfrom skin graft on upper RLE. 7x9 cm dry wound w/ granulation \ntissue. Wound was not visualized and left in dressing.\n\nDISCHARGE PHYSICAL EXAM\nVS: T: 97.4 F BP: 150/90 HR: 85 RR:20 O2: 100% RA\nGeneral: alert, oriented, NAD, obese\nHEENT: sclera anicteric, MMM \nLUNGS: CTAB, no wheezes, rhonchi, or crackles\nCardiac: RRR, no r/m/g\nAbdomen: soft, NT, ND, bowel sounds present\nExtremities: warm, 3+ edema in bilateral lower extremities, ACE \nbandages over lower extremity ulcers, RLE donor site for skin \ngraft healing with granulation tissue', 'diagnoses': [{'icd_code': '5990', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': '4010', 'desc': 'Malignant essential hypertension'}, {'icd_code': '27651', 'desc': 'Dehydration'}, {'icd_code': '42789', 'desc': 'Other specified cardiac dysrhythmias'}, {'icd_code': '33385', 'desc': 'Subacute dyskinesia due to drugs'}, {'icd_code': 'E9479', 'desc': 'Unspecified drug or medicinal substance causing adverse effects in therapeutic use'}, {'icd_code': '78079', 'desc': 'Other malaise and fatigue'}, {'icd_code': '56210', 'desc': 'Diverticulosis of colon (without mention of hemorrhage)'}, {'icd_code': '53081', 'desc': 'Esophageal reflux'}, {'icd_code': '2724', 'desc': 'Other and unspecified hyperlipidemia'}, {'icd_code': '2189', 'desc': 'Leiomyoma of uterus, unspecified'}, {'icd_code': '3659', 'desc': 'Unspecified glaucoma'}, {'icd_code': 'V140'}], 'summary': "ADMISSION LABS\n___ 10:00AM WBC-3.5* RBC-2.79* HGB-10.7* HCT-31.3* \nMCV-112* MCH-38.4* MCHC-34.3 RDW-22.6*\n___ 10:00AM NEUTS-63.5 LYMPHS-17.6* MONOS-2.8 EOS-15.9* \nBASOS-0.1\n___ 10:00AM ___ PTT-27.6 ___\n___ 10:00AM PLT COUNT-288\n___ 10:32AM LACTATE-3.6* K+-3.9\n___ 10:00AM GLUCOSE-99 UREA N-29* CREAT-1.0 SODIUM-136 \nPOTASSIUM-4.1 CHLORIDE-101 TOTAL CO2-26 ANION GAP-13\n\nOTHER RELEVANT LABS\n___ 08:05AM BLOOD Lactate-1.8\n___ 08:10AM BLOOD ESR-66*\n___ 08:35AM BLOOD ESR-80*\n___ 09:51PM BLOOD Ret Aut-1.3\n___ 07:15AM BLOOD LD(LDH)-264* CK(CPK)-95\n___ 09:51PM BLOOD calTIBC-259* VitB12-450 Folate-8.0 \n___ Ferritn-162 TRF-199*\n___ 08:35AM BLOOD %HbA1c-5.7 eAG-117\n___ 08:10AM BLOOD CRP-52.1*\n___ 08:35AM BLOOD CRP-64.9*\n\nDISCHARGE LABS\n___ 06:20AM BLOOD Glucose-88 UreaN-20 Creat-0.6 Na-138 \nK-4.4 Cl-102 HCO3-32 AnGap-8\n___ 06:20AM BLOOD Calcium-8.4 Phos-3.3 Mg-2.3\n___ 06:20AM BLOOD WBC-3.5* RBC-2.44* Hgb-9.5* Hct-28.0* \nMCV-115* MCH-39.0* MCHC-34.1 RDW-21.6* Plt ___\n___ 06:20AM BLOOD ___ PTT-30.0 ___\n\nIMAGING\n___ CT lower extremity\nIMPRESSION: \n1. No evidence of fracture. No bone destruction or periosteal \nreaction to suggest osteomyelitis. MRI is more sensitive in \ndetecting more subtle or early signs of osteomyelitis. \n2. Unchanged soft tissue defect of the anterolateral soft \ntissues which may \nbe due to an ulcer or post-surgical changes. \n3. No subcutaneous gas to suggest necrotizing fasciitis. \n4. No definite organized fluid collection to suggest an \nabscess, although the \nexam is limited by lack of intravenous contrast. \n5. Extensive subcutaneous edema and stranding consistent with \nwidespread \ncellulitis. \n6. Stable severe degenerative changes of the knee, ankle, and \nmid foot. \n\n___ ___ placement\nIMPRESSION: Technically successful placement of a left basilic \nsingle-lumen\nPreliminary ReportPowerPICC with ultrasound and fluoro guidance \nthe tip in the mid portion of\nPreliminary Reportthe SVC. The catheter was flushed and is ready \nfor use.\n\nMICROBIOLOGY\n___ 2:34 pm SWAB Source: R lower extremity. \n\n **FINAL REPORT ___\nMr. ___ is a ___ yo M w/ h/o chronic venous stasis ulcers, \ncellulitis, VRE, hypereosinophilia syndrome s/p STSG presents w/ \nincreased RLE swelling, serosanguinous discharge, and pain \nassociated with graft. \n\n# Hypereosinophilic syndrome - Presentation with lower extremity \nswelling and pain thought to be flare of HES with cellulitis. \nHas oropharyngeal ulcers, upper & lower extremity swelling. On \n___, began experiencing jaw/mouth pain, diffuse arthralgia. He \nalso developed an erythematous maculopapular rash on both arms. \nDermatology was consulted, biopsied rash on left arm. Pathology \nshowed eosinophilic infiltration. Started steroid pulse 100mg \non ___. Zyprexa dose was increased to 5mg PO BID for mood \nstabilization while on high dose steroids. For pain, dilaudid \nand gabapentin were added.\n- plastic surgery was also consulted during his stay, and \nperformed BID dressing changes. Although OR debridement was \nconsidered, they ultimately felt that continued dressing changes \nand 2 week post discharge follow up was most appropriate\n\n# Cellulitis - Pt has chronic venous stasis ulcers and history \nof resistant polymicrobial cellulitis. He received linezolid x1 \nin the ED. On the floor, empirically treated with meropenem and \ndaptomycin (avoided linezolid because of marrow suppression, and \non admission, pt's WBC was 3.5). No fevers during \nhospitalization. Blood cx negative. ID was consulted and \nrecommended continuing IV meropenem and daptopmycin for ___ \nweeks as an outpatient.\n\n#Leukopenia: On admission had WBC of 3.5, and on discharge had \nWBC of 3.5. HES is likely cause based on persistence w/ abx, \nand other HES sx. He does not have neutropenia or bands.\n\n#Anemia: HCT ranged from ___ during this admission, HCT was 28 \non discharge. Most likely related to HES and possible \nmyelosuppresion based on macrocytosis. B12 and folate WNL. \nIron studies consistent with anemia of chronic disease. \nHemolysis labs WNL\n\n# h/o DVT - ___ - found to be subtherapeutic on ___. \nIncreased warfarin dose and bridged with heparin drip for 1 day. \n On discharge, INR was 2.9 on warfarin dose of 6mg daily\n\nCHRONIC ISSUES\n# OSA - continued home CPAP\n# HTN - continued home furosemide & lisinopril, held for \nhypotension but restarted upon discharge\n\nTRANSITION OF CARE ISSUES\n- Follow-up with Dr. ___ prednisone dosage\n- Follow-up with Dr. ___ continuation of IV \nantibiotics\n- Follow-up with Dr. ___ wound care\n- Stitches on left arm to be removed around ___"}}
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{'final_diagnoses': ['Hypereosinophilic Syndrome', 'Cellulitis', 'Venous stasis \nulcers', 'Anemia', 'Leukopenia'], 'procedures': ['-Wound debridement', '-PICC placement', '-Skin biopsy'], 'visit_summary': "Mr. ___ is a ___ yo M w/ h/o chronic venous stasis ulcers, \ncellulitis, VRE, hypereosinophilia syndrome s/p STSG presents w/ \nincreased RLE swelling, serosanguinous discharge, and pain \nassociated with graft. \n\n# Hypereosinophilic syndrome - Presentation with lower extremity \nswelling and pain thought to be flare of HES with cellulitis. \nHas oropharyngeal ulcers, upper & lower extremity swelling. On \n___, began experiencing jaw/mouth pain, diffuse arthralgia. He \nalso developed an erythematous maculopapular rash on both arms. \nDermatology was consulted, biopsied rash on left arm. Pathology \nshowed eosinophilic infiltration. Started steroid pulse 100mg \non ___. Zyprexa dose was increased to 5mg PO BID for mood \nstabilization while on high dose steroids. For pain, dilaudid \nand gabapentin were added.\n- plastic surgery was also consulted during his stay, and \nperformed BID dressing changes. Although OR debridement was \nconsidered, they ultimately felt that continued dressing changes \nand 2 week post discharge follow up was most appropriate\n\n# Cellulitis - Pt has chronic venous stasis ulcers and history \nof resistant polymicrobial cellulitis. He received linezolid x1 \nin the ED. On the floor, empirically treated with meropenem and \ndaptomycin (avoided linezolid because of marrow suppression, and \non admission, pt's WBC was 3.5). No fevers during \nhospitalization. Blood cx negative. ID was consulted and \nrecommended continuing IV meropenem and daptopmycin for ___ \nweeks as an outpatient.\n\n#Leukopenia: On admission had WBC of 3.5, and on discharge had \nWBC of 3.5. HES is likely cause based on persistence w/ abx, \nand other HES sx. He does not have neutropenia or bands.\n\n#Anemia: HCT ranged from ___ during this admission, HCT was 28 \non discharge. Most likely related to HES and possible \nmyelosuppresion based on macrocytosis. B12 and folate WNL. \nIron studies consistent with anemia of chronic disease. \nHemolysis labs WNL\n\n# h/o DVT - ___ - found to be subtherapeutic on ___. \nIncreased warfarin dose and bridged with heparin drip for 1 day. \n On discharge, INR was 2.9 on warfarin dose of 6mg daily\n\nCHRONIC ISSUES\n# OSA - continued home CPAP\n# HTN - continued home furosemide & lisinopril, held for \nhypotension but restarted upon discharge\n\nTRANSITION OF CARE ISSUES\n- Follow-up with Dr. ___ prednisone dosage\n- Follow-up with Dr. ___ continuation of IV \nantibiotics\n- Follow-up with Dr. ___ wound care\n- Stitches on left arm to be removed around ___", 'medications_prescribed': ['Outpatient Lab Work\nICD-9: 682.9 - Cellulitis\nPLEASE FAX RESULTS to Dr. ___ at ___. \n(Telephone: ___\n___ will draw weekly labs and deliver to ___:\n- CBC with diff, Chem 7, LFTs, ESR, CRP, CPK', 'Atovaquone Suspension 750 mg PO DAILY \n10mL once daily ', 'Hydroxyurea 500 mg PO TID \nTWO tablets TID ', 'Nystatin Oral Suspension ___ mL PO QID:PRN mouth pain ', 'OLANZapine 5 mg PO BID \nRX *olanzapine 5 mg 1 tablet(s) by mouth twice a day Disp #*60 \nTablet Refills:*0', 'Omeprazole 20 mg PO DAILY ', 'Warfarin 6 mg PO DAILY16 \nRX *Coumadin 2 mg 3 tablet(s) by mouth daily Disp #*90 Tablet \nRefills:*0', 'Citalopram 20 mg PO DAILY \nRX *citalopram 20 mg 1 tablet(s) by mouth DAILY Disp #*30 \nCapsule Refills:*0', 'Gabapentin 200 mg PO TID \nhold for sedation \nRX *gabapentin 100 mg 2 capsule(s) by mouth three times a day \nDisp #*180 Capsule Refills:*0', 'Heparin Flush (10 units/ml) 2 mL IV PRN line flush \nPICC, heparin dependent: Flush with 10mL Normal Saline followed \nby Heparin as above daily and PRN per lumen. \nRX *heparin lock flush 10 unit/mL flush 2 mL PRN Disp #*30 \nSyringe Refills:*3', 'Meropenem 1000 mg IV Q8H \nRX *meropenem 1 gram 1 gram every eight (8) hours Disp #*84 Gram \nRefills:*0', 'Miconazole 2% Cream 1 Appl TP BID \nApply to hands and feet \nRX *miconazole nitrate 2 % apply to feet twice a day Disp #*1 \nTube Refills:*3', 'Collagenase Ointment 1 Appl TP DAILY ', 'Dexamethasone Intensol *NF* (dexamethasone) 1 mg/mL ORAL \nTID-QID:PRN mouth pain ', 'Sildenafil 100 mg PO DAILY:PRN ED ', 'PredniSONE 100 mg PO DAILY \nRX *prednisone 50 mg 2 tablet(s) by mouth DAILY Disp #*20 \nCapsule Refills:*0', 'HYDROmorphone (Dilaudid) ___ mg PO Q6H:PRN pain \ngive 1 hr before dressing changes, hold for sedation or RR< 12 \nRX *hydromorphone 2 mg ___ tablet(s) by mouth every six (6) \nhours Disp #*40 Capsule Refills:*0', 'Calcium Carbonate 500 mg PO BID \nRX *calcium carbonate 500 mg calcium (1,250 mg) 1 tablet(s) by \nmouth twice a day Disp #*60 Tablet Refills:*0', 'Vitamin D 400 UNIT PO DAILY \nRX *ergocalciferol (vitamin D2) 400 unit 1 tablet(s) by mouth \ndaily Disp #*30 Tablet Refills:*0', 'Furosemide 20 mg PO QAM ', 'Lisinopril 40 mg PO DAILY ', 'Daptomycin 800 mg IV Q24H \nRX *CUBICIN 500 mg 800 mg IV Q24H Disp #*22.4 Gram Refills:*0', 'Sodium Chloride 0.9% Flush 10 mL IV PRN line flush \nPICC, non-heparin dependent: Flush with 10 mL Normal Saline \ndaily and PRN per lumen. ', 'PICC flush\nSodium Chloride 0.9% Flush 10 mL IV PRN line flush \n\nFlush PICC with 10 mL Normal Saline daily and PRN per lumen.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 45, 'gender': 'F', 'symptoms': 'R-sided weakness, numbness, incontinence', 'medical_history': ['-Left inguinal hernia, s/p repair ___ years ago', '-Right inguinal hernia (not yet repaired)', '-L4/5 and S1 herniated disk, s/p L4-S1 decompression on ___ \nin ___', '-Chronic low back pain s/p steroid injections ___ years\nago)', '-L shoulder surgery', '-R knee pain/injury'], 'family_history': 'Father with MI in early ___.', 'present_illness': 'this is a ___ y.o male with past medical history significant for \ncauda equina syndrome, s/p decompressive laminectomy at \n___ later complicated by soft tissue MSSA \ninfection, now presenting with subjective fevers and complaints \nof right leg weakness after being discharged from ___ \n___. The patient completed a 2 week course of nafcillin at \n___. Over the weekend, the patient reports having fevers \nto 99-100 degrees and reported vomiting ___ times. He also \nreports increasing back pain over the weekend. He denies cough, \nshortness of breath, or diarrhea. He does report some increased \nurinary frequency over the past several days but denies any \ndysuria.', 'medications': [{'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'TraMADOL (Ultram)', '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': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neutra-Phos', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Sulfameth/Trimethoprim DS', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': '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': 'Amoxicillin-Clavulanic Acid', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Ciprofloxacin HCl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Piperacillin-Tazobactam', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'OxyCODONE SR (OxyconTIN)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q12H', 'doses_per_24_hrs': 2.0}, {'medication': 'Fluconazole', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Rifaximin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY: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': 'Albumin 25% (12.5g / 50mL)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', '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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Cepacol (Sore Throat Lozenge)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H: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': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Lidocaine 0.5%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'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': 'Discontinued', '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 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': 'Sodium Chloride Nasal', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NU', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'TID: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': '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': 'Inactive (Due to a change order)', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': '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': 'Inactive (Due to a change order)', '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': 'OxycoDONE (Immediate Release) ', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Lactulose', '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', 'route': 'PO/NG', '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': 'MetRONIDAZOLE (FLagyl)', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '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': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', '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 = >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': 151.0, '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': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': None, 'valuenum': None, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': '<10.'}, {'value': '24', 'valuenum': 24.0, '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': '134', 'valuenum': 134.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '198', 'valuenum': 198.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23.4', 'valuenum': 23.4, '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': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', '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': '244', 'valuenum': 244.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.58', 'valuenum': 2.58, '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': '68.9', 'valuenum': 68.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', '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': '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': '226', 'valuenum': 226.0, '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': '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': '3.1', 'valuenum': 3.1, '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 105.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '3.9', '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': '8', 'valuenum': 8.0, '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': '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': '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': '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': '182', 'valuenum': 182.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '22.2', 'valuenum': 22.2, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '45.4', 'valuenum': 45.4, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '215', 'valuenum': 215.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, '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': '36', 'valuenum': 36.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '2.8', 'valuenum': 2.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.4', 'valuenum': 7.4, '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': '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': '200', 'valuenum': 200.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21.3', 'valuenum': 21.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.42', 'valuenum': 2.42, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.5', 'valuenum': 6.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '69.8', 'valuenum': 69.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'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': '215', 'valuenum': 215.0, '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, 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'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.3', 'valuenum': 23.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '184', 'valuenum': 184.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '21.0', 'valuenum': 21.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.47', 'valuenum': 2.47, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '71.8', 'valuenum': 71.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 3.5, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': 'GREEN TOP TUBE.'}, {'value': '19.5', 'valuenum': 19.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.6', 'valuenum': 6.6, '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': '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': '92', 'valuenum': 92.0, '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': '20.4', 'valuenum': 20.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.12', 'valuenum': 2.12, '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': '68.1', 'valuenum': 68.1, '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': '19.7', 'valuenum': 19.7, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '44.2', 'valuenum': 44.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, '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': '182', 'valuenum': 182.0, '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': '29', 'valuenum': 29.0, '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 2.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'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': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'VEN.', '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': 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': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '142', 'valuenum': 142.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '21.4', 'valuenum': 21.4, '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': '6.7', 'valuenum': 6.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '68.3', 'valuenum': 68.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.7', 'valuenum': 3.7, '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': '25.3', 'valuenum': 25.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.3', 'valuenum': 8.3, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '146', 'valuenum': 146.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.0', 'valuenum': 23.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.75', 'valuenum': 2.75, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', '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': '74.4', 'valuenum': 74.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '17.5', 'valuenum': 17.5, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '39.1', 'valuenum': 39.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '192', 'valuenum': 192.0, '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': '29', 'valuenum': 29.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, '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': '99', 'valuenum': 99.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.4', 'valuenum': 4.4, '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': '5', 'valuenum': 5.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', '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': 'ROUTINE', 'comments': None}, {'value': '241', 'valuenum': 241.0, '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': '29', 'valuenum': 29.0, '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': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, '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': '101', 'valuenum': 101.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': "Using this patient's age, gender, and serum creatinine value of 0.5,. Estimated GFR = >75 if non African-American (mL/min/1.73 m2). Estimated GFR = >75 if African-American (mL/min/1.73 m2). For comparison, mean GFR for age group 40-49 is 99 (mL/min/1.73 m2). GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.7', 'valuenum': 4.7, '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': '6', 'valuenum': 6.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '25.8', 'valuenum': 25.8, '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': '30.2', 'valuenum': 30.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.9', 'valuenum': 32.9, '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': '155', 'valuenum': 155.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22.3', 'valuenum': 22.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '2.81', 'valuenum': 2.81, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '5.2', 'valuenum': 5.2, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '72.4', 'valuenum': 72.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '16.8', 'valuenum': 16.8, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '38.5', 'valuenum': 38.5, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'GEN: No acute distress. The patient was rude and uncooperative.\nHEENT: Mucous membranes moist, no lesions noted. Sclerae \nanicteric. No conjunctival pallor noted. \nNECK: JVP not elevated. No lympadenopathy.\nCV: Regular rate and rhythm, no murmurs, rubs ___\nPULM: Clear to auscultation bilaterally, no wheezes, rales or \nrhonchi.\nABD: Soft, non-tender, non distended, bowel sounds present. No \nhepatosplenomegaly\nBACK: Surgical incision appears clean, no erythema noted. There \nis no fluctuance or drainage noted. There is some mild \ntenderness on palpation of the superior edge of his surgical \nincision.\nEXTR: No edema, 2+ Dorsalis pedis and radial pulses bilaterally. \n Right ipsilateral straight leg raise positive.\nNEURO: Alert and oriented x3. Upper extremity strength normal. \nRight knee flexion and extension 4+/5 strength, remainder of \nlower extremity strength intact. Gait normal. Rectal tone \nnormal. \nSKIN: No ulcerations or rashes noted.\n\nDischarge exam unchanged', 'diagnoses': [{'icd_code': 'K551', 'desc': 'Chronic vascular disorders of intestine'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'C7B02', 'desc': 'Secondary carcinoid tumors of liver'}, {'icd_code': 'R188', 'desc': 'Other ascites'}, {'icd_code': 'I8510', 'desc': 'Secondary esophageal varices without bleeding'}, {'icd_code': 'E46', 'desc': 'Unspecified protein-calorie malnutrition'}, {'icd_code': 'K766', 'desc': 'Portal hypertension'}, {'icd_code': 'C7A098', 'desc': 'Malignant carcinoid tumors of other sites'}, {'icd_code': 'N390', 'desc': 'Urinary tract infection, site not specified'}, {'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'D630', 'desc': 'Anemia in neoplastic disease'}, {'icd_code': 'K7469', 'desc': 'Other cirrhosis of liver'}, {'icd_code': 'R141', 'desc': 'Gas pain'}, {'icd_code': 'R197', 'desc': 'Diarrhea, unspecified'}, {'icd_code': 'E869', 'desc': 'Volume depletion, unspecified'}, {'icd_code': 'Z923', 'desc': 'Personal history of irradiation'}, {'icd_code': 'Z6820', 'desc': 'Body mass index [BMI] 20.0-20.9, adult'}, {'icd_code': 'R000', 'desc': 'Tachycardia, unspecified'}, {'icd_code': 'B9620', 'desc': 'Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere'}, {'icd_code': 'K7290', 'desc': 'Hepatic failure, unspecified without coma'}, {'icd_code': 'J069', 'desc': 'Acute upper respiratory infection, unspecified'}, {'icd_code': 'B373', 'desc': 'Candidiasis of vulva and vagina'}, {'icd_code': 'E876', 'desc': 'Hypokalemia'}], 'summary': "___ 04:15PM GLUCOSE-84 UREA N-22* CREAT-0.7 SODIUM-134 \nPOTASSIUM-4.1 CHLORIDE-98 TOTAL CO2-25 ANION GAP-15\n___ 04:15PM ALT(SGPT)-39 AST(SGOT)-37 ALK PHOS-119 TOT \nBILI-0.5\n___ 04:15PM LIPASE-26\n___ 04:15PM CRP-7.5*\n___ 04:15PM WBC-11.3*# RBC-3.97* HGB-10.2* HCT-31.2* \nMCV-79* MCH-25.6* MCHC-32.6 RDW-16.7*\n___ 04:15PM NEUTS-63.5 ___ MONOS-5.8 EOS-1.1 \nBASOS-0.7\n___ 04:15PM PLT COUNT-391\n___ 04:15PM SED RATE-27*\n\nAbdominal ultrasound. \n \nCOMPARISON: None. \n \nFINDINGS: The liver demonstrates a normal echotexture with no \nfocal lesion or \nintrahepatic biliary dilatation. The portal vein is patent and \nshows normal \nhepatopetal flow. \n \nThe common bile duct measures 5 mm in caliber. The gallbladder \nis normal and \nshows no stone, wall edema, or pericholecystic fluid. A \nsonographic ___ \nsign was negative. \n \nThe pancreas is not visualized due to overlying bowel gas. \n \nIMPRESSION: Unremarkable right upper quadrant ultrasound without \n\ncholelithiasis or cholecystitis. \n\nMRI of the lumbar spine was performed utilizing sagittal T1, T2 \nand STIR and axial T2 and T1 sequences without intravenous \ncontrast. After \nthe administration of intravenous contrast, sagittal and axial \nT1-weighted \nsequences were repeated. \n \nCOMPARISON: MRI of the spine performed ___ and \n___. \n \nFINDINGS: Enhancing tissue is again noted in the surgical bed of \nthe L4 \nthrough S1 decompression. The enhancing granulation tissue \nextends from the \nsubcutaneous tissues and abuts the thecal sac within the \nsurgical site, \npartially surrounding the thecal sac similar to that seen on the \nprior study. \nThe extent of the enhancing tissue is similar to that seen on \nthe prior study \non ___ with encasement of the right L5 nerve in \nthe subarticualr \nzone. The fluid collection within the posterior subcutaneous \ntissues, within \nthe enhancing tissue L4-S1, is increased in size compared with \nthe prior \nstudy, measuring 3.7 cm in AP dimension, 3.9 cm in superior \ninferior extent \nand up to 9 mm in transverse dimension. The fluid collection is \nmultiloculated. \n \nT12-L1: The right subarticular focal disc extrusion is \nunchanged. The \nextrusion indents the ventral thecal sac, narrowing of the right \nlateral \nrecess, resulting in a moderate narrowing of the lateral recess \nwith \ndisplacement of nerve roots and mild narrowing of the right \nneural foramen. \nThe left neural foramen is patent. \n \nL1-L2: A diffuse disc bulge is present with mild narrowing of \nthe spinal \ncanal. The neural foraminae are not significantly narrowed. \n \nL2-L3: Mild disc bulge, asymmetric to the left, is present \nwithout \nsignificant spinal canal or neural foraminal narrowing. \n \nL3-L4: A diffuse disc bulge is present with flattening of the \nventral thecal \nsac and mild spinal canal narrowing. The neural foramina are not \n\nsignificantly narrowed. \n \nL4-L5: A diffuse disc bulge is present which along with facet \nDJD results in \nmild bilateral neural foraminal narrowing. The spinal canal is \nnot \nsignificantly narrowed. \nThe increased STIR signal in the inferior L4 is decreased from \nprior. \nSchmorl's node in this location is unchanged. \n \nL5-S1: A diffuse disc bulge is present without significant \nspinal canal \nnarrowing. The disc bulge along with facet DJD results in \nmoderate bilateral \nneural foraminal narrowing. \nMinimal enhancement on the surface of the lower cord is likely \nvascular. \n \n \nIMPRESSION: \n1. The patient is status post L4-S1 laminectomy with enhancing \nsoft tissue \nwithin the posterior surgical bed, similar to that seen on the \nprior \npostoperative study performed ___, likely \nrepresenting \npostoperative granulation/scar tissue, although infection cannot \nbe excluded \ngiven the enhancement and can be correlated clinically. \nEncasement of the \nright L5 nerve in the spinal canal by granulation/scar tissue as \nseen earlier. \n \n2. There is a subcutaneous fluid collection, likely \nmultiloculated, within \nthe posterior soft tissues L4-S1 as described above which has \nmoderately \nincreased in size compared with the prior MRI. Infection in this \ncollection \ncannot be excluded. If clinically warranted, sampling can be \nperformed for \ndiagnosis. \n3. Lumbar spondylosis, not significantly changed compared to the \nprior study \ndescribed above. \n\nHelical MDCT images were acquired from the lung bases through \nthe \ngreater trochanters with intravenous and without oral contrast. \nCoronal and \nsagittal multiplanar reformations were generated. \n \nFINDINGS: Mild atelectasis is noted at the lung bases. There are \nno pleural \neffusions. The heart is normal in size, without pericardial \neffusion. \n \nABDOMEN: Nonspecific hepatic hypodensities measuring 11 mm in \nsegment VII \n(2:11) and 7 mm in segment VI (2:19) are too small to \ncharacterize. The \ngallbladder and pancreas are normal. The spleen is normal in \nsize. \n \nThe adrenals are normal. The kidneys enhance and excrete \ncontrast promptly \nand symmetrically, without masses or hydronephrosis. \n \nThe stomach and small bowel are normal. \n \nPELVIS: The colon and rectum are unremarkable. The bladder is \ndistended with \nurine and appears normal. Coarse central calcifications are \nnoted in the \nprostate. There is no free intraperitoneal fluid or air. \n \nProminent mesenteric and retroperitoneal lymph nodes are \npresent, measuring up \nto 8 mm in the mid abdomen and 6 mm in the para-aortic region. \nProminent \ninguinal lymph nodes measure up to 8 mm bilaterally. \n \nChanges of L4-S1 laminectomy are present, with spinal canal \nappearing widely \npatent. Within and superficial to the surgical bed, there is \nextensive fat \nstranding and fascial induration, consistent with post-surgical \ninflammatory \nchanges. In addition, there is a subcutaneous fluid collection \nmeasuring \napproximately 8.2 cm SI x 4.5 cm AP x 1 cm TV, and demonstrating \nperipheral \nrim enhancement. This abuts the posterior margins of the \nparaspinal muscles, \nbut there is no evidence of deep intramuscular or osseous \nextension. \n \nIMPRESSION: Subcutaneous inflammatory changes and fluid \ncollection \nsuperficial to the laminectomy bed. Although this may represent \npost-surgical \nchanges, infection cannot be excluded. These findings are better \nevaluated on \nrecent spine MR.\nThis is a ___ M with recent cauda equina s/p L4-S1 laminectomies \nfollowed by post-operative infection treated with 2 week course \nof IV nafcillin who now returns with complaints of recurrent \nneurologic symptoms, fevers, chills and back pain.\n. \n# Right lower extremity weakness - ortho spine had evaluated him \nin the emergency room and believed that his exam was consistent \nwith his prior known right lower extremity weakness; his \nadmission exam to the medicine service demonstrates similar \nweakness, although he is able to ambulate without difficulty \nwhich lessens the clinical suspicion for acute neurologic \nimpairment. His MRI of his spine demonstrates a subcutaneous \nfluid collection, however this does not appear to be impinging \non his spine. The patient was ambulatory throughout his entire \nhospitalization.\n.\n# Fevers/chills - The patient had a recent infection of his \nprevious spinal surgical site for which he just finished a 2 \nweek course of nafcillin. The patient was afebrile since his \nadmission and demonstrated no evidence of acute infection. \nVancomycin was initially started on admission but was promptly \ndiscontinued.\n\n# Back pain - The patient's symptoms are consistent with a \npotential lumbosacral radiculopathy that is causing sciatica \nlike pain on his right leg. This was treated with MScontin 30mg \ntwice daily. He was discharged with outpatient physical \ntherapy."}}
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{'final_diagnoses': ['Lumbosacral radiculopathy'], 'procedures': ['None'], 'visit_summary': "This is a ___ M with recent cauda equina s/p L4-S1 laminectomies \nfollowed by post-operative infection treated with 2 week course \nof IV nafcillin who now returns with complaints of recurrent \nneurologic symptoms, fevers, chills and back pain.\n. \n# Right lower extremity weakness - ortho spine had evaluated him \nin the emergency room and believed that his exam was consistent \nwith his prior known right lower extremity weakness; his \nadmission exam to the medicine service demonstrates similar \nweakness, although he is able to ambulate without difficulty \nwhich lessens the clinical suspicion for acute neurologic \nimpairment. His MRI of his spine demonstrates a subcutaneous \nfluid collection, however this does not appear to be impinging \non his spine. The patient was ambulatory throughout his entire \nhospitalization.\n.\n# Fevers/chills - The patient had a recent infection of his \nprevious spinal surgical site for which he just finished a 2 \nweek course of nafcillin. The patient was afebrile since his \nadmission and demonstrated no evidence of acute infection. \nVancomycin was initially started on admission but was promptly \ndiscontinued.\n\n# Back pain - The patient's symptoms are consistent with a \npotential lumbosacral radiculopathy that is causing sciatica \nlike pain on his right leg. This was treated with MScontin 30mg \ntwice daily. He was discharged with outpatient physical \ntherapy.", 'medications_prescribed': ['1. senna 8.6 mg Tablet Sig: One (1) Tablet PO BID (2 times a \nday) as needed for constipation.\nDisp:*30 Tablet(s)* Refills:*0*', '2. docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*30 Capsule(s)* Refills:*0*', '3. acetaminophen 500 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours) as needed for pain/fever. ', '4. morphine 30 mg Tablet Sustained Release Sig: One (1) Tablet \nSustained Release PO Q12H (every 12 hours) for 2 weeks.\nDisp:*28 Tablet Sustained Release(s)* Refills:*0*', '5. nicotine (polacrilex) 2 mg Lozenge Sig: One (1) lozenge \nBuccal q1-2h as needed for craving for cigarettes.\nDisp:*60 lozenges* Refills:*0*', '6. omeprazole 40 mg Capsule, Delayed Release(E.C.) Sig: One (1) \nCapsule, Delayed Release(E.C.) PO once a day.\nDisp:*30 Capsule, Delayed Release(E.C.)(s)* Refills:*2*', '7. Outpatient Physical Therapy\nPatient is status post laminectomy from cauda equina syndrome \nwith right leg weakness. Please assess and treat.']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 24, 'gender': 'F', 'symptoms': 'Right hip pain', 'medical_history': ['HTN', 'gastritis', 'BPH', 'depression'], 'family_history': 'nc', 'present_illness': 'Mr. ___ presents with increasing right hip pain. He \nexperiences groin pain and lateral hip pain radiating into \nthigh. The pain\nhas been there for several years; however, has progressively\nworsened over the past few weeks such that it is interferring \nwith his ability to perform his activities of daily living. He \nnotes that the pain is\nidentical in location and quality as his contralateral hip pain\nwas prior to total hip arthroplasty of the left hip. He \ncurrently walks with\nassistive device due to right hip pain. He has ongoing chronic\nlow back pain. He continues to take Vicodin for this pain. He\nalso has taken Celebrex, which has not relieved the pain\nsignificantly.', 'medications': [{'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Enoxaparin Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Multivitamins', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', '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': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', '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': 'Prochlorperazine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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}]}, 'clinical_findings': {'labs': [{'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': '27.3', 'valuenum': 27.3, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '328', 'valuenum': 328.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 10.2, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '128', 'valuenum': 128.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', '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': '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': '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': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.0', 'valuenum': 8.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': 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': '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': '35.1', 'valuenum': 35.1, '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': '11', 'valuenum': 11.0, 'valueuom': '%', 'ref_range_lower': 18.0, 'ref_range_upper': 42.0, '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': '34.3', 'valuenum': 34.3, 'valueuom': '%', 'ref_range_lower': 31.0, 'ref_range_upper': 35.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': 2.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': '%', 'ref_range_lower': 50.0, 'ref_range_upper': 70.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '307', 'valuenum': 307.0, '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': '4.37', 'valuenum': 4.37, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.8', 'valuenum': 12.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '6.0', 'valuenum': 6.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.020', 'valuenum': 1.02, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Clear', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'Yellow', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 'NEG', 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.8', 'valuenum': 7.8, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '107', 'valuenum': 107.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '161', 'valuenum': 161.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': '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': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.2', 'valuenum': 33.2, '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': '27.3', 'valuenum': 27.3, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '316', 'valuenum': 316.0, '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': '4.15', 'valuenum': 4.15, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, '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': '13', 'valuenum': 13.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '7.9', 'valuenum': 7.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '2.6', 'valuenum': 2.6, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '3.9', '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': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '27.8', 'valuenum': 27.8, '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': '80', 'valuenum': 80.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '332', 'valuenum': 332.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, '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': '4.22', 'valuenum': 4.22, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.5', 'valuenum': 1.5, 'valueuom': '%', 'ref_range_lower': 1.2, 'ref_range_upper': 3.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '12.4', 'valuenum': 12.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.4, 'ref_range_upper': 4.8, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25', 'valuenum': 25.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.1', 'valuenum': 8.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '1.07', 'valuenum': 1.07, 'valueuom': 'Ratio', 'ref_range_lower': 0.8, 'ref_range_upper': 1.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.9', 'valuenum': 3.9, 'valueuom': 'ug/dL', 'ref_range_lower': 4.4, 'ref_range_upper': 11.4, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '62', 'valuenum': 62.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'ng/mL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '124', 'valuenum': 124.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '61', 'valuenum': 61.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'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': '3.1', 'valuenum': 3.1, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.29', 'valuenum': 0.29, 'valueuom': 'uIU/mL', 'ref_range_lower': 0.27, 'ref_range_upper': 4.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'ug/dL', 'ref_range_lower': 4.6, 'ref_range_upper': 12.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '0.94', 'valuenum': 0.94, 'valueuom': 'ng/dL', 'ref_range_lower': 0.93, 'ref_range_upper': 1.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.93', 'valuenum': 0.93, 'valueuom': 'Ratio', 'ref_range_lower': 0.77, 'ref_range_upper': 1.25, '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': '396', 'valuenum': 396.0, 'valueuom': 'pg/mL', 'ref_range_lower': 240.0, 'ref_range_upper': 900.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '52', 'valuenum': 52.0, 'valueuom': 'pg/mL', 'ref_range_lower': 15.0, 'ref_range_upper': 65.0, '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': 'HOLD.'}, {'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': '7.52', 'valuenum': 7.52, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, '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* Incision healing well with staples \n* Scant serosanguinous drainage \n* Thigh full but soft \n* No calf tenderness \n* ___ strength \n* SILT, NVI distally \n* Toes warm', 'diagnoses': [{'icd_code': '0579', 'desc': 'Viral exanthem, unspecified'}, {'icd_code': '25541', 'desc': 'Glucocorticoid deficiency'}, {'icd_code': '2825', 'desc': 'Sickle-cell trait'}, {'icd_code': '311', 'desc': 'Depressive disorder, not elsewhere classified'}, {'icd_code': '4580', 'desc': 'Orthostatic hypotension'}, {'icd_code': '72989', 'desc': 'Other musculoskeletal symptoms referable to limbs'}, {'icd_code': '56400', 'desc': 'Constipation, unspecified'}, {'icd_code': '2859', 'desc': 'Anemia, unspecified'}, {'icd_code': '53550', 'desc': 'Unspecified gastritis and gastroduodenitis, without mention of hemorrhage'}], 'summary': "___ 05:35AM BLOOD WBC-7.2 RBC-3.74* Hgb-10.8* Hct-32.9* \nMCV-88 MCH-28.8 MCHC-32.7 RDW-15.7* Plt ___\n___ 07:10AM BLOOD WBC-7.0 RBC-3.73* Hgb-10.3*# Hct-31.9* \nMCV-86# MCH-27.6 MCHC-32.3 RDW-15.8* Plt ___\n___ 05:35AM BLOOD Glucose-100 UreaN-9 Creat-0.9 Na-141 \nK-3.6 Cl-101 HCO3-34* AnGap-10\n___ 07:10AM BLOOD Glucose-107* UreaN-16 Creat-1.0 Na-134 \nK-3.0* Cl-97 HCO3-33* AnGap-7*\n___ 07:10AM BLOOD Calcium-8.4 Phos-3.8 Mg-2.1\nThe patient was admitted to the orthopaedic 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\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The patient \nreceived lovenox for DVT prophylaxis starting on the morning of \nPOD#1. The foley was removed on POD#2 and the patient was \nvoiding independently thereafter. The surgical dressing was \nchanged on POD#2 and the surgical incision was found to be clean \nand intact without erythema or abnormal drainage. The patient \nwas seen daily by physical therapy. Labs were checked throughout \nthe hospital course and repleted accordingly. At the time of \ndischarge the patient was tolerating a regular diet and feeling \nwell. The patient was afebrile with stable vital signs. The \npatient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with posterior precautions. \nWalker or two crutches at all times for 6 weeks.\n\nMr. ___ is discharged to home with services in stable \ncondition."}}
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{'final_diagnoses': ['Right hip osteoarthritis'], 'procedures': ['___: s/p Right total hip arthroplasty'], 'visit_summary': "The patient was admitted to the orthopaedic 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\nOtherwise, pain was initially controlled with a PCA followed by \na transition to oral pain medications on POD#1. The patient \nreceived lovenox for DVT prophylaxis starting on the morning of \nPOD#1. The foley was removed on POD#2 and the patient was \nvoiding independently thereafter. The surgical dressing was \nchanged on POD#2 and the surgical incision was found to be clean \nand intact without erythema or abnormal drainage. The patient \nwas seen daily by physical therapy. Labs were checked throughout \nthe hospital course and repleted accordingly. At the time of \ndischarge the patient was tolerating a regular diet and feeling \nwell. The patient was afebrile with stable vital signs. The \npatient's hematocrit was acceptable and pain was adequately \ncontrolled on an oral regimen. The operative extremity was \nneurovascularly intact and the wound was benign. \n\nThe patient's weight-bearing status is weight bearing as \ntolerated on the operative extremity with posterior precautions. \nWalker or two crutches at all times for 6 weeks.\n\nMr. ___ is discharged to home with services in stable \ncondition.", 'medications_prescribed': ['oxycodone 5 mg Tablet Sig: ___ Tablets PO Q3H (every 3 hours) \nas needed for Pain.\nDisp:*100 Tablet(s)* Refills:*0*', 'acetaminophen 325 mg Tablet Sig: Two (2) Tablet PO Q6H (every \n6 hours). ', 'enoxaparin 40 mg/0.4 mL Syringe Sig: One (1) syringe \nSubcutaneous DAILY (Daily) for 4 weeks.\nDisp:*28 syringe* Refills:*0*', 'docusate sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day).\nDisp:*60 Capsule(s)* Refills:*2*', 'multivitamin Tablet Sig: One (1) Cap PO DAILY (Daily). ', 'citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily). ', 'diltiazem HCl 120 mg Capsule, Extended Release Sig: Two (2) \nCapsule, Extended Release PO DAILY (Daily). ', 'hydrochlorothiazide 50 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily). ', 'aspirin 81 mg Tablet, Delayed Release (E.C.) Sig: One (1) \nTablet, Delayed Release (E.C.) PO DAILY (Daily). ']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 36, 'gender': 'M', 'symptoms': 'Malaise and fatigue, constipation and poor PO intake. Acute \nrenal failure', 'medical_history': ['-- Recent diagnosis of pancreatic adenocarcinoma', '-- Diabetes diagnosed ___ years ago currently on Insulin.', '-- Chronic kidney failure secondary to diabetes.', '-- Emphysema, currently followed by a pulmonary doctor.', '-- Hypertension.', '-- Status post cardiac arrest, past surgery ___ years prior.', '-- Peripheral vascular disease.', '-- Stroke TIA in ___.', '-- Sleep apnea on CPAP at night.', '-- CABG ___ ago'], 'family_history': 'He has a sister with cancer of unknown origin, a\nfather who died of heart disease, and a mother who died of old\nage.', 'present_illness': '___ with history of pancreatic adenocarcinoma currently \nundergoing gemcitabine therapy on Day 8 of third cycle. s/p EGD \nthis am for fiduciary placement for cyberknife. Presents with 2 \nweeks of nausea/vomiting unrelieved by zofran, compazine, \nreglan. Denies abd pain but feels acid reflux type discomfort. \nThe EGD today showed no ulcers or other problems. He also c/o \nconstipation -last BM 2 days ago, but "it wasn\'t much" He has \nhad very poor po intake at home, because of the nausea and \nbecause he feels full. He denies dizziness, chest pain, sob.\n\nHe states that he got very constipated with the first ___ut never this severe. Per OMR, with the ___ cycle he \nwas hospitalized for biliary obstruction and had to stop cycle \nearly, He got a full ___ cycle. \n\nA KUB today showed lots of stool, but no air-fluid levels \nindicative of obstruction. \n\nAll other ros negative.', 'medications': [{'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Ketorolac', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': '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': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', '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': 'Clonazepam', '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': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [], 'exams': 'Vitals: T 97.6 BP 106/53 P 69 R 16 98% RA\nGeneral: elderly male, NAD, appears comfortable \nHEENT: Mucous membranes moist. Oropharynx clear. Sclerae are \nanicteric, PERRLA, EOMI \nNeck: Supple, no LAD, no nodes, no jvp \nHeart: Regular. no M/R/G \nLungs: CTAB, no wheezes, no crackles, breathing comfortably \nAbd: decreased bowel sounds. mass palpated in rlq (?stool) and \nruq (?pancreatic neoplasm). tender to palpation in ruq. -Murphys\nExt: 1+ ___ edema bilat to mid shin \nNeuro: A and O x 3. moves all extremities symmetrically \nbilaterally. no focal abnormalities \nSkin: no rash.', 'diagnoses': [{'icd_code': '5920', 'desc': 'Calculus of kidney'}, {'icd_code': '5921', 'desc': 'Calculus of ureter'}, {'icd_code': '78701', 'desc': 'Nausea with vomiting'}, {'icd_code': '78869', 'desc': 'Other abnormality of urination'}], 'summary': '___ 11:13AM BLOOD WBC-6.4 RBC-3.12* Hgb-9.1* Hct-26.7* \nMCV-86 MCH-29.3 MCHC-34.2 RDW-17.5* Plt ___\n___ 05:55AM BLOOD WBC-7.4 RBC-2.97* Hgb-8.6* Hct-25.9* \nMCV-87 MCH-29.0 MCHC-33.2 RDW-18.6* Plt ___\n___ 11:13AM BLOOD Glucose-144* UreaN-53* Creat-3.0* Na-135 \nK-4.5 Cl-96 HCO3-31 AnGap-13\n___ 05:55AM BLOOD Glucose-91 UreaN-30* Creat-2.2* Na-141 \nK-4.8 Cl-108 HCO3-27 AnGap-11\n___ 11:13AM BLOOD ALT-16 AST-19 LD(LDH)-146 AlkPhos-314* \nTotBili-0.8\n___ 11:13AM BLOOD Albumin-2.5* Calcium-8.9 Phos-4.1 Mg-1.9\n___ 11:44AM URINE Hours-RANDOM Creat-81 Na-78 K-23 Cl-28\n___ 11:44AM URINE Osmolal-___\nPatient was admitted from outpatient clinic because of a 2 week \nhistory of increasing constipation, nausea and vomiting during \nconcurrent chemotherapy leading to poor po intake with an \nassociated increase in his baseline creatinine of 1.8-2.4 to \n3.0. A KUB performed prior to admission showed no evidence of \nobstruction, but demonstrated severe constipation. He was given \nIV fluids, IV antiemetics and a bowel regimen. We also held his \nlasix and HCTZ while creatinine remained elevated. His \nconstipation resolved and he was sent home on a more aggressive \nbowel regimen. His nausea and vomiting was controlled with IV \ncompazine and he was tolerating meals. His po intake remained \ndecreased however, and his am blood sugars were low (39/29/36) \ntherefore we halved his regular NPH dose until oral intake \nresumes to full. His renal failure resolved with hydration. A \nbladder scan showed no residual amd a renal ultrasound showed no \nevidence of hydronephrosis. He will follow up on ___ with \nradiation oncology to begain radiation therapy and follow up \nwith his primary oncologist on ___. He should also follow up \nwith Dr ___ his blood sugars within 2 weeks.'}}
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{'final_diagnoses': ['Acute Renal Failure', 'Constipation', 'Nausea/Vomiting', 'Diabetes Mellitus'], 'procedures': ['None'], 'visit_summary': 'Patient was admitted from outpatient clinic because of a 2 week \nhistory of increasing constipation, nausea and vomiting during \nconcurrent chemotherapy leading to poor po intake with an \nassociated increase in his baseline creatinine of 1.8-2.4 to \n3.0. A KUB performed prior to admission showed no evidence of \nobstruction, but demonstrated severe constipation. He was given \nIV fluids, IV antiemetics and a bowel regimen. We also held his \nlasix and HCTZ while creatinine remained elevated. His \nconstipation resolved and he was sent home on a more aggressive \nbowel regimen. His nausea and vomiting was controlled with IV \ncompazine and he was tolerating meals. His po intake remained \ndecreased however, and his am blood sugars were low (39/29/36) \ntherefore we halved his regular NPH dose until oral intake \nresumes to full. His renal failure resolved with hydration. A \nbladder scan showed no residual amd a renal ultrasound showed no \nevidence of hydronephrosis. He will follow up on ___ with \nradiation oncology to begain radiation therapy and follow up \nwith his primary oncologist on ___. He should also follow up \nwith Dr ___ his blood sugars within 2 weeks.', 'medications_prescribed': ['Atorvastatin 20 mg Tablet Sig: One (1) Tablet PO DAILY \n(Daily).', 'Levofloxacin 500 mg Tablet Sig: One (1) Tablet PO Q24H (every \n24 hours) for 1 days.\nDisp:*1 Tablet(s)* Refills:*0*', 'Lorazepam 0.5 mg Tablet Sig: ___ Tablets PO Q4H (every 4 \nhours) as needed for nausea.', 'Metoclopramide 10 mg Tablet Sig: One (1) Tablet PO Q6H (every \n6 hours) as needed for nausea.', 'Pantoprazole 40 mg Tablet, Delayed Release (E.C.) Sig: One \n(1) Tablet, Delayed Release (E.C.) PO BID (2 times a day) as \nneeded for GERD.', 'Polyethylene Glycol 3350 100 % Powder Sig: One (1) PO DAILY \n(Daily) as needed for constipation.', 'Docusate Sodium 100 mg Capsule Sig: One (1) Capsule PO BID (2 \ntimes a day) as needed for constipation.', 'Senna 8.6 mg Tablet Sig: Two (2) Tablet PO BID (2 times a \nday) as needed for constipation.', 'Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: One (1) \n10 Subcutaneous at bedtime: Until PO intake resumes to normal \nlevel, please use ___ of normal dose. (Use 14 units of NPH qam \nand 10 units NPH qpm until eating normally).', 'Doxazosin 1 mg Tablet Sig: One (1) Tablet PO DAILY (Daily) \nas needed for BPH.', 'Lisinopril 20 mg Tablet Sig: Two (2) Tablet PO DAILY \n(Daily).', 'Hydrochlorothiazide 50 mg Tablet Sig: One (1) Tablet PO QAM \n(once a day (in the morning)).', 'Compazine 10 mg Tablet Sig: One (1) Tablet PO every ___ \nhours as needed for nausea.', 'Insulin NPH Human Recomb 100 unit/mL Cartridge Sig: One (1) \n14 units Subcutaneous qam.', 'Maalox 200-200-20 mg/5 mL Suspension Sig: ___ PO four \ntimes a day as needed for indigestion.\nDisp:*qs * 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': '?R thumb infection with lymphangitis', 'medical_history': ['Negative other than ___ knee joint pain/arthritis', '___ R thumb \nulnar collateral ligament tear.'], 'family_history': 'Mother passed. Father with ?___ gout, never diagnosed. Brother \n___, healthy.', 'present_illness': 'This is a RHD ___ yo F who presents with acute R thumb pain and \nswelling starting around 1am. She had associated nausea and low \ngrade temperature. The pain woke her up from sleep and she \npresented to the ED. She denies any history of trauma to the \narea.', 'medications': [{'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 12H', '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': 'TraMADol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Fentanyl Citrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Expired', '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': 'Docusate Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q24H', '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': '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': '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': 'Pantoprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q24H', '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': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Calcium Carbonate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'PHENYLEPHrine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'Albumin 5% (12.5g / 250mL)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Glycopyrrolate (CVICU Reversal Protocol)', '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': 'Lactulose', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoclopramide', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Propofol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO RASS', 'doses_per_24_hrs': 0.0}, {'medication': 'Mupirocin Ointment 2%', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', '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': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': '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': 'Furosemide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin Glargine (CVICU Protocol)', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'SC', '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Heparin', 'proc_type': 'IV Piggyback', 'status': 'Inactive (Due to a change order)', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'CeFAZolin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Expired', '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': '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': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Simethicone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID:PRN', 'doses_per_24_hrs': None}, {'medication': 'Neostigmine (CVICU Reversal Protocol)', 'proc_type': 'Unit Dose', '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': 'Acetaminophen IV', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': 'Calcium Gluconate', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Phosphorus', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Ondansetron', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PR', 'frequency': 'DAILY: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': 'Atenolol', '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': 'Mouth Care 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': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Fluticasone Propionate NASAL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NU', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'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': 'Potassium Chloride', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', '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': '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': 'Expired', 'route': 'IV', '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': 'HYDROmorphone (Dilaudid)', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Polyethylene Glycol', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'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': '#/hpf', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 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': '#/hpf', 'ref_range_lower': 0.0, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'STAT', 'comments': '<1.'}, {'value': '1.007', 'valuenum': 1.007, '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': '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': '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': '52.3', 'valuenum': 52.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '16', 'valuenum': 16.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'g/dL', 'ref_range_lower': 3.5, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'IU/L', 'ref_range_lower': 35.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '81', 'valuenum': 81.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'IU/L', 'ref_range_lower': 0.0, 'ref_range_upper': 40.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.5', 'valuenum': 0.5, 'valueuom': 'mg/dL', 'ref_range_lower': 0.0, 'ref_range_upper': 1.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '108', 'valuenum': 108.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': "Using this patient's age, gender, and serum creatinine value of 1.0, . estimated GFR (eGFR) is likely between 55 and 67 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': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '24', 'valuenum': 24.0, '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': '181', 'valuenum': 181.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34', 'valuenum': 34.0, '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': '___', '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': 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': '13', 'valuenum': 13.0, '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': '38.4', 'valuenum': 38.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '33.9', 'valuenum': 33.9, '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': '230', 'valuenum': 230.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.4', 'valuenum': 13.4, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.33', 'valuenum': 4.33, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '___', 'valuenum': 111.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': '___'}, {'value': '77.7', 'valuenum': 77.7, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '83.9', 'valuenum': 83.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': 'abnormal', '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': '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': '104', 'valuenum': 104.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.23', 'valuenum': 1.23, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, 'flag': None, 'priority': None, 'comments': None}, {'value': '93', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '11.6', 'valuenum': 11.6, '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', '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': '7.41', 'valuenum': 7.41, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '284', 'valuenum': 284.0, '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': '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': '1', 'valuenum': 1.0, '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': '1.13', 'valuenum': 1.13, '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': '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': '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': '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': '345', 'valuenum': 345.0, 'valueuom': 'mm Hg', 'ref_range_lower': 85.0, 'ref_range_upper': 105.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '5.1', 'valuenum': 5.1, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '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': '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': '123', 'valuenum': 123.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, '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': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '2.8', 'valuenum': 2.8, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 'ref_range_upper': 2.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '35', 'valuenum': 35.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '7.45', 'valuenum': 7.45, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': None, 'priority': None, 'comments': None}, {'value': '309', 'valuenum': 309.0, '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': 3.3, 'ref_range_upper': 5.1, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '0', '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': '106', 'valuenum': 106.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.19', 'valuenum': 1.19, 'valueuom': 'mmol/L', 'ref_range_lower': 1.12, 'ref_range_upper': 1.32, '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, 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '8.8', 'valuenum': 8.8, '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': '3.1', 'valuenum': 3.1, 'valueuom': 'mmol/L', 'ref_range_lower': 0.5, 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{'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': '122', 'valuenum': 122.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.33', 'valuenum': 3.33, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.6', 'valuenum': 13.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '43.8', 'valuenum': 43.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.2', 'valuenum': 1.2, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '27.6', 'valuenum': 27.6, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': None}, {'value': '23', 'valuenum': 23.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 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None}, {'value': 'VEN.', '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': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 21.0, 'ref_range_upper': 30.0, 'flag': None, 'priority': None, 'comments': None}, {'value': '1.04', 'valuenum': 1.04, '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': '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': '31', 'valuenum': 31.0, 'valueuom': 'mm Hg', 'ref_range_lower': 35.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '7.44', 'valuenum': 7.44, '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': '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '___', 'valuenum': 9.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 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'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': '2.9', 'valuenum': 2.9, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.8, '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': 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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '25.6', 'valuenum': 25.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.8', 'valuenum': 32.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '92', 'valuenum': 92.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '134', 'valuenum': 134.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.79', 'valuenum': 2.79, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.1', 'valuenum': 13.1, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.6', 'valuenum': 47.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '23.6', 'valuenum': 23.6, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.7', 'valuenum': 7.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, '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': '32.6', 'valuenum': 32.6, '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': '124', 'valuenum': 124.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.3', 'valuenum': 14.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.59', 'valuenum': 2.59, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '13.7', 'valuenum': 13.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '47.4', 'valuenum': 47.4, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', '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': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.6', 'valuenum': 8.6, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 0.4, '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 4.5, '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': 135.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '13', 'valuenum': 13.0, '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': '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': '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': '98', 'valuenum': 98.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 105.0, 'flag': None, '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': '94', 'valuenum': 94.0, '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': '7.49', 'valuenum': 7.49, 'valueuom': 'units', 'ref_range_lower': 7.35, 'ref_range_upper': 7.45, 'flag': 'abnormal', 'priority': None, 'comments': None}, {'value': '67', 'valuenum': 67.0, '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': 'ART.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': None, 'comments': '___'}, {'value': '24.5', 'valuenum': 24.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, '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': '9.1', 'valuenum': 9.1, 'valueuom': 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'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': 138.0, 'valueuom': 'mEq/L', 'ref_range_lower': 135.0, 'ref_range_upper': 147.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, '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, 'priority': None, 'comments': None}, {'value': '7.40', 'valuenum': 7.4, 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'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': 400.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.38', 'valuenum': 2.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.9', 'valuenum': 48.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 10.0, 'valueuom': 'mEq/L', 'ref_range_lower': 10.0, 'ref_range_upper': 18.0, 'flag': None, 'priority': 'STAT', 'comments': 'New reference range as of ___.'}, {'value': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '22', 'valuenum': 22.0, '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': '2.4', 'valuenum': 2.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', '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': 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': '15', 'valuenum': 15.0, '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': 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': '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': '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': 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': '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': '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': 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': 140.0, '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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '23.9', 'valuenum': 23.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, '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, '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': '21.5', 'valuenum': 21.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, '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': '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': '92', 'valuenum': 92.0, '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': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14.6', 'valuenum': 14.6, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.34', 'valuenum': 2.34, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '48.6', 'valuenum': 48.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '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': '___', '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': '29', 'valuenum': 29.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 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': '4', 'valuenum': 4.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', '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': 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': '20', 'valuenum': 20.0, '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': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '26.8', 'valuenum': 26.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, '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': '24', 'valuenum': 24.0, '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': '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': 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': '14', 'valuenum': 14.0, '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': '___', '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': 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': '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': '25.4', 'valuenum': 25.4, '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': '30.1', 'valuenum': 30.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.5', 'valuenum': 33.5, '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': '192', 'valuenum': 192.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '2.82', 'valuenum': 2.82, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8.8', 'valuenum': 8.8, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '51.2', 'valuenum': 51.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAM: \n100.2 VSS\nRIGHT HAND: \nTense edematous circumferential right thumb. Small area of about \n5mm of echymosis noted to the volar aspect of the DIPJ of the \nright thumb. Pain upon palpation. Pain with passive and active \nflexion, extension, abduction, adduction of the right thumb. \nAssociated lymphangitis to level of axilla. No palpable lymph \nnodes although tender to palpation. Neurovascularly intact in \nmedian/radial/ulnar distributions. 2+ radial/ulnar pulses. \nWarm, well-perfused.', 'diagnoses': [{'icd_code': 'I25110', 'desc': 'Atherosclerotic heart disease of native coronary artery with unstable angina pectoris'}, {'icd_code': 'D62', 'desc': 'Acute posthemorrhagic anemia'}, {'icd_code': 'E785', 'desc': 'Hyperlipidemia, unspecified'}, {'icd_code': 'I252', 'desc': 'Old myocardial infarction'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'Z8249', 'desc': 'Family history of ischemic heart disease and other diseases of the circulatory system'}, {'icd_code': 'I952', 'desc': 'Hypotension due to drugs'}, {'icd_code': 'T41295A', 'desc': 'Adverse effect of other general anesthetics, initial encounter'}, {'icd_code': 'Y92239', 'desc': 'Unspecified place in hospital as the place of occurrence of the external cause'}], 'summary': '___ Radiology HAND (AP, LAT & OBLIQUE): FINDINGS: Three \nviews of the right hand demonstrate minimal induration along the \ndistal thumb without evidence of fracture or malalignment of \nosseous structures. Distal second phalanx is somewhat obscured \nby an oximetry device. There is no radiopaque foreign body or \ngas within the soft tissue. Mild degenerative changes of the CMC \njoint with joint space narrowing and mild sclerosis. \n.\n___ 04:45AM BLOOD WBC-10.3 RBC-4.10* Hgb-12.8 Hct-37.1 \nMCV-90 MCH-31.3 MCHC-34.6 RDW-12.7 Plt ___\n___ 04:45AM BLOOD Plt ___\n___ 04:45AM BLOOD Glucose-136* UreaN-10 Creat-0.8 Na-137 \nK-3.7 Cl-104 HCO3-24 AnGap-13\n___ 04:58AM BLOOD Lactate-1.5\n___ 10:30AM BLOOD HERPES SIMPLEX VIRUS 1 AND 2 ANTIBODY \nIGM-PND\n___ 10:30AM BLOOD HERPES SIMPLEX (HSV) 1, IGG-PND\n___ 10:30AM BLOOD HERPES SIMPLEX (HSV) 2, IGG-PND\n.\n___ 3:30 pm SWAB PALMAR CULTURE RT. \n\n GRAM STAIN (Final ___: \n 1+ (<1 per 1000X FIELD): POLYMORPHONUCLEAR \nLEUKOCYTES. \n NO MICROORGANISMS SEEN. \n\n WOUND CULTURE (Preliminary): \n\n ANAEROBIC CULTURE (Preliminary): \n\n FUNGAL CULTURE (Preliminary): \n___ 3:30 pm SWAB BLISTER FROM RIGHT THUMB. \n\n GRAM STAIN (Final ___: \n NO POLYMORPHONUCLEAR LEUKOCYTES SEEN. \n NO MICROORGANISMS SEEN. \n\n WOUND CULTURE (Preliminary): \n\n FUNGAL CULTURE (Preliminary): \n\n ANAEROBIC CULTURE (Preliminary): \n___ BLOOD CULTURE :P\n___ BLOOD CULTURE :P\nThe patient was admitted to the plastic surgery service on \n___ and had an incision and drainage of her right thumb. \nDeep wound cultures were sent that grew beta strep group A. She \nwas started on IV vanc, po cipro, po flagyl, as well as \nvalcyclovir for suspicion of a viral infection. The infectious \ndisease team was consulted.\n.\nNeuro: Post-operatively, the patient received IV pain \nmedications with good effect and adequate pain control. When \ntolerating oral intake, the patient was transitioned to oral \npain medications. \n.\nCV: The patient was stable from a cardiovascular standpoint; \nvital signs were routinely monitored.\n.\nPulmonary: The patient was stable from a pulmonary standpoint; \nvital signs were routinely monitored.\n.\nGI/GU: Post-operatively, the patient was given IV fluids until \ntolerating oral intake. Her diet was advanced when appropriate, \nwhich was tolerated well. She was also started on a bowel \nregimen to encourage bowel movement. Intake and output were \nclosely monitored. \n.\nID: Post-operatively, the patient was started on IV vanc, cipro \nand flagyl. ID was consulted and they recommended vanc, \npenicillin G 3mill units q4h and clindamycin. They recommended 2 \nweeks of IV pen g 4 million units q4hours. A PICC line was \nplaced on ___ without complication. She was also continued \non valacyclovir to complete the recommended 10 day course. She \nhas scheduled follow up with ID. \n.\nProphylaxis: The patient received subcutaneous heparin during \nthis stay, and was encouraged to get up and ambulate as early as \npossible. \n.\nAt the time of discharge on POD#4, the patient was doing well, \nafebrile with stable vital signs, tolerating a regular diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. \n.\nRight hand: She was instructed to perform BID dilute betadine \nsoaks with dsd dressing changes daily. ___ was arranged for \nassistance. Pt has scheduled follow up with Dr. ___ in 2 \nweeks.'}}
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{'final_diagnoses': ['1. Cellulitis right hand.', '2. Felon right thumb.', '3. BETA STREPTOCOCCUS GROUP A right thumb'], 'procedures': ['incision and drainage right thumb ___'], 'visit_summary': 'The patient was admitted to the plastic surgery service on \n___ and had an incision and drainage of her right thumb. \nDeep wound cultures were sent that grew beta strep group A. She \nwas started on IV vanc, po cipro, po flagyl, as well as \nvalcyclovir for suspicion of a viral infection. The infectious \ndisease team was consulted.\n.\nNeuro: Post-operatively, the patient received IV pain \nmedications with good effect and adequate pain control. When \ntolerating oral intake, the patient was transitioned to oral \npain medications. \n.\nCV: The patient was stable from a cardiovascular standpoint; \nvital signs were routinely monitored.\n.\nPulmonary: The patient was stable from a pulmonary standpoint; \nvital signs were routinely monitored.\n.\nGI/GU: Post-operatively, the patient was given IV fluids until \ntolerating oral intake. Her diet was advanced when appropriate, \nwhich was tolerated well. She was also started on a bowel \nregimen to encourage bowel movement. Intake and output were \nclosely monitored. \n.\nID: Post-operatively, the patient was started on IV vanc, cipro \nand flagyl. ID was consulted and they recommended vanc, \npenicillin G 3mill units q4h and clindamycin. They recommended 2 \nweeks of IV pen g 4 million units q4hours. A PICC line was \nplaced on ___ without complication. She was also continued \non valacyclovir to complete the recommended 10 day course. She \nhas scheduled follow up with ID. \n.\nProphylaxis: The patient received subcutaneous heparin during \nthis stay, and was encouraged to get up and ambulate as early as \npossible. \n.\nAt the time of discharge on POD#4, the patient was doing well, \nafebrile with stable vital signs, tolerating a regular diet, \nambulating, voiding without assistance, and pain was well \ncontrolled. \n.\nRight hand: She was instructed to perform BID dilute betadine \nsoaks with dsd dressing changes daily. ___ was arranged for \nassistance. Pt has scheduled follow up with Dr. ___ in 2 \nweeks.', 'medications_prescribed': ['1. penicillin G pot in dextrose 3,000,000 unit/50 mL Piggyback \nSig: One (1) bag Intravenous Q4H (every 4 hours) for 2 weeks.\nDisp:*84 bags* Refills:*0*', '2. valacyclovir 500 mg Tablet Sig: One (1) Tablet PO BID (2 \ntimes a day) for 3 days.\nDisp:*6 Tablet(s)* Refills:*0*', '3. oxycodone-acetaminophen ___ mg Tablet Sig: ___ Tablets PO \nQ4H (every 4 hours) as needed for pain.\nDisp:*30 Tablet(s)* Refills:*0*', '4. Colace 100 mg Capsule Sig: One (1) Capsule PO twice a day as \nneeded for constipation.\nDisp:*30 Capsule(s)* Refills:*0*', '5. penicillin G pot in dextrose 1,000,000 unit/50 mL Piggyback \nSig: One (1) bag Intravenous every four (4) hours for 2 weeks.\nDisp:*84 bags* Refills:*0*']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 35, 'gender': 'M', 'symptoms': 'Back pain', 'medical_history': ['- IBS', '- Dyslipidemia', '- Asthma', '- Anxiety', '- Seizure Disorder'], 'family_history': 'N/C', 'present_illness': '___ EMT who was helping an ambulance back up when it \nstruck his chest and pinned him against the wall at approx. \n1:30PM today. The ambulance was going <5 mph at the time. \nPatient had onset of pain in his sternum and upper back but was \n\nambulatory at the scene. No head strike/LOC. Denies any \nweakness/numbness/tingling/bowel or bladder incontinence.', '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': 'Diazepam', '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': 'Ferrous Sulfate', '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': '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': 'Gabapentin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Loperamide', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QID: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': None, 'proc_type': 'IV Large Volume', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Diazepam', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', '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': 'Creon 12', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QIDWMHS', 'doses_per_24_hrs': 4.0}, {'medication': 'Amitriptyline', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'HS', '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': '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': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'units', 'ref_range_lower': 5.0, 'ref_range_upper': 8.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.006', 'valuenum': 1.006, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': 'NEG', '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': 'NEG', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', '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': 'STAT', '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': 'HOLD.', 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': '___'}, {'value': '34.8', 'valuenum': 34.8, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 52.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'g/dL', 'ref_range_lower': 14.0, 'ref_range_upper': 18.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '24.1', 'valuenum': 24.1, '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': '79', 'valuenum': 79.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '16.3', 'valuenum': 16.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.42', 'valuenum': 4.42, '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': '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': '102', 'valuenum': 102.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'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': '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': '4.2', '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': '8', 'valuenum': 8.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.1', 'valuenum': 31.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'A&O X 3; NAD\nRRR\nCTA B\nAbd soft NT/ND\n+ thoracic pain at midline to palpation\nBUE- good strength at deltoid, biceps, triceps, wrist \nflexion/extension, finger flexion/extension and intrinics; \nsensation intact C5-T1 dermatomes; - ___, reflexes \nsymmetric at biceps, triceps and brachioradialis\nBLE- good strength at hip flexion/extension, knee \nflexion/extension, ankle dorsiflexion and plantar flexion, \n___ sensation intact L1-S1 dermatomes; - clonus, reflexes \nsymmetric at quads and Achilles', 'diagnoses': [{'icd_code': '30391', 'desc': 'Other and unspecified alcohol dependence, continuous'}, {'icd_code': '7295', 'desc': 'Pain in limb'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '5778', 'desc': 'Other specified diseases of pancreas'}, {'icd_code': '7850', 'desc': 'Tachycardia, unspecified'}, {'icd_code': '3051', 'desc': 'Tobacco use disorder'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}], 'summary': '___ 02:50PM BLOOD WBC-4.8 RBC-4.71 Hgb-14.2 Hct-41.4 MCV-88 \nMCH-30.3 MCHC-34.4 RDW-12.9 Plt ___\n___ 02:50PM BLOOD ___ PTT-23.9 ___\n___ 02:50PM BLOOD Plt ___\n___ 03:00PM BLOOD Glucose-77 Lactate-1.6 Na-142 K-4.5 \nCl-102 calHCO3-27\nMr. ___ was admitted to the service of Dr. ___ for \nmanagement of his T8 compression fracture. He was fitted for a \nTLSO brace and was seen by physical therapy. His hospital \ncourse was otherwise unremarkable.\nHe was discharged in good condition and will follow up in the \nOrthopaedic Spine clinic.'}}
|
{'final_diagnoses': ['T8 compression fracture'], 'procedures': ['None'], 'visit_summary': 'Mr. ___ was admitted to the service of Dr. ___ for \nmanagement of his T8 compression fracture. He was fitted for a \nTLSO brace and was seen by physical therapy. His hospital \ncourse was otherwise unremarkable.\nHe was discharged in good condition and will follow up in the \nOrthopaedic Spine clinic.', 'medications_prescribed': ['1. hydromorphone 2 mg Tablet Sig: ___ Tablets PO Q3H (every 3 \nhours) as needed for Pain.\nDisp:*100 Tablet(s)* Refills:*0*', '2. bisacodyl 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:
|
{'patient_profile': {'age': 43, 'gender': 'M', 'symptoms': 'dyspnea', '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', '-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 ___, who presents with \n2 days of worsening SOB, fever, and cough with clear sputum. He \nnotes the fever to 102 on Tylenol and he has been increasing the \nuse of his inhalers. He also notes some increasing diarrhea, \nnausea and vomitting with difficulty tolerating POs. Admits to \npleuritic chest pain.\n\nOf note, he recently travelled to his father's farm in ___ \n___ and returned the day PTA. While there he was in the \nprocess of settling his father's estate and inspected the \ngrounds thoroughly. He had exposure to goats, chickens, horses, \nwaterfowl, hay, barns, and grain silos. He also had insect \nbites on his lower extremities with associated pruritis and \nswelling.\n. \nOn arrival to the medical floor, notes his SOB improves with \nnebulizer use. He still has diarrhea.", 'medications': [{'medication': 'Nicotine Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'ONCE MR1', 'doses_per_24_hrs': 1.0}, {'medication': 'Vancomycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q 8H', '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': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Methadone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Ibuprofen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'Q8H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q4H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Lidocaine 2%/Epi 1:100,000', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Clindamycin', 'proc_type': 'IV Piggyback', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'OxyCODONE (Immediate Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '2.23', 'valuenum': 2.23, 'valueuom': 'K/uL', 'ref_range_lower': 1.2, 'ref_range_upper': 3.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': '%', 'ref_range_lower': 0.0, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.7', 'valuenum': 2.7, 'valueuom': '%', 'ref_range_lower': 1.0, 'ref_range_upper': 7.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.3', 'valuenum': 37.3, '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': '21.9', 'valuenum': 21.9, 'valueuom': '%', 'ref_range_lower': 19.0, 'ref_range_upper': 53.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': '%', 'ref_range_lower': 5.0, 'ref_range_upper': 13.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '62.9', 'valuenum': 62.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 71.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '376', 'valuenum': 376.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, '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': 6.1, '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': '0.06', 'valuenum': 0.06, 'valueuom': 'K/uL', 'ref_range_lower': 0.01, 'ref_range_upper': 0.08, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.28', 'valuenum': 0.28, 'valueuom': 'K/uL', 'ref_range_lower': 0.04, 'ref_range_upper': 0.54, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.18', 'valuenum': 1.18, 'valueuom': 'K/uL', 'ref_range_lower': 0.2, 'ref_range_upper': 0.8, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '6.42', 'valuenum': 6.42, 'valueuom': 'K/uL', 'ref_range_lower': 1.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.3', 'valuenum': 0.3, 'valueuom': '%', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.5', 'valuenum': 42.5, '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': '12.4', 'valuenum': 12.4, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.08', 'valuenum': 0.08, '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': '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': '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': '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': 0.5, '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 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': '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': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', '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': '12', 'valuenum': 12.0, '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': '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': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, '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': '13.0', 'valuenum': 13.0, 'valueuom': 'ug/mL', 'ref_range_lower': 10.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 40.0, 'ref_range_upper': 51.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 13.7, 'ref_range_upper': 17.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '29.1', 'valuenum': 29.1, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.0', 'valuenum': 32.0, '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': '339', 'valuenum': 339.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.98', 'valuenum': 3.98, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.2', 'valuenum': 43.2, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.8', 'valuenum': 35.8, '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': '29.5', 'valuenum': 29.5, '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': '342', 'valuenum': 342.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.0', 'valuenum': 13.0, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.90', 'valuenum': 3.9, 'valueuom': 'm/uL', 'ref_range_lower': 4.6, 'ref_range_upper': 6.1, 'flag': 'abnormal', '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': '43.7', 'valuenum': 43.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 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': '0', 'valuenum': 0.0, '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': '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': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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': '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.5, 'ref_range_upper': 1.2, 'flag': None, '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': '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': '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': '4.7', 'valuenum': 4.7, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '140', 'valuenum': 140.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '12.2', 'valuenum': 12.2, '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': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '389', 'valuenum': 389.0, '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': '4.15', 'valuenum': 4.15, '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': '42.5', 'valuenum': 42.5, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'Vitals: T997 130/80 71 24 95%2L\nGen: well appearing gentleman, sitting upright in bed, NAD\nHEENT: MMM, OP clear, no thyromegally or nodules\nCV: RRR, nl S1/S2, no MRG\nRESP: prolonged exp. phase and diffuse exp. rhonchi\nABD: soft, non-distended, reports tenderness to light palpation\ndiffusely R>L without rebound or guarding, NABS\nExt: left leg with inscect bite, associated erythema, tenderness\nand swelling. No significant warmth noted. palpable DP pulses.\nNeuro: CN2-12 grossly intact. Moves all extremities.\n\nOn discharge:\n95% on room air, 94% on ambulation\nLungs: few diffuse rhonchi and wheezes, good air movement.', 'diagnoses': [{'icd_code': 'H00034', 'desc': 'Abscess of left upper eyelid'}, {'icd_code': 'F1120', 'desc': 'Opioid dependence, uncomplicated'}, {'icd_code': 'L03211', 'desc': 'Cellulitis of face'}, {'icd_code': 'J328', 'desc': 'Other chronic sinusitis'}, {'icd_code': 'F17210', 'desc': 'Nicotine dependence, cigarettes, uncomplicated'}], 'summary': "On admission:\n___ 08:50PM BLOOD WBC-7.5# RBC-3.89* Hgb-14.8 Hct-43.8\nMCV-112* MCH-38.0* MCHC-33.8 RDW-13.4 Plt ___\n___ 08:50PM BLOOD Neuts-71.2* ___ Monos-7.1 Eos-1.0\nBaso-0.9\n___ 08:50PM BLOOD Glucose-110* UreaN-10 Creat-0.9 Na-135\nK-4.6 Cl-100 HCO3-21* AnGap-19\n___ 08:50PM BLOOD LD(LDH)-366*\n___ 08:30PM BLOOD Lactate-1.7 K-4.2\n\nOn discharge:\n___ 05:20AM BLOOD WBC-6.1 RBC-3.52* Hgb-13.1* Hct-40.5\nMCV-115* MCH-37.2* MCHC-32.3 RDW-13.6 Plt ___\n\nMICRO:\nBCX - pending at time of discharge\nStool culture negative\nCdiff negative\nLegionella - negative\nSputum - contaminated specimen, no rpt sent\nMr. ___ is a ___ yoM with HIV/HCV, COPD, and MMP, who presents\nwith fevers, cough, SOB, diarrhea, nausea and vomitting.\n\nPt was intially treated for a COPD exacerbatin with prednisone\nburst X 5 days, azithromycin, and nebulizers. Repeat CXR with\nlateral was obtained and showed a small wedge shaped infiltrate\nin the RLL consistent with PNA. Pt was started on levofloxacin.\nLegionella antigen returned negative. Sputum culture was\ncontiminated. Blood cultures were pending at time of discharge.\nPt discharged with nebulizer. Pt was exhibiting hypertension\nduring his hospitalization, thought to be secondary to steroid\nuse. However, he likely has an underlyign primary hypertension\nwhich should be assessed and treatment started.\n\nLeft leg had a flea bit with erythema, edema, and tenderness\nwhich resolved over the course of his hospitalization, possibly\nsecondary to levofloxacin.\n\nPt's diarrhea improved during the course of his hospitalization.\nWas thought to be secondary to his pulmonary illness. Stool\ncultures were negative.\n\nChronic pain from spinal stenosis persisted throughout his\nhospitalization. Pt requesting extra medications, particularly\nintravenous narcotics. He was given small doses. He was\nprescribed 1 week worth of percocet for pain control to hold him\nover until his next PCP ___. However patient does not have a\nnarcotics contract with his PCP and would likely benefit from\none.\n\nHIV: CD4 ~900 in ___. He was continued on his home regimen.\n- continue regimen of efavirenz, combivir, tenofovir"}}
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{'final_diagnoses': ['COPD', 'community acquired pneumonia', 'flea bite', 'spinal stenosis', 'HIV'], 'procedures': ['none'], 'visit_summary': "Mr. ___ is a ___ yoM with HIV/HCV, COPD, and MMP, who presents\nwith fevers, cough, SOB, diarrhea, nausea and vomitting.\n\nPt was intially treated for a COPD exacerbatin with prednisone\nburst X 5 days, azithromycin, and nebulizers. Repeat CXR with\nlateral was obtained and showed a small wedge shaped infiltrate\nin the RLL consistent with PNA. Pt was started on levofloxacin.\nLegionella antigen returned negative. Sputum culture was\ncontiminated. Blood cultures were pending at time of discharge.\nPt discharged with nebulizer. Pt was exhibiting hypertension\nduring his hospitalization, thought to be secondary to steroid\nuse. However, he likely has an underlyign primary hypertension\nwhich should be assessed and treatment started.\n\nLeft leg had a flea bit with erythema, edema, and tenderness\nwhich resolved over the course of his hospitalization, possibly\nsecondary to levofloxacin.\n\nPt's diarrhea improved during the course of his hospitalization.\nWas thought to be secondary to his pulmonary illness. Stool\ncultures were negative.\n\nChronic pain from spinal stenosis persisted throughout his\nhospitalization. Pt requesting extra medications, particularly\nintravenous narcotics. He was given small doses. He was\nprescribed 1 week worth of percocet for pain control to hold him\nover until his next PCP ___. However patient does not have a\nnarcotics contract with his PCP and would likely benefit from\none.\n\nHIV: CD4 ~900 in ___. He was continued on his home regimen.\n- continue regimen of efavirenz, combivir, tenofovir", 'medications_prescribed': ['1. Guaifenesin 100 mg/5 mL Syrup Sig: ___ MLs PO Q6H (every 6\nhours).', '2. Fluticasone-Salmeterol 250-50 mcg/Dose Disk with Device Sig:\nOne (1) Disk with Device Inhalation BID (2 times a day).\nDisp:*2 Disk with Device(s)* Refills:*0*', '3. Levofloxacin 250 mg Tablet Sig: Three (3) Tablet PO DAILY\n(Daily) for 2 days.\nDisp:*6 Tablet(s)* Refills:*0*', '4. Thiamine HCl 100 mg Tablet Sig: One (1) Tablet PO DAILY\n(Daily).', '5. Pyridoxine 50 mg Tablet Sig: One (1) Tablet PO DAILY (Daily).', '6. Promethazine 25 mg Tablet Sig: One (1) Tablet PO Q6H (every 6\nhours) as needed for nausea.', '7. Tenofovir Disoproxil Fumarate 300 mg Tablet Sig: One (1)\nTablet PO DAILY (Daily).', '8. Citalopram 20 mg Tablet Sig: Two (2) Tablet PO DAILY (Daily).', '9. Gabapentin 300 mg Capsule Sig: Two (2) Capsule PO TID (3\ntimes a day).', '10. Lamivudine-Zidovudine 150-300 mg Tablet Sig: One (1) Tablet\nPO BID (2 times a day).', '11. Methadone 10 mg Tablet Sig: Fifteen (15) Tablet PO DAILY\n(Daily).', '12. Oxycodone 40 mg Tablet Sustained Release 12 hr Sig: One (1)\nTablet Sustained Release 12 hr PO QID (4 times a day).', '13. Efavirenz 600 mg Tablet Sig: One (1) Tablet PO DAILY\n(Daily).', '14. Oxycodone-Acetaminophen ___ mg Tablet Sig: ___ Tablets PO\nQ6H (every 6 hours) as needed for pain.', '15. Nebulizer\nPlease dispense one nebulizer', '16. Ipratropium Bromide 0.02 % Solution Sig: One (1) nebulizer\nInhalation Q6H (every 6 hours).\nDisp:*30 vials* Refills:*0*', '17. Albuterol Sulfate 2.5 mg /3 mL (0.083 %) Solution for\nNebulization Sig: One (1) nebulizer Inhalation Q2H (every 2\nhours) as needed for sob/wheeze.\nDisp:*30 nebulizer* Refills:*0*', '18. Albuterol Sulfate 90 mcg/Actuation HFA Aerosol Inhaler Sig:\n___ puffs Inhalation four times a day as needed for shortness of\nbreath or wheezing.\nDisp:*1 inhalers* 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': 'F', 'symptoms': 'Hypernatremia', 'medical_history': ['- INFECTION RISK: NEEDS ETHANOL LOCK ON ADMISSION FOR ___. \nGO TO MEDICATIONS-> SEARCH ETHANOL-> 70% ETHANOL', '- Congenital intestinal pseudoobstruction s/p multiple bowel \nresections including partial colectomy', '- small bowel transplant x2 (___), both complicated \nby rejection, s/p removal ___', '- G-tube ___, used for venting only (any po intake exits via \nG-tube)', '- s/p G-tube resiting in ___', '- MRSA catheter tip infection ___', '- V. fib arrest in ___, s/p ICD placement', '- MRSA septicemia ___ ICD pocket infection s/p device removal\n___ (wires left in place), course c/b hypoxic respiratory\nfailure due to multifocal aspiration pneumonia', '- MRSA septicemia ___ (tunneled line was replaced at this\ntime, no evidence of endocarditis on TEE during this admission,\ncardiac surgery did not wish to remove wires)', '- ___ ___', '- MRSA septicemia ___ (tunneled line was NOT replaced during \nthis admission)', '- RUE brachial DVT dx ___: planned lovenox 60mg BID x3\nmonths, pt refused injections', '- cirrhosis secondary to chronic TPN', '- PE in ___ (at ___)', '- s/p appendectomy', '- s/p cholecystectomy'], 'family_history': 'Sister, only sibling, is in good health.', 'present_illness': 'Mr. ___ is a ___ yo M with complicated PMH including \ncongential intestinal pseudoobstruction with failed intestinal \ntransplants and now dependent on TPN with G tube for venting and \nfeeding for comfort only and recent cellulitis of left hand s/p \ncompletion of daptomycin who presents from home because his \nweekly lab work noted elevated sodium. \nHe reports that he is feeling well. He has been getting 4L \nnormal saline through ___ daily and has been having the same \namount of urine output (actually urinary problems have improved \ndue to scheduled voids). He also has continued to eat for \ncomfort and the G tube is working fine, although he notes that \nthe output has been slightly more in the past few days which he \nthinks is causing the dehydration. No problems with the \n___--pain at the site where it tunnels under the clavicle is \npersistent since it was placed, no problems flushing or \ninfusing, still using the ethanol locks at home. His left \nthumb/wrist is improved swelling and redness, now only painful \nwhen he moves the thumb, completed the course of daptomycin \nwithout problems.', 'medications': [{'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', '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': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Morphine Sulfate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q2H: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': 'HydrALAzine', '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': 'OxycoDONE (Immediate Release) ', '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': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PR', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': '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': 'Clopidogrel', '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': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}]}, 'clinical_findings': {'labs': [{'value': '32.4', 'valuenum': 32.4, 'valueuom': '%', 'ref_range_lower': 36.0, 'ref_range_upper': 48.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '11.0', 'valuenum': 11.0, 'valueuom': 'g/dL', 'ref_range_lower': 12.0, 'ref_range_upper': 16.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, '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': '185', 'valuenum': 185.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.55', 'valuenum': 3.55, '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': '11', 'valuenum': 11.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28', 'valuenum': 28.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, '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': 0.4, '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 = 73 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': 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': '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': '5.2', 'valuenum': 5.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '3.8', 'valuenum': 3.8, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.1', 'valuenum': 1.1, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 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': '30.8', 'valuenum': 30.8, 'valueuom': 'pg', 'ref_range_lower': 27.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, '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': '202', 'valuenum': 202.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 440.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '13.3', 'valuenum': 13.3, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.82', 'valuenum': 3.82, 'valueuom': 'm/uL', 'ref_range_lower': 4.2, 'ref_range_upper': 5.4, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '7.0', 'valuenum': 7.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 11.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '9.1', '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': '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': 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': '2.2', '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': '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': '137', 'valuenum': 137.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12', 'valuenum': 12.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'ADMISSION PHYSICAL EXAM: \nVS: 98.7, 98/65, 92, 16, 100% RA \nGENERAL: well appearing, NAD, less cachectic and depressed than \nprior known to this resident \nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM \nNECK: supple, no JVD \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored, \nno accessory muscle use \nHEART: RRR, no MRG, nl S1-S2 \nABDOMEN: very thin with multiple scars on abdomen and G tube \nsite without leakage or excoriations, NABS, soft/NT/ND, no \nmasses or HSM, no rebound/guarding \nEXTREMITIES: WWP, no edema bilaterally in lower extremities, no \nerythema, induration, or swelling of left wrist/thumb and full \nrange of motion of all joints \nNEURO: awake, A&Ox3, CNs II-XII grossly intact, muscle strength \n___ throughout, sensation grossly intact throughout\n\nDISCHARGE PHYSICAL EXAM: \nVS: 98.8 ___ 18 100%RA\nGENERAL: moderate distress, cachetic\nHEENT: NC/AT, PERRLA, EOMI, sclerae anicteric, MMM. Broken tooth \nin bottom left of mouth \nNECK: supple, no JVD \nLUNGS: CTA bilat, no r/rh/wh, good air movement, resp unlabored, \nno accessory muscle use. Tunneled catheter tender c/d/i \nHEART: RRR, no MRG, nl S1-S2 \nABDOMEN: very thin with multiple scars on scaphoid abdomen and G \ntube site without leakage or excoriations, NABS, soft/NT/ND, no \nmasses or HSM, no rebound/guarding \nEXTREMITIES: WWP, no edema bilaterally in lower extremities. \nPossible splinter hemorrhages in R middle finger\nNEURO: awake, A&Ox3, CNs II-XII grossly intact', 'diagnoses': [{'icd_code': '4373', 'desc': 'Cerebral aneurysm, nonruptured'}, {'icd_code': '25000', 'desc': 'Diabetes mellitus without mention of complication, type II or unspecified type, not stated as uncontrolled'}, {'icd_code': '34690', 'desc': 'Migraine, unspecified, without mention of intractable migraine without mention of status migrainosus'}, {'icd_code': 'V1083', 'desc': 'Personal history of other malignant neoplasm of skin'}, {'icd_code': 'V1582', 'desc': 'Personal history of tobacco use'}, {'icd_code': 'V5867', 'desc': 'Long-term (current) use of insulin'}], 'summary': "ADMISSION:\n___ 10:10PM BLOOD WBC-2.7* RBC-5.00# Hgb-10.4*# Hct-34.0*# \nMCV-68* MCH-20.7* MCHC-30.5* RDW-17.8* Plt Ct-84*\n___ 10:10PM BLOOD Plt Ct-84*\n___ 10:10PM BLOOD Glucose-88 UreaN-27* Creat-0.7 Na-149* \nK-4.3 Cl-103 HCO3-34* AnGap-16\n___ 06:15AM BLOOD ALT-58* AST-53* AlkPhos-329* TotBili-2.9*\n___ 10:10PM BLOOD Calcium-9.3 Phos-3.9 Mg-2.0\n___ 04:42AM BLOOD calTIBC-165* Ferritn-969* TRF-127*\n___ 06:15AM BLOOD FATTY ACIDS PROFILE, ESSENTIAL-PND\n\nMICRO:\n___\n STAPH AUREUS COAG +. \n STAPH AUREUS COAG +\n | \nOXACILLIN------------- R\n\n Aerobic Bottle Gram Stain (Final ___: \n THIS IS A CORRECTED REPORT ___. \n GRAM POSITIVE COCCI IN CLUSTERS. \n GRAM POSITIVE COCCI IN CHAINS. \n Reported to and read back by ___ AT 11:30AM ON \n___. \n PREVIOUSLY REPORTED WITHOUT GRAM POSITIVE COCCI IN \nCHAINS. \n ORIGINALLY Reported to and read back by ___ AT \n10:20AM ON\n Anaerobic Bottle Gram Stain (Final ___: \n GRAM POSITIVE COCCI IN PAIRS AND CLUSTERS. \n\n___ BCx Negatavive:\n___ BCx negative\n___ BCx pending:\n\nIMAGING:\nSuboptimal image quality. The left atrium is normal in size. \nLeft ventricular wall thicknesses are normal. The left \nventricular cavity size is normal. Due to suboptimal technical \nquality, a focal wall motion abnormality cannot be fully \nexcluded. Overall left ventricular systolic function is mildly \ndepressed (LVEF ? 45 %). Right ventricular chamber size and free \nwall motion are normal. The aortic valve is not well seen. There \nis no aortic valve stenosis. No aortic regurgitation is seen. \nThe mitral valve appears structurally normal with trivial mitral \nregurgitation. There is no mitral valve prolapse. Mild (1+) \nmitral regurgitation is seen. The estimated pulmonary artery \nsystolic pressure is normal. There is no pericardial effusion.\n\nCompared with the findings of the prior study (images reviewed) \nof ___, no gross changes, but the technically \nsuboptimal nature of both studies precludes definitve \ncomparison.\n\nIMPRESSION: Suboptimal image quality. No definite vegetations \nseen.\n\nDISCHARGE LABS:\n___ 06:00AM BLOOD WBC-1.3* RBC-3.32* Hgb-6.8* Hct-22.7* \nMCV-69* MCH-20.4* MCHC-29.8* RDW-17.9* Plt Ct-56*\n___ 06:00AM BLOOD Neuts-45.8* Lymphs-48.8* Monos-3.5 \nEos-1.5 Baso-0.5\n___ 06:00AM BLOOD Glucose-102* UreaN-19 Creat-0.5 Na-136 \nK-3.6 Cl-105 HCO3-27 AnGap-8\n___ 06:07AM BLOOD ALT-59* AST-80* AlkPhos-476* TotBili-2.2*\n___ 06:00AM BLOOD CK(CPK)-15*\n___ 06:00AM BLOOD Calcium-8.0* Phos-3.4 Mg-1.7\n___ 04:42AM BLOOD calTIBC-165* Ferritn-969* TRF-127*\n\nFATTY ACIDS PROFILE, ESSENTIAL\nTest Name Flag Results Units \nReference Values\n--------- ---- ------- ----- \n----------------\nFatty Acid Profile, Essential,S \n Lauric Acid, C12:0 7 nmol/mL \n___\n Myristic Acid, C14:0 55 nmol/mL \n___\n Hexadecenoic Acid, C16:1w9 30 nmol/mL \n___\n Palmitoleic Acid, C16:1w7 233 nmol/mL \n___\n Palmitic Acid, C16:0 L 1475 nmol/mL \n1480-3730\n g-Linolenic Acid, C18:3w6 20 nmol/mL \n___\n a-Linolenic Acid, C18:3w3 L 3 nmol/mL \n50-130\n Linoleic Acid, C18:2w6 L 355 nmol/mL \n2270-3850\n Oleic Acid, C18:1w9 1218 nmol/mL \n___\n Vaccenic Acid, C18:1w7 L 230 nmol/mL \n280-740\n Stearic Acid, C18:0 L 485 nmol/mL \n___\n EPA, C20:5w3 L 8 nmol/mL \n___\n Arachidonic Acid, C20:4w6 L 370 nmol/mL \n___\n Mead Acid, C20:3w9 H 58 nmol/mL \n___\n h-g-Linolenic C20:3w6 L 47 nmol/mL \n50-250 \n Arachidic Acid, C20:0 L 14 nmol/mL \n___\n DHA, C22:6w3 40 nmol/mL \n___\n DPA, C22:5w6 52 nmol/mL \n___\n DPA, C22:5w3 L 18 nmol/mL \n___\n DTA, C22:4w6 28 nmol/mL \n___\n Docosenoic Acid, C22:1 5 nmol/mL \n___\n Nervonic Acid, C24:1w9 L 50 nmol/mL \n60-100\n Triene Tetraene Ratio H 0.157 \n0.010-0.038\n Total Saturated Acid L 2.1 nmol/mL \n2.5-5.5\n Total Monounsaturatd Acid 1.8 nmol/mL \n1.3-5.8\n Total Polyunsaturated Acid L 1.0 nmol/mL \n3.2-5.8\n Total w3 L 0.1 nmol/mL \n0.2-0.5\n Total w6 L 0.9 nmol/mL \n3.0-5.4\n Total Fatty Acids L 4.9 nmol/mL \n7.3-16.8\n \n Interpretation\n -------------- \n In this sample, the concentrations of linoleic and \nalpha-linolenic acids\n were reduced; the triene/tetraene ratio was elevated. These \nfindings are\n suggestive of a nutritional deficiency of essential fatty \nacids.\n Gas Chromatography-Mass Spectrometry (GC-MS) Stable Isotope \nDilution Analysis.\n___ yo M with congential intestinal pseudoobstruction s/p failed \ntransplants now dependent on TPN with G tube for comfort \npresents with hypernatremia and elevated BUN and found to have \ntunneled line culture positive.\n\nACTIVE ISSUES:\n# Tunnelled ___'s +: patient reports no worsening \nredness or erythema although it does chronically hurt. Drew \ncultures with subjective chills and leukopenia. ___ positive for \nGPC's in catheter but not peripherally. There were extensive \ndiscussions with ID, Surgery, the venous access team, \nInterventional Radiology. It is clear that it would be ideal if \nline could be removed to allow clearance of infection, however, \ngiven the patient's extremely difficult anatomy, it is doubtful \nthat new access could be obtained. Patient dependent on access \nfor nutritional/hydration support. He was switched from \nVancomycin to Daptomycin given progressive neutropenia. Patient \nwas placed on Ethanol locks for management of his tunneled line \nwhich need to be ordered immediately upon every admission. TTE \nprior to discharge did not show a vegetation. Patient was \ndischarged on Daptomycin.\n\n# Pancytopenia: pt with pancytopenia at baseline thought to be \nsecondary to hypersplenism and Linezolid. Only symptoms of \nanemia would be fatigue. Patient also has thalasemia \ncontributing to anemia. Patient had progressive leukopenia that \nprogressed to neutropenia. Vancomycin was thought to contribute \nto this and patient was discharged on Daptomycin with a stable \nWBC 1.4 with ANC ~600.\n \n# Congenital pseudo-obstruction: TPN dependent, eats for \npleasure \nwith venting. PEG site c/d/i. Continued on TPN and IVF regimen. \nPatient was found to have an Essential Fatty Acid Deficiency. \nNutrition recommended lipids added to TPN. Patient has had liver \nproblems previously with lipids and after touching base with Dr. \n___ GI doctor), this will be addressed as an \noutpatient. \n\n# Broken tooth: Patient reports due to his chronic admissions, \nhe never is able to follow up his dental issues. Panorex ordered \nbut dental consult not obtained prior to discharge. Patient has \nobvious dental issues with broken teeth in bottom left and right \nof mouth. No obvious signs of infection but potential nidus for \ninfection in the future. Patient should have dental/maxilofacial \nfollow up to have this taken care of as this is the main cause \nof his pain as well.\n\n# Hypernatremia: Patient initially admitted with hypernatremia. \nReports that he has been maintaining the same fluid infusions \n(4L NS per day) although he has slightly increased Gtube outpt \nrecently. Patient resolved over first 24hrs with free water \nrepletion and maintained Na with home dose of fluids. Total in \nand out (including G-tube) were measure daily and patient had \nappropriate fluid status. \n \n# chronic pain: from multiple surgeries plus teeth pain as well. \nPatient continued on home Fentanyl, IV Tylenol, and IV Dilaudid \n(initially avoided but added on cause felt patient's pain was \nreal). \n \nCHRONIC ISSUES:\n# s/p Vfib arrest: s/p ICD removal, leads in place with no \nevidence lead infection. Previous concern of lead infection.\n\nTRANSITIONAL ISSUES:\n- F/u for duration of Daptomycin tx\n- Discussion of whether patient should start on lipid \nreplacement due to EFAD\n- F/u with dental surgery for broken teeth"}}
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{'final_diagnoses': ['Hypernatremia', 'Methicillin Resistant Staphylcoccal Aureus', 'Chronic Total Parenteral Nutrition due to intestinal \npseudoobstruction'], 'procedures': ['None'], 'visit_summary': "___ yo M with congential intestinal pseudoobstruction s/p failed \ntransplants now dependent on TPN with G tube for comfort \npresents with hypernatremia and elevated BUN and found to have \ntunneled line culture positive.\n\nACTIVE ISSUES:\n# Tunnelled ___'s +: patient reports no worsening \nredness or erythema although it does chronically hurt. Drew \ncultures with subjective chills and leukopenia. ___ positive for \nGPC's in catheter but not peripherally. There were extensive \ndiscussions with ID, Surgery, the venous access team, \nInterventional Radiology. It is clear that it would be ideal if \nline could be removed to allow clearance of infection, however, \ngiven the patient's extremely difficult anatomy, it is doubtful \nthat new access could be obtained. Patient dependent on access \nfor nutritional/hydration support. He was switched from \nVancomycin to Daptomycin given progressive neutropenia. Patient \nwas placed on Ethanol locks for management of his tunneled line \nwhich need to be ordered immediately upon every admission. TTE \nprior to discharge did not show a vegetation. Patient was \ndischarged on Daptomycin.\n\n# Pancytopenia: pt with pancytopenia at baseline thought to be \nsecondary to hypersplenism and Linezolid. Only symptoms of \nanemia would be fatigue. Patient also has thalasemia \ncontributing to anemia. Patient had progressive leukopenia that \nprogressed to neutropenia. Vancomycin was thought to contribute \nto this and patient was discharged on Daptomycin with a stable \nWBC 1.4 with ANC ~600.\n \n# Congenital pseudo-obstruction: TPN dependent, eats for \npleasure \nwith venting. PEG site c/d/i. Continued on TPN and IVF regimen. \nPatient was found to have an Essential Fatty Acid Deficiency. \nNutrition recommended lipids added to TPN. Patient has had liver \nproblems previously with lipids and after touching base with Dr. \n___ GI doctor), this will be addressed as an \noutpatient. \n\n# Broken tooth: Patient reports due to his chronic admissions, \nhe never is able to follow up his dental issues. Panorex ordered \nbut dental consult not obtained prior to discharge. Patient has \nobvious dental issues with broken teeth in bottom left and right \nof mouth. No obvious signs of infection but potential nidus for \ninfection in the future. Patient should have dental/maxilofacial \nfollow up to have this taken care of as this is the main cause \nof his pain as well.\n\n# Hypernatremia: Patient initially admitted with hypernatremia. \nReports that he has been maintaining the same fluid infusions \n(4L NS per day) although he has slightly increased Gtube outpt \nrecently. Patient resolved over first 24hrs with free water \nrepletion and maintained Na with home dose of fluids. Total in \nand out (including G-tube) were measure daily and patient had \nappropriate fluid status. \n \n# chronic pain: from multiple surgeries plus teeth pain as well. \nPatient continued on home Fentanyl, IV Tylenol, and IV Dilaudid \n(initially avoided but added on cause felt patient's pain was \nreal). \n \nCHRONIC ISSUES:\n# s/p Vfib arrest: s/p ICD removal, leads in place with no \nevidence lead infection. Previous concern of lead infection.\n\nTRANSITIONAL ISSUES:\n- F/u for duration of Daptomycin tx\n- Discussion of whether patient should start on lipid \nreplacement due to EFAD\n- F/u with dental surgery for broken teeth", 'medications_prescribed': ['Resume TPN\nOk to resume TPN', 'Ethanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL \nDAILY', 'Medication\nEthanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL \nDAILY \nEthanol 70% Catheter DWELL (Tunneled Access Line) 2 mL DWELL \nDAILY Not for IV use. To be instilled into central catheter port \nfor local dwell. Right After TPN finishes in AM. Please leave in \nfor 1.5-2 hrs, then Aspirate and Flush with saline and heparin \nafterwards.', 'DiphenhydrAMINE ___ mg IV Q6H:PRN sleep/itch', 'Fentanyl Patch 100 mcg/h TP Q72H', 'Lorazepam 1 mg IV HS:PRN sleep', 'Pantoprazole 80 mg IV Q24H', 'Daptomycin 300 mg IV Q24H \nRX *daptomycin [CUBICIN] 500 mg 300 mg(s) IV daily Disp #*42 \nUnit Refills:*0']}
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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': 'left sided chest pain and shortness of breath', 'medical_history': ['CARDIAC RISK FACTORS: +Diabetes (IDDM), Dyslipidemia, + \nHypertension', 'CARDIAC HISTORY:', '-CABG:', '*Anatomy:', '-PERCUTANEOUS CORONARY INTERVENTIONS:', '-PACING/ICD:', 'OTHER PAST MEDICAL HISTORY:', '- CVA, ?carotid a stenosis', '- ?blood clot spleen', '___ c/b ptx and sternal fx', 'hx of hysterectomy ___ years ago', 'R shoulder repair', 'surgery of 3 anal fistulas'], 'family_history': 'Mother had an MI in her ___ and died of a stroke. She has 2 \nsisters that died of a stroke.', 'present_illness': '___ with PMH CVA, HTN, IDDM, and prior ___ c/b ptx and \nsternal who was transferred from EMS from ___ for \nfurther evaluation of left sided CP and SOB.\n\nAbout four days ago she suffered a fall (which she believes is \nsecondary to her carotid stensosis), striking her right chest \nwall against the corner of a table. She has severe right-sided \nflank pain. Today she had worsening of her ongoing left-sided \nchest pain as well as shortness of breath, and presented to \n___. Left sided chest pain radiated to her left jaw \nand left arm intermittently for one week with associated nausea, \ndyspnea, and ___ edema. She had felt unwell for "weeks." She \nnotes she has had diffuse chest pain in the past for which she \nhas not seen a physician. Patient states that about ___ years ago \nshe had a cardiac MRI which showed \'narrowing of her arteries\' \nand she was referred for surgery (likely CABG) but did not keep \nher follow up. States that she has not seen a doctor since that \ntime. She has also had intermittent "racing of her heart for \nmonths" but palpitations are new. Regarding her falls, she notes \nthat she has been falling more freuqently than usual, \nnonmechanical falls. She states that she has not had associated \nbowel/bladder incontinence or syncope.\n\nAlso, patient notes she has not been taking her 80U humulin \n70/30 BID and has only been taking 20U humulin BID because of \nconcern that insulin will cause her to hav eweight gain.\n\nAt ___, she was found to be in atrial flutter with \n2:1 block and hypoxic to 89% on RA. She was initially provided \nwith full dose aspirin, diltiazem 15 mg IV x1. Her heart rate \nimproved however blood pressure dipped into the ___ systolic. \nShe was given a small bolus of IV fluid and started on a \ndiltiazem drip. Unfortunately again her blood pressure dipped, \nand the diltiazem drip was discontinued. She was subsequently \nloaded with digoxin 0.5 mg IV x1 followed by 0.25 mg IV x1. \nPatient did feel somewhat improved after these efforts. \nMagnesium found to be 1.5mg/dL which was subsequently replaced. \nA stat echocardiogram was performed by cardiology at outside \nhospital which showed focal inferior posterior wall hypokinesis. \nTroponin returned elevated 0.39. Patient referred further \ntertiary care evaluation.\n\nIn the ED, initial vitals were: 98.4 110 102/65 (systolics as \nlow as 90) 18 98% 3L Nasal Cannula in aflutter.\nLabs and imaging significant for troponin of 0.66, rose to 0.75; \nU/A with 40 ket and 1000 glc, OSH CT chest with right rib fx, \nand CXR with mild pulmonary edema.\n\nIn the ED pt received 6 units of Lispro, 1g ceftriaxone, 600mg \nibuprofen, 1g acetaminophen, 12.5mg po metoprolol, and was \nplaced on a heparin drip. She was also administered 250cc NS per \nhr and started on insulin drip 30 min prior to transfer.\n\nVitals prior to transfer were T98.4 HR110 BP102/65 18 98% 3L \nNasal Cannula \n\nPrior to transfer, Pain ___ 97/63 22 97% Nasal Cannula \nGlc 304\nUpon arrival to the floor, patient c/o of chest pain and \nnausea. She was given 1g tylenol, 2mg morphine, and 4mg zofran.', 'medications': [{'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrochlorothiazide', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Levothyroxine Sodium', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': None, 'proc_type': 'IV Large Volume', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PR', 'frequency': 'ONCE', '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': 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': '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': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'Meclizine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'TID: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': 'Tamsulosin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Lidocaine 5% Patch', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'TD', 'frequency': 'QAM', 'doses_per_24_hrs': 1.0}, {'medication': 'Heparin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lubiprostone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Lisinopril', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Atenolol', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'OLANZapine', '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/NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'NG', 'frequency': 'BID', 'doses_per_24_hrs': 2.0}, {'medication': 'TraZODone', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS:PRN', 'doses_per_24_hrs': None}, {'medication': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'BID:PRN', 'doses_per_24_hrs': None}, {'medication': 'DiphenhydrAMINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QHS: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': 'OLANZapine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'QHS', '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': 'Senna', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'NG', 'frequency': 'BID: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}]}, 'clinical_findings': {'labs': [{'value': '31.4', 'valuenum': 31.4, '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': '20.0', 'valuenum': 20.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', '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': '64', 'valuenum': 64.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.90', 'valuenum': 4.9, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '6.3', 'valuenum': 6.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, '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, 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'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '22', 'valuenum': 22.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, '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': '1.1', 'valuenum': 1.1, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '129', 'valuenum': 129.0, 'valueuom': 'ng/mL', 'ref_range_lower': 13.0, 'ref_range_upper': 150.0, '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': '181', 'valuenum': 181.0, 'valueuom': 'mg/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 200.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '115', 'valuenum': 115.0, 'valueuom': 'ug/dL', 'ref_range_lower': 30.0, 'ref_range_upper': 160.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '364', 'valuenum': 364.0, 'valueuom': 'ug/dL', 'ref_range_lower': 260.0, 'ref_range_upper': 470.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 379.0, 'valueuom': 'IU/L', 'ref_range_lower': 94.0, 'ref_range_upper': 250.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'SPECIMEN SLIGHTLY HEMOLYZED..'}, {'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': '2.5', 'valuenum': 2.5, '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': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '280', 'valuenum': 280.0, 'valueuom': 'mg/dL', 'ref_range_lower': 200.0, 'ref_range_upper': 360.0, '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': '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': '28.9', 'valuenum': 28.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'm/uL', 'ref_range_lower': 0.02, 'ref_range_upper': 0.1, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': '%', 'ref_range_lower': 0.4, 'ref_range_upper': 2.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'UNABLE TO REPORT.'}, {'value': None, 'valuenum': None, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': '___'}, {'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': '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': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.5', 'valuenum': 2.5, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.2', 'valuenum': 4.2, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '18', 'valuenum': 18.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, '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': '20.3', 'valuenum': 20.3, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '30.8', 'valuenum': 30.8, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '66', 'valuenum': 66.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': 'abnormal', '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': '15.8', 'valuenum': 15.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.69', 'valuenum': 4.69, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '5.0', 'valuenum': 5.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '35.9', 'valuenum': 35.9, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, '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': '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': '98', 'valuenum': 98.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.9', 'valuenum': 0.9, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 125.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'IF FASTING, 70-100 NORMAL, >125 PROVISIONAL DIABETES.'}, {'value': '1.9', 'valuenum': 1.9, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '133', 'valuenum': 133.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, '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': '11.9', 'valuenum': 11.9, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, '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}], 'exams': 'Admission Exam\n==============\nVS: T=98.6 BP=91/56 HR=115 RR=17 O2 sat= 98%3L NC\nGeneral: female lying in mild distress in bed, oriented x 3 \nHEENT: NCAT, dry mmm, OP clear\nNeck: JVP 8cm\nCV: irregularly irregular, no m/r/g\nLungs: ctab except crackles bases\nAbdomen: soft, nondistended, nontender, normoactive bowel \nsounds\nExt: no ___ edema\nNeuro: CNII-XII intact\nSkin: R sided bruising \n.\nDischarge Exam\n==============\nGeneral: Resting comfortably in bed, NAD, more alert and \nconversant\nHEENT: NCAT\nCV: regular rate rhythem, S1+S2+S4, nmr\nLungs: No anterior w/r/r, cannot participate in posterior exam\nAbdomen: soft, nondistended, nontender, normoactive bowel \nsounds\nExt: trace pitting edema in b/l ___ WWP, RUE with mild erythema \nfirm but improved\nNeuro: CN II-XII grossly intact, MAE spontaneously', 'diagnoses': [{'icd_code': 'E871', 'desc': 'Hypo-osmolality and hyponatremia'}, {'icd_code': 'N179', 'desc': 'Acute kidney failure, unspecified'}, {'icd_code': 'R45851', 'desc': 'Suicidal ideations'}, {'icd_code': 'I959', 'desc': 'Hypotension, unspecified'}, {'icd_code': 'Z6841', 'desc': 'Body mass index [BMI] 40.0-44.9, adult'}, {'icd_code': 'D649', 'desc': 'Anemia, unspecified'}, {'icd_code': 'I10', 'desc': 'Essential (primary) hypertension'}, {'icd_code': 'E02', 'desc': 'Subclinical iodine-deficiency hypothyroidism'}, {'icd_code': 'T502X5A', 'desc': 'Adverse effect of carbonic-anhydrase inhibitors, benzothiadiazides and other diuretics, initial encounter'}, {'icd_code': 'T464X5A', 'desc': 'Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter'}, {'icd_code': 'Z23', 'desc': 'Encounter for immunization'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'G4700', 'desc': 'Insomnia, unspecified'}, {'icd_code': 'E669', 'desc': 'Obesity, unspecified'}, {'icd_code': 'R42', 'desc': 'Dizziness and giddiness'}], 'summary': '___ 08:20PM BLOOD WBC-12.4* RBC-3.96* Hgb-11.5* Hct-34.8* \nMCV-88 MCH-29.0 MCHC-33.0 RDW-14.1 Plt ___\n___ 08:20PM BLOOD Neuts-91.1* Lymphs-4.7* Monos-3.6 Eos-0.6 \nBaso-0.1\n___ 08:20PM BLOOD ___ PTT-20.6* ___\n___ 08:20PM BLOOD Glucose-365* UreaN-19 Creat-0.6 Na-132* \nK-4.3 Cl-98 HCO3-17* AnGap-21*\n___ 08:20PM BLOOD ALT-25 AST-37 AlkPhos-107* TotBili-0.8\n___ 08:20PM BLOOD cTropnT-0.69* proBNP-6092*\n___ 08:20PM BLOOD Albumin-3.7 Calcium-8.8 Phos-3.4 Mg-2.4\n\nCardiac Biomarkers\n==================\n___ 08:20PM BLOOD cTropnT-0.69* proBNP-6092*\n___ 08:30PM BLOOD cTropnT-0.66* proBNP-5948*\n___ 02:15AM BLOOD CK-MB-24* MB Indx-10.8*\n___ 02:15AM BLOOD cTropnT-0.75*\n___ 08:00AM BLOOD CK-MB-28* MB Indx-10.9* cTropnT-1.03*\n___ 02:50PM BLOOD CK-MB-27* MB Indx-11.8* cTropnT-1.10*\n___ 08:12PM BLOOD CK-MB-30* MB Indx-13.4* cTropnT-1.04*\n___ 01:55AM BLOOD CK-MB-32* MB Indx-13.1* cTropnT-1.13*\n___ 03:48PM BLOOD CK-MB-43* cTropnT-2.40*\n___ 10:38PM BLOOD CK-MB-47* MB Indx-12.0* cTropnT-2.33*\n___ 04:52AM BLOOD CK-MB-40* MB Indx-15.5* cTropnT-1.89*\n___ 06:17AM BLOOD CK-MB-6 cTropnT-1.67*\n___ 04:40PM BLOOD CK-MB-5 cTropnT-1.76*\n___ 07:45PM BLOOD CK-MB-5 cTropnT-1.75*\n___ 04:55AM BLOOD CK-MB-4 cTropnT-1.75*\n___ 05:00PM BLOOD CK-MB-1 cTropnT-1.22*\n.\nMicro\n=====\n___ UCx pan-sensitive E. Coli\n___ MRSA neg\n___ Sputum Cx sparse yeast\n___ UCx ___ yeast\n___ BCx x2 negative\n___ BCx negative\n___ BCx negative\n.\nImaging\n=======\n___ EKG: Supraventricular tachycardia. Consider atrial flutter \nwith 2:1 block. Borderline intraventricular conduction delay. \nST-T wave abnormalities of intraventricular conduction delay \nand/or ischemia. Inferior Q waves. Consider inferior wall \nmyocardial infarction of indeterminate age. No previous tracing \navailable for comparison. \n.\n___ CXR: The heart is normal in size. The aortic arch shows \npatchy \ncalcification. There is a suspected small pleural effusion on \nthe left and a possible layering pleural effusion on the right. \nPulmonary architecture appears coarse and irregular. The \ninterstitium is also moderately prominent in the mid-to-lower \nlungs. There is no pneumothorax. Prior healed rib fractures \ninvolve the right posterior third through fifth ribs. The right \nacromioclavicular joint is widened and the distal right clavicle \nhas an expansile appearance. The latter findings are probably \nalso post-traumatic. \nIMPRESSION: Findings suggesting mild pulmonary edema, possibly \nsuperimposed on an underlying parenchymal abnormality. \n.\n___ TTE: The left atrium is mildly dilated. Left ventricular \nwall thicknesses are normal. The left ventricular cavity size is \nnormal. Overall left ventricular systolic function is moderately \ndepressed (LVEF = 35 %) secondary to akinesis of the inferior \nand posterior wall, and hypokinesis of the lateral wall and \napex. Tissue Doppler imaging suggests an increased left \nventricular filling pressure (PCWP>18mmHg). The right \nventricular free wall thickness is normal. Right ventricular \nchamber size is normal. with moderate global free wall \nhypokinesis. The aortic valve leaflets (3) are mildly thickened \nbut aortic stenosis is not present. No aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. Moderate \nto severe (3+) mitral regurgitation is seen. There is moderate \npulmonary artery systolic hypertension. There is no pericardial \neffusion. \n.\n___ Cardiac Cath: HEMODYNAMICS RESULTS BODY SURFACE AREA: 1.74 \nm2 \n HEMOGLOBIN: 11 gms % \n FICK \n**PRESSURES \nRIGHT ATRIUM {a/v/m} ___ \nRIGHT VENTRICLE {s/ed} ___ \nPULMONARY ARTERY {s/d/m} ___ \nPULMONARY WEDGE {a/v/m} 44/34/35 \nLEFT VENTRICLE {s/ed} ___ \nAORTA {s/d/m} 73/45/56 \n**CARDIAC OUTPUT \nHEART RATE {beats/min} 102 \nCARD. OP/IND FICK {l/mn/m2} 3.16/1.82 \n**% SATURATION DATA (NL) \nPA MAIN 51 \nAO 97 \n1. Selective coronary angiography of this right dominant system \ndemonstrated three-vessel coronary artery disease. The LMCA had \na 99% \nstenosis at the origin. The LAD had mild disease. The LCX had a \n70% mid \nstenosis. The RCA had a 50% stenosis at the origin and was \noccluded \ndistally. \n2. Resting hemodynamics revealed severely elevated left and \nright-sided \nfilling pressures with an RA pressure of 17 mmHg, mean PA \npressure of 39 \nmmHg, and PCWP and LVEDP of 35 mmHg. \n3. After coronary angiography revealed three vessel disease, an \nintra-aortic balloon pump was inserted but could not be started. \n\nSubsequently, the patient had a PEA arrest requiring CPR, \ntemporary \npacemaker insertion, LMCA stenting (with DES), and initiation of \nECMO. \n4. \nFINAL DIAGNOSIS: \n1. Three vessel coronary artery disease, cardiac arrest. \n2. Continue ECMO and remove in AM if patient is stable. \n3. Serial echocardiograms and diuresis. \n4. Inotropic support. \n.\n___ TTE: Mild spontaneous echo contrast throughout all chambers \nof the heart (moderate-severe in the proximal ascending aorta). \nNo atrial septal defect is seen by 2D or color Doppler. There is \nsevere global left ventricular hypokinesis (LVEF = ___ %). \nThere is no ventricular septal defect or left ventricular free \nwall rupture or papillary muscle rupture. Right ventricle with \nsevere global free wall hypokinesis (with worse function of the \nRV apex). The aortic valve is not well seen, but does not appear \nto be opening fully. Aortic regurgitation is present, but cannot \nbe quantified. The mitral valve leaflets are mildly thickened. \nThe mitral valve leaflets do not fully coapt. Severe (4+) mitral \nregurgitation is seen. Moderate [2+] tricuspid regurgitation is \nseen. The pulmonary artery systolic pressure could not be \ndetermined. There is no pericardial effusion. Well positioned \nECMO catheter seen in the right atrium.\nIMPRESSION: Severe biventricular global systolic dysfunction. No \nventricular septal defect. No ventricular free wall rupture. \nSevere functional mitral regurgitation. Incomplete opening of \nthe aortic valve during systole with moderate-severe SEC seen in \nthe ascending aorta. Well positioned ECMO catheter.\n.\n___ CXR: An enteric catheter courses below the left \nhemidiaphragm and out of view. A Swan-Ganz catheter is likely \npositioned within the main pulmonary artery. An inferior, \nlikely femoral approach, ECMO venous cannula terminates within \nthe distal superior vena cava rather than right atrium. No \ndefinite arterial cannula is identified suggesting this is \neither a ___ ECMO technique or there is renal arterial \nECMO access. Cardiomediastinal and hilar contours are not \nsignificantly changed compared to prior examination. There is \nstable if not slightly worsened pulmonary edema compared to ___, not an unexpected finding. However, there is a new \nretrocardiac opacification which may be due to a combination of \nedema, atelectasis and new small left pleural effusion. \nIMPRESSION: Appropriately positioned Swan-Ganz catheter and \nenteric catheter. Venous ECMO cannula appears to be positioned \nin the distal superior vena cava rather than right atrium. \nStable if not slightly increased pulmonary edema. New \nretrocardiac opacification, likely combination of atelectasis, \nedema and new small left pleural effusion. Please note a small \nhemothorax is a consideration given likely anticoagulant therapy \nor possibly ECMO-induced coagulopathy. \n.\n___ TTE: The left atrium is elongated. Left ventricular wall \nthicknesses and cavity size are normal. There is mild to \nmoderate regional left ventricular systolic dysfunction with \nakinesis of the inferior and inferolateral walls. The remaining \nsegments contract normally (LVEF = 35-40%). The right \nventricular cavity is mildly dilated with mild global free wall \nhypokinesis. The aortic valve leaflets (3) are mildly thickened \nbut aortic stenosis is not present. No aortic regurgitation is \nseen. The mitral valve leaflets are mildly thickened. An \neccentric, posteriorly-directed jet of moderate to severe (3+) \nmitral regurgitation is seen. The tricuspid valve leaflets are \nmildly thickened. There is mild pulmonary artery systolic \nhypertension. There is no pericardial effusion. \nIMPRESSION: Regional left ventricular systolic dysfunction, c/w \nPDA disease. Moderate to severe ischemic mitral regurgitation. \nMild pulmonary hypertension.\n.\n___ CXR: Interval removal of the nasogastric tube and \nendotracheal tube. The right internal jugular central line \ncontinues to have its tip in the pulmonary outflow tract. There \nis persistent layering left effusion with retrocardiac opacity \nmost likely reflecting compressive atelectasis, although \npneumonia cannot be entirely excluded. There is resolving mild \npulmonary and interstitial edema. No pneumothorax. Overall \ncardiac and mediastinal contours are unchanged. \n.\n___ RUE U/S: The left internal jugular and axillary veins are \npatent and \ncompressible with transducer pressure. There is normal flow \nwith respiratory variation in the bilateral subclavian veins. \nThe left brachial and basilic veins are patent and compressible \nwith transducer pressure and show normal color flow and \naugmentation. There is nearly completely occlusive thrombus in \nthe cephalic vein from the antecubital fossa to the mid arm. \nIMPRESSION: Nearly completely occlusive thrombus in the \ncephalic vein from the antecubital fossa to the mid arm.\nMs. ___ is a ___ y.o. woman with h/o IDDM presents with \nNSTEMI, new onset aflutter, and DKA, hospital course complicated \nby PEA arrest during cardiac cath with brief ECMO requirement \nand intubation, HCAP.\n\n# PEA arrest s/p cath and LMCA stenting, c/b ischemic mitral \nregurgitation: Pt presented with left-sided chest pain, nausea, \nelevated troponins, and TTE with focal inferior/posterior wall \nhypokinesis. Because her presentation was complicated by DKA \nshe was managed medically initially for NSTEMI. On night of HD1 \nshe had persistent nausea not managed by multiple antiemetics \n(which should now be considered her anginal equivalent) and \ncontinued troponin rise. She was urgently cathed on the morning \nof HD2 with findings as above, most notable for 99% left main \nstenosis. The LAD had mild disease. The LCX had a 70% mid \nstenosis. The RCA had a 50% stenosis at the origin and was \noccluded \ndistally. Her cath was complicated by PEA arrest in the setting \nof transient LAD flow interruption, and she received ~20 minutes \nof CPR with ROSC. The cath team managed to stent her left main \nwith DES and she was placed emergently on ECMO and supported \nwith low-dose levophed. This was gradually weaned over 24 hours \nas her cardiac function improved, with f/u TTE 48hrs post-arrest \nshowing only basal inferior akinesis and LVEF 35-40%, though \nwith severe ischemic mitral regurg. She was extubated on the \nnight of HD3. She was weaned off levophed transitioned onto \nafterload management with lasix and captopril, which were \ntitrated to swan-ganz numbers and UOP/BP. Additional medical \nmanagement for her NSTEMI was continued with ASA81, plavix, \nmetoprolol, and atorvastatin.\n.\n# Acute Systolic CHF (EF30%). The patient presented in \ncongestive heart failure which was likely triggered by her MI. \nAfter initial aggressive diuresis, patient was transitioned to \nlasix 80mg po daily. She was also maintained on lisinopril 10mg \ndaily, metop XL 75mg daily, and eplerenone 25mg po daily. \n.\n# Afib w/ RVR: On HD3 patient acutely entered afib w/ RVR, \nlikely precipitated by her critical illness. This was her first \nknown period in afib. She was IV amio loaded and transitioned \nto maintenance dosing, though this was discontinued as it became \napparent she was well-controlled on metoprolol. She \nsubsequently re-enter afib ___ days later for which she was \nrestarted on amiodarone and a heparin drip. She was transitioned \nto lovenox bridge and coumadin for anticoagulation. She was also \ndischarged on metoprolol XL as above.\n.\n# DKA: Though patient is historically a type II diabetic, she \nwas insulin-dependent prior to admission. She was initially \nmanaged with insulin and dextrose gtts, and with the assistance \nof our ___ transitioned to standing glargine with \na humolog sliding scale. Dextrose infusion was continued while \npatient had poor PO intake. Patient was effectively transitioned \nto long acting insulin and insulin sliding scale. She will need \nteaching regarding insulin control and use of sliding scale \ninsulin prior to discharge. \n.\n# Fevers: Patient began spiking fevers on afternoon of HD2. She \nhad been on mechanical ventilation <48hrs at the time but \npresented from and outside hospital and thus was started on \nempiric vanc/cefepime for HCAP coverage. Chest xray showed a \nretrocardiac opacity that could not be definitively ruled out \nfor pneumonia. Sputum, urine, and blood cultures were \nunrevealing. As she was MRSA negative, vancomycin was d/ced \nafter 72 hours and she was continued on a course of cefepime. \nCefipeme was subsequently discontinued quickly given low \nsuspicion for HCAP. \n.\n# LUE superficial thrombus: On HD4 patient developed \nthrombophlebitis of LUE, demonstrated to be in the cephalic \nvein. Given her high risk she was maintained on a heparin drip. \nAs described above, patient was transitioned to lovenox bridge \nand coumadin for anticoagulation for LUE thrombus and her atrial \nfibrillation.\n.\n# Acute anemia: Received a total of 4 units prbcs in the setting \nof blood loss from ECMO. H/H remained stable the remainder of \nher hospital stay. \n.\n# UTI: Stable. Completed a 5 day course of cefipeme for \npresumed HCAP above which also covered for her UTI.\n.\n# Right rib fx s/p fall: Stable. Pain was controlled with \noxycodone and lidocaine patch on discharge. \n.\n# ? Carotid artery stenosis: per patient hx. She has also had hx \nof basal ganglia stroke. Consider bilateral carotid u/s in the \noutpatient setting.\n.\n# Depression: Appears be long standing prior to admission. TSH \nnormal. Patient denied any suicidal or homicideal ideation \nduring hospitalization. Patient was started on sertraline.\n.\nTRANSITIONAL ISSUES\n- consider bilateral carotid u/s in the outpatient setting for \nhx of carotid artery stenosis\n- amiodarone dosing and tapering: as of ___: had 3.5 grams, \ncont amiodarone 400 mg daily for 10 more days, then decrease to \n200 mg daily on ___ for total of 7.5 grams load. \n- consider xarelto instead of coumadin for anticoagulation in \nthe future - patient is known to have poor medication compliance \n\n- adjust antidepressants (sertraline) accordingly \n\nCommunication: HCP ___ ___\nCode status: DNR/DNI, no mechanical support'}}
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{'final_diagnoses': ['ST elevation myocardial infarction', 'Left cephalic vein thrombus', 'Diabetic Ketoacidosis', 'Atrial fibrillation', 'Coronary artery disease', 'PEA arrest', 'Anemia', 'Urinary tract infection', 'Hypertension', 'Sacral ulcer'], 'procedures': ['Cardiac catheterization', 'Mechanical Intubation', 'Extracorporeal membrane oxygenation'], 'visit_summary': 'Ms. ___ is a ___ y.o. woman with h/o IDDM presents with \nNSTEMI, new onset aflutter, and DKA, hospital course complicated \nby PEA arrest during cardiac cath with brief ECMO requirement \nand intubation, HCAP.\n\n# PEA arrest s/p cath and LMCA stenting, c/b ischemic mitral \nregurgitation: Pt presented with left-sided chest pain, nausea, \nelevated troponins, and TTE with focal inferior/posterior wall \nhypokinesis. Because her presentation was complicated by DKA \nshe was managed medically initially for NSTEMI. On night of HD1 \nshe had persistent nausea not managed by multiple antiemetics \n(which should now be considered her anginal equivalent) and \ncontinued troponin rise. She was urgently cathed on the morning \nof HD2 with findings as above, most notable for 99% left main \nstenosis. The LAD had mild disease. The LCX had a 70% mid \nstenosis. The RCA had a 50% stenosis at the origin and was \noccluded \ndistally. Her cath was complicated by PEA arrest in the setting \nof transient LAD flow interruption, and she received ~20 minutes \nof CPR with ROSC. The cath team managed to stent her left main \nwith DES and she was placed emergently on ECMO and supported \nwith low-dose levophed. This was gradually weaned over 24 hours \nas her cardiac function improved, with f/u TTE 48hrs post-arrest \nshowing only basal inferior akinesis and LVEF 35-40%, though \nwith severe ischemic mitral regurg. She was extubated on the \nnight of HD3. She was weaned off levophed transitioned onto \nafterload management with lasix and captopril, which were \ntitrated to swan-ganz numbers and UOP/BP. Additional medical \nmanagement for her NSTEMI was continued with ASA81, plavix, \nmetoprolol, and atorvastatin.\n.\n# Acute Systolic CHF (EF30%). The patient presented in \ncongestive heart failure which was likely triggered by her MI. \nAfter initial aggressive diuresis, patient was transitioned to \nlasix 80mg po daily. She was also maintained on lisinopril 10mg \ndaily, metop XL 75mg daily, and eplerenone 25mg po daily. \n.\n# Afib w/ RVR: On HD3 patient acutely entered afib w/ RVR, \nlikely precipitated by her critical illness. This was her first \nknown period in afib. She was IV amio loaded and transitioned \nto maintenance dosing, though this was discontinued as it became \napparent she was well-controlled on metoprolol. She \nsubsequently re-enter afib ___ days later for which she was \nrestarted on amiodarone and a heparin drip. She was transitioned \nto lovenox bridge and coumadin for anticoagulation. She was also \ndischarged on metoprolol XL as above.\n.\n# DKA: Though patient is historically a type II diabetic, she \nwas insulin-dependent prior to admission. She was initially \nmanaged with insulin and dextrose gtts, and with the assistance \nof our ___ transitioned to standing glargine with \na humolog sliding scale. Dextrose infusion was continued while \npatient had poor PO intake. Patient was effectively transitioned \nto long acting insulin and insulin sliding scale. She will need \nteaching regarding insulin control and use of sliding scale \ninsulin prior to discharge. \n.\n# Fevers: Patient began spiking fevers on afternoon of HD2. She \nhad been on mechanical ventilation <48hrs at the time but \npresented from and outside hospital and thus was started on \nempiric vanc/cefepime for HCAP coverage. Chest xray showed a \nretrocardiac opacity that could not be definitively ruled out \nfor pneumonia. Sputum, urine, and blood cultures were \nunrevealing. As she was MRSA negative, vancomycin was d/ced \nafter 72 hours and she was continued on a course of cefepime. \nCefipeme was subsequently discontinued quickly given low \nsuspicion for HCAP. \n.\n# LUE superficial thrombus: On HD4 patient developed \nthrombophlebitis of LUE, demonstrated to be in the cephalic \nvein. Given her high risk she was maintained on a heparin drip. \nAs described above, patient was transitioned to lovenox bridge \nand coumadin for anticoagulation for LUE thrombus and her atrial \nfibrillation.\n.\n# Acute anemia: Received a total of 4 units prbcs in the setting \nof blood loss from ECMO. H/H remained stable the remainder of \nher hospital stay. \n.\n# UTI: Stable. Completed a 5 day course of cefipeme for \npresumed HCAP above which also covered for her UTI.\n.\n# Right rib fx s/p fall: Stable. Pain was controlled with \noxycodone and lidocaine patch on discharge. \n.\n# ? Carotid artery stenosis: per patient hx. She has also had hx \nof basal ganglia stroke. Consider bilateral carotid u/s in the \noutpatient setting.\n.\n# Depression: Appears be long standing prior to admission. TSH \nnormal. Patient denied any suicidal or homicideal ideation \nduring hospitalization. Patient was started on sertraline.\n.\nTRANSITIONAL ISSUES\n- consider bilateral carotid u/s in the outpatient setting for \nhx of carotid artery stenosis\n- amiodarone dosing and tapering: as of ___: had 3.5 grams, \ncont amiodarone 400 mg daily for 10 more days, then decrease to \n200 mg daily on ___ for total of 7.5 grams load. \n- consider xarelto instead of coumadin for anticoagulation in \nthe future - patient is known to have poor medication compliance \n\n- adjust antidepressants (sertraline) accordingly \n\nCommunication: HCP ___ ___\nCode status: DNR/DNI, no mechanical support', 'medications_prescribed': ['Aspirin 81 mg PO DAILY \ndo not stop taking this medicine unless Dr. ___ \nthat it is Ok to do so.', 'Acetaminophen 500 mg PO Q4H:PRN breakthrough pain', 'Amiodarone 400 mg PO DAILY \nchange to 200 mg daily on ___. Atorvastatin 80 mg PO DAILY', 'Clopidogrel 75 mg PO DAILY \ndo not stop taking this medicine unless Dr. ___ \nthat it is Ok to do so.', 'Docusate Sodium 100 mg PO BID', 'Enoxaparin Sodium 60 mg SC BID \nStart: Today - ___, First Dose: Next Routine Administration \nTime', 'Eplerenone 25 mg PO DAILY', 'Furosemide 80 mg PO DAILY', 'Glargine 35 Units Lunch\nInsulin SC Sliding Scale using HUM Insulin', 'Lidocaine 5% Patch 1 PTCH TD QAM', 'Lisinopril 10 mg PO DAILY', 'Metoprolol Succinate XL 75 mg PO DAILY', 'OxycoDONE (Immediate Release) ___ mg PO Q2H:PRN pain', 'Pantoprazole 40 mg PO Q24H', 'Senna 8.6 mg PO BID constipation', 'Sertraline 50 mg PO DAILY', 'Warfarin 3 mg PO DAILY16']}
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Generate a treatment plan with clinical reasoning for this case:
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{'patient_profile': {'age': 60, 'gender': 'F', 'symptoms': 'Trauma: gunshot wound to face', 'medical_history': ['unknown'], 'family_history': 'unknown', 'present_illness': '___ Y/o female with no known ___ transferred from ___ for GSW to the face. Per EMS report, was at home\nwith her boyfriend when the two engaged in an argument and\nhe shot a gun at the patient from above her head. On arrival\nto OSH, patient was awake and able to verbalize history.\nNoted to have wounds at the left nasal bridge and swelling\nto the right mandibular fossa. Underwent CT imaging which\ndemonstrated a bullet in the thoracic inlet, marked neck\nswelling. Was intubated prior to transfer with etomidate and\nsuccinylcholine, first attempt, no complications. No lab\nresults at this time. The patient was paralyzed with\nvecuronium for transfer but noted to be moving all\nextremities spontaneously prior to intubation. Received\nAncef and TDap.', 'medications': [{'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q6H', 'doses_per_24_hrs': 4.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', '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': 'Isosorbide Mononitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'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': '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': 'Q2H:PRN', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', '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': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Isosorbide Dinitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'TID', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', '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': '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': 'Expired', 'route': 'PO', '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': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Isosorbide Mononitrate (Extended Release)', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Magnesium Sulfate', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'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': 'Influenza Vaccine Quadrivalent', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'NOW X1', 'doses_per_24_hrs': 0.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'LORazepam', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', '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}, {'medication': 'NiCARdipine', 'proc_type': 'IV Piggyback', 'status': 'Discontinued via patient discharge', 'route': 'IV DRIP', 'frequency': 'TITRATE TO', 'doses_per_24_hrs': None}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Expired', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'CefTRIAXone', 'proc_type': 'IV Piggyback', 'status': 'Expired', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Aspirin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Succinate XL', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucose Gel', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'PRN', 'doses_per_24_hrs': None}, {'medication': 'Bisacodyl', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY:PRN', 'doses_per_24_hrs': None}, {'medication': 'Glucagon', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IM', 'frequency': 'Q15MIN:PRN', 'doses_per_24_hrs': None}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'ASDIR', 'doses_per_24_hrs': None}, {'medication': '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': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'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': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Metoprolol Tartrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'BREAKFAST', 'doses_per_24_hrs': 1.0}, {'medication': 'Sodium Chloride 0.9% Flush', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Losartan Potassium', 'proc_type': 'Unit Dose', 'status': 'Discontinued', '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': 'QHS', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SC', 'frequency': 'HS', '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': 'Dextrose 50%', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'IV', 'frequency': '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'IV', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'Q8H', 'doses_per_24_hrs': 3.0}, {'medication': 'DULoxetine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Acetaminophen', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', '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': 'Nitroglycerin SL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'SL', 'frequency': 'Q5MIN: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': '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': 'Isosorbide Mononitrate', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'ONCE', 'doses_per_24_hrs': 1.0}, {'medication': 'Atorvastatin', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'QPM', 'doses_per_24_hrs': 1.0}, {'medication': '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': 'Insulin', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'SC', 'frequency': 'HS', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorthalidone', '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': 'HydrALAZINE', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'IV', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': None}, {'medication': 'Hydrocortisone', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', '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': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', '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': 'Metoprolol Succinate XL', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Pseudoephedrine', 'proc_type': 'Unit Dose', 'status': 'Discontinued', 'route': 'PO', 'frequency': 'Q6H:PRN', 'doses_per_24_hrs': 0.0}, {'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': 'Chlorthalidone', 'proc_type': 'Unit Dose', 'status': 'Inactive (Due to a change order)', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'amLODIPine', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO/NG', 'frequency': 'DAILY', 'doses_per_24_hrs': 1.0}, {'medication': 'Omeprazole', 'proc_type': 'Unit Dose', 'status': 'Discontinued via patient discharge', 'route': 'PO', 'frequency': 'DAILY', '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}]}, 'clinical_findings': {'labs': [{'value': '35.7', 'valuenum': 35.7, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.5', 'valuenum': 32.5, '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': '282', 'valuenum': 282.0, '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': '4.07', 'valuenum': 4.07, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.5', 'valuenum': 10.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '43.2', 'valuenum': 43.2, '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': '11.6', 'valuenum': 11.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '19', 'valuenum': 19.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '24', 'valuenum': 24.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': 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 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 250.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '7', 'valuenum': 7.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '2.4', 'valuenum': 2.4, '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': 3.3, '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': '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', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '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': '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': 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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 47.0, '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': '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': 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': '___', 'valuenum': 55.0, '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': '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': '___', '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.0', 'valuenum': 33.0, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '10.7', 'valuenum': 10.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'STAT', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '32.4', 'valuenum': 32.4, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '90', 'valuenum': 90.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '256', 'valuenum': 256.0, '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': '3.67', 'valuenum': 3.67, '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': '46.3', 'valuenum': 46.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '14', 'valuenum': 14.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.9', 'valuenum': 8.9, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 19.9, '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': 45.0, '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': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 145.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '0', 'valuenum': 0.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '3.2', 'valuenum': 3.2, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.3', 'valuenum': 4.3, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '145', 'valuenum': 145.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '___', 'valuenum': 0.04, 'valueuom': 'ng/mL', 'ref_range_lower': 0.0, 'ref_range_upper': 0.01, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'cTropnT > 0.10 ng/mL suggests Acute MI.'}, {'value': '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': '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': '31.9', 'valuenum': 31.9, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': '8.7', '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': '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': 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', 'valuenum': 2.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.1', 'valuenum': 2.1, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.3', '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': '145', 'valuenum': 145.0, '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': '6', 'valuenum': 6.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '34.9', 'valuenum': 34.9, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.4', 'valuenum': 11.4, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.4', 'valuenum': 28.4, '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': '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': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.5', 'valuenum': 13.5, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.02', 'valuenum': 4.02, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '8.5', 'valuenum': 8.5, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': 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': '150', 'valuenum': 150.0, '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': '1.012', 'valuenum': 1.012, 'valueuom': ' ', 'ref_range_lower': 1.001, 'ref_range_upper': 1.035, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Clear.'}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': 'Straw.'}, {'value': None, 'valuenum': None, 'valueuom': 'mg/dL', 'ref_range_lower': 0.2, 'ref_range_upper': 1.0, 'flag': None, 'priority': 'STAT', 'comments': 'NEG.'}, {'value': '150', 'valuenum': 150.0, 'valueuom': 'mEq/L', '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': '491', 'valuenum': 491.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '158', 'valuenum': 158.0, 'valueuom': 'mEq/L', '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': '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': '105', 'valuenum': 105.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.6', 'valuenum': 0.6, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 172.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '2', '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.0', 'valuenum': 3.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.6', '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': '11', 'valuenum': 11.0, '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': '33.1', 'valuenum': 33.1, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '10.8', 'valuenum': 10.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, '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': '13.6', 'valuenum': 13.6, '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': 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': '41.7', 'valuenum': 41.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '1.0', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': 0.9, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'sec', 'ref_range_lower': 9.4, 'ref_range_upper': 12.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '31.0', 'valuenum': 31.0, 'valueuom': 'sec', 'ref_range_lower': 25.0, 'ref_range_upper': 36.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 7.5, 'valueuom': '%', 'ref_range_lower': 4.0, 'ref_range_upper': 6.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'ADA recommendations:. <7% goal of therapy. >8% warrants therapeutic action.'}, {'value': '___', 'valuenum': 169.0, 'valueuom': 'mg/dL', 'ref_range_lower': 68.0, 'ref_range_upper': 126.0, 'flag': 'abnormal', 'priority': 'ROUTINE', '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '97', 'valuenum': 97.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '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': 192.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'STAT', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '1', 'valuenum': 1.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '5.1', 'valuenum': 5.1, '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': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11', 'valuenum': 11.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '38.7', 'valuenum': 38.7, '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': '29.0', 'valuenum': 29.0, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '33.9', 'valuenum': 33.9, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '310', 'valuenum': 310.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.9', 'valuenum': 13.9, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.52', 'valuenum': 4.52, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.6', 'valuenum': 11.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', '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': '34.5', 'valuenum': 34.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '11.5', 'valuenum': 11.5, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '255', 'valuenum': 255.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '13.8', 'valuenum': 13.8, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '4.03', 'valuenum': 4.03, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'STAT', 'comments': None}, {'value': '9.6', 'valuenum': 9.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, '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': '15', 'valuenum': 15.0, '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': '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': 7.6, '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': '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': 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': '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': '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': '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': '139', 'valuenum': 139.0, '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': '36.8', 'valuenum': 36.8, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.0', 'valuenum': 12.0, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.2', 'valuenum': 28.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '32.6', 'valuenum': 32.6, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '87', 'valuenum': 87.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '276', 'valuenum': 276.0, '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': '4.25', 'valuenum': 4.25, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.6', 'valuenum': 10.6, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.7', 'valuenum': 42.7, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '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': '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': 139.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.0', 'valuenum': 2.0, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.4', 'valuenum': 3.4, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, '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': '5', 'valuenum': 5.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, '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': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '___', 'valuenum': 13.2, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Normal diurnal pattern: 7-10am 6.2-19.4 / 4-8pm 2.3-11.9.'}, {'value': '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 = 73 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': 93.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '4', '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': '1.8', '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': '3.5', 'valuenum': 3.5, 'valueuom': 'mEq/L', 'ref_range_lower': 3.3, 'ref_range_upper': 5.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '141', 'valuenum': 141.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9', 'valuenum': 9.0, '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.'}, {'value': '37.5', 'valuenum': 37.5, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.7', 'valuenum': 12.7, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, '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': '33.9', 'valuenum': 33.9, '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': '304', 'valuenum': 304.0, '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': '4.32', 'valuenum': 4.32, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.3', 'valuenum': 11.3, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '42.8', 'valuenum': 42.8, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '17', 'valuenum': 17.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.0', 'valuenum': 9.0, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '100', 'valuenum': 100.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '0.8', '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 = 73 if non African-American (mL/min/1.73 m2) . Estimated GFR = >75 if African-American (mL/min/1.73 m2) . For comparison, mean GFR for age group 70+ is 75 (mL/min/1.73 m2) . GFR<60 = Chronic Kidney Disease, GFR<15 = Kidney Failure."}, {'value': '___', 'valuenum': 119.0, 'valueuom': 'mg/dL', 'ref_range_lower': 70.0, 'ref_range_upper': 100.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': 'If fasting, 70-100 normal, >125 provisional diabetes.'}, {'value': '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': '2.2', 'valuenum': 2.2, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '3.9', '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': '139', 'valuenum': 139.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '21', 'valuenum': 21.0, 'valueuom': 'mg/dL', 'ref_range_lower': 6.0, 'ref_range_upper': 20.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '8', 'valuenum': 8.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '36.3', 'valuenum': 36.3, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '12.1', 'valuenum': 12.1, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '29.2', 'valuenum': 29.2, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, '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': '292', 'valuenum': 292.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '14.1', 'valuenum': 14.1, 'valueuom': '%', 'ref_range_lower': 10.5, 'ref_range_upper': 15.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '10.0', 'valuenum': 10.0, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '44.1', 'valuenum': 44.1, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 11.6, 'valueuom': 'ug/dL', 'ref_range_lower': 2.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': 'Normal diurnal pattern: 7-10am 6.2-19.4 / 4-8pm 2.3-11.9.'}, {'value': '15', 'valuenum': 15.0, 'valueuom': 'mEq/L', 'ref_range_lower': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '27', 'valuenum': 27.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.1', 'valuenum': 9.1, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, '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': '___', 'valuenum': 21.4, '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': 0.4, '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': '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': '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': '132', 'valuenum': 132.0, 'valueuom': 'mEq/L', 'ref_range_lower': 133.0, 'ref_range_upper': 145.0, 'flag': 'abnormal', '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': '10', 'valuenum': 10.0, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '37.5', 'valuenum': 37.5, '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': '28.8', 'valuenum': 28.8, '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': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '292', 'valuenum': 292.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 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': '4.38', 'valuenum': 4.38, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.7', 'valuenum': 8.7, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '42.3', 'valuenum': 42.3, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': None, 'valuenum': None, 'valueuom': None, 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': 'RANDOM.'}, {'value': '683', 'valuenum': 683.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': None, 'ref_range_upper': None, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '157', 'valuenum': 157.0, 'valueuom': 'mEq/L', 'ref_range_lower': None, 'ref_range_upper': None, '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': '26', 'valuenum': 26.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.3', 'valuenum': 9.3, 'valueuom': 'mg/dL', 'ref_range_lower': 8.4, 'ref_range_upper': 10.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '95', 'valuenum': 95.0, 'valueuom': 'mEq/L', 'ref_range_lower': 96.0, 'ref_range_upper': 108.0, 'flag': 'abnormal', 'priority': 'ROUTINE', 'comments': None}, {'value': '0.7', 'valuenum': 0.7, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 211.0, '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': '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': '277', 'valuenum': 277.0, 'valueuom': 'mOsm/kg', 'ref_range_lower': 275.0, 'ref_range_upper': 310.0, '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': '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': '30', 'valuenum': 30.0, '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': 8.0, 'ref_range_upper': 20.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '30', 'valuenum': 30.0, 'valueuom': 'mEq/L', 'ref_range_lower': 22.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '9.2', 'valuenum': 9.2, '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': '0.8', 'valuenum': 0.8, 'valueuom': 'mg/dL', 'ref_range_lower': 0.4, 'ref_range_upper': 1.1, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '___', 'valuenum': 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': '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': '1.8', 'valuenum': 1.8, 'valueuom': 'mg/dL', 'ref_range_lower': 1.6, 'ref_range_upper': 2.6, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.0', 'valuenum': 4.0, 'valueuom': 'mg/dL', 'ref_range_lower': 2.7, 'ref_range_upper': 4.5, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '4.1', 'valuenum': 4.1, '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': '12', 'valuenum': 12.0, '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': '35.4', 'valuenum': 35.4, 'valueuom': '%', 'ref_range_lower': 34.0, 'ref_range_upper': 45.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '11.8', 'valuenum': 11.8, 'valueuom': 'g/dL', 'ref_range_lower': 11.2, 'ref_range_upper': 15.7, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '28.5', 'valuenum': 28.5, 'valueuom': 'pg', 'ref_range_lower': 26.0, 'ref_range_upper': 32.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '33.3', 'valuenum': 33.3, 'valueuom': 'g/dL', 'ref_range_lower': 32.0, 'ref_range_upper': 37.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '86', 'valuenum': 86.0, 'valueuom': 'fL', 'ref_range_lower': 82.0, 'ref_range_upper': 98.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '279', 'valuenum': 279.0, 'valueuom': 'K/uL', 'ref_range_lower': 150.0, 'ref_range_upper': 400.0, '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': '4.14', 'valuenum': 4.14, 'valueuom': 'm/uL', 'ref_range_lower': 3.9, 'ref_range_upper': 5.2, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '8.4', 'valuenum': 8.4, 'valueuom': 'K/uL', 'ref_range_lower': 4.0, 'ref_range_upper': 10.0, 'flag': None, 'priority': 'ROUTINE', 'comments': None}, {'value': '41.6', 'valuenum': 41.6, 'valueuom': 'fL', 'ref_range_lower': 35.1, 'ref_range_upper': 46.3, 'flag': None, 'priority': 'ROUTINE', 'comments': None}], 'exams': 'PHYSICAL EXAMINATION ___ upon admission:\n\nConstitutional: Intubated, paralyzed.\nHEENT: Pupils equal, round and reactive to light. No\nproptosis or chemosis. Wound to left nasal bridge.\nETT and OGT in place, dried blood in oropharynx. C-spine\nimmobilized in collar. With removal of collar, no visible\nwounds; prominent R neck and submandibular swelling.\nChest: Clear to auscultation\nCardiovascular: Regular Rate and Rhythm, Normal first and\nsecond heart sounds\nAbdominal: Soft, Nondistended. No visible wounds.\nPelvic: Pelvis stable.\nExtr/Back: No visible deformities or open extremity injury.\nNo injuries to back or axillae. ___ pulses equal, intact\nbilaterally.\nSkin: No rash\nNeuro: Intubated, paralyzed. GCS = 3T.\n\nPhysical Examination ___ on discharge:\n\nVS: 98.7 HR 81 BP 123/69 RR 18 O2 Sat 100% on trach mask\nNAD, AAOx3, answers questions appropriately\nPERRL, No lymphadenopathy, head atraumatic, obvious right sided \nmandibular edema, +TTP. Well healing wound to nasal bridge. \nAll packing removed from nares and oropharynx, dental braces \nintact over remaining teeth. 2 drains to bulb suction in place \nwith serosanguineous drainage. Incision clean, dry, and intact \nwith staples. #7 tracheostomy tube in place. \nLungs clear to auscultation bilaterally. Cor RRR, No M/R/G \n+S1/S2\nAbdomen soft, non-tender, non-distended. PEG in place, site \nclean.\nNo lower extremity edema', 'diagnoses': [{'icd_code': 'D352', 'desc': 'Benign neoplasm of pituitary gland'}, {'icd_code': 'I214', 'desc': 'Non-ST elevation (NSTEMI) myocardial infarction'}, {'icd_code': 'E232', 'desc': 'Diabetes insipidus'}, {'icd_code': 'I110', 'desc': 'Hypertensive heart disease with heart failure'}, {'icd_code': 'I5032', 'desc': 'Chronic diastolic (congestive) heart failure'}, {'icd_code': 'E222', 'desc': 'Syndrome of inappropriate secretion of antidiuretic hormone'}, {'icd_code': 'Q245', 'desc': 'Malformation of coronary vessels'}, {'icd_code': 'J342', 'desc': 'Deviated nasal septum'}, {'icd_code': 'K219', 'desc': 'Gastro-esophageal reflux disease without esophagitis'}, {'icd_code': 'F329', 'desc': 'Major depressive disorder, single episode, unspecified'}, {'icd_code': 'Z87891', 'desc': 'Personal history of nicotine dependence'}, {'icd_code': 'I25119', 'desc': 'Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris'}, {'icd_code': 'K5900', 'desc': 'Constipation, unspecified'}, {'icd_code': 'I255', 'desc': 'Ischemic cardiomyopathy'}, {'icd_code': 'E1165', 'desc': 'Type 2 diabetes mellitus with hyperglycemia'}], 'summary': "___ 05:14AM BLOOD WBC-12.4* RBC-2.46* Hgb-7.2* Hct-23.2* \nMCV-94 MCH-29.3 MCHC-31.0* RDW-13.5 RDWSD-46.1 Plt ___\n___ 04:08AM BLOOD WBC-12.4* RBC-2.54* Hgb-7.5* Hct-23.7* \nMCV-93 MCH-29.5 MCHC-31.6* RDW-13.5 RDWSD-45.8 Plt ___\n___ 10:58AM BLOOD WBC-10.8* RBC-2.49* Hgb-7.3* Hct-23.1* \nMCV-93 MCH-29.3 MCHC-31.6* RDW-13.2 RDWSD-43.3 Plt ___\n___ 02:28AM BLOOD WBC-23.6* RBC-3.81* Hgb-11.8 Hct-34.9 \nMCV-92 MCH-31.0 MCHC-33.8 RDW-13.4 RDWSD-45.5 Plt ___\n___ 06:14AM BLOOD ___ PTT-27.6 ___\n___ 01:00AM BLOOD ___ PTT-31.4 ___\n___ 04:08AM BLOOD Glucose-121* UreaN-7 Creat-0.5 Na-136 \nK-3.8 Cl-100 HCO3-25 AnGap-15\n___ 10:58AM BLOOD Glucose-132* UreaN-5* Creat-0.6 Na-136 \nK-3.7 Cl-100 HCO3-26 AnGap-14\n___ 04:08AM BLOOD Calcium-9.4 Phos-3.0 Mg-2.1\n___ 11:42PM BLOOD freeCa-1.08*\n___ 07:04AM BLOOD freeCa-1.10*\n\nCT NECK W/O CONTRAST ___\nIMPRESSION: \n \n \n1. Multiple deep soft tissue metallic fragments scattered \nthroughout the \nneck,, with the largest fragment seen at the level of the \nthoracic inlet just \nto the left post lower outer aspect of the trachea and \nesophagus, unchanged in \nlocation. Although process visualization of the esophagus is \ndifficult at \nthis level due to hardware artifact and edema, there are no \nsecondary signs of \nesophageal perforation such as mediastinal or deep soft tissue \nneck emphysema. \n2. Sequelae of gunshot wound to the face and bullet fragments \ntraversing \nthrough the neck including right greater than left subcutaneous \nfat stranding \nedema and prevertebral fluid, similar to prior exam. Interval \nresolution of \nprior neck subcutaneous and deep soft tissue emphysema. \n3. Patient is status post interval tracheostomy tube insertion, \nwith distal \ntip seen in the distal thoracic trachea 1.4 cm above the carina. \n\n4. Re- demonstration of known comminuted right maxillary \nfracture. \n\nCXR ___\nIMPRESSION: \n \nTracheostomy tube is in standard position. Cardiomediastinal \ncontours are \nunchanged. Ill-defined opacities in the left infrahilar region \nbe \natelectasis, aspiration cannot be excluded. There is no \npneumothorax or \npleural effusion. Left PICC tip is in the lower SVC. No other \ninterval \nchange \n\nPICC PLACEMENT ___\nIMPRESSION: \n \nCompared to chest radiographs ___ through ___ at \n05:47. \n \nNew left PIC line ends in the low SVC. ET tube and nasogastric \ndrainage tube \nin standard placements. Bullet fragments and surgical material \nunchanged in \nposition in the lower neck and cervicothoracic junction. \n \nRight lung clear. Heterogeneous opacification at the left lung \nbase mild \ncould be aspiration or atelectasis. No pneumothorax or pleural \neffusion. \nNormal cardiomediastinal and hilar silhouettes. \n\nEKG ___\nSinus rhythm. Within normal limits. No previous tracing \navailable for \ncomparison. \n\n___: CT of the neck:\n. Multiple deep soft tissue metallic fragments scattered \nthroughout the \nneck,, with the largest fragment seen at the level of the \nthoracic inlet just to the left post lower outer aspect of the \ntrachea and esophagus, unchanged in location. Although process \nvisualization of the esophagus is difficult at this level due to \nhardware artifact and edema, there are no secondary signs of \nesophageal perforation such as mediastinal or deep soft tissue \nneck emphysema. \n2. Sequelae of gunshot wound to the face and bullet fragments \ntraversing \nthrough the neck including right greater than left subcutaneous \nfat stranding edema and pre-vertebral fluid, similar to prior \nexam. Interval resolution of prior neck subcutaneous and deep \nsoft tissue emphysema. \n3. Patient is status post interval tracheostomy tube insertion, \nwith distal tip seen in the distal thoracic trachea 1.4 cm above \nthe carina. \n4. Re- demonstration of known comminuted right maxillary \nfracture.\n___ year old female with no known ___ transferred from an OSH for \nGSW to the face. Per EMS report, was at home with her boyfriend \nwhen the two engaged in an argument andhe shot a gun at the \npatient from above her head. On arrival to OSH, patient was \nawake and able to verbalize history. She was noted to have \nwounds at the left nasal bridge and swelling to the right \nmandibular fossa. Underwent CT imaging which\ndemonstrated a bullet in the thoracic inlet, marked neck \nswelling. She was intubated prior to transfer with etomidate \nand succinylcholine, first attempt, no complications. No lab \nresults at this time. The patient was paralyzed with\nvecuronium for transfer but noted to be moving all extremities \nspontaneously prior to intubation. She received Ancef and TDap.\n\nOn ___, the patient was taken to the OR for neck exploration. \nCT of the trachea showed no defects in esophagus/trachea. \nBecause of the facial injuries, the ___ service was consulted. \nThe patient was taken to the operating room on ___ for a trach \nand Peg, the ___ team was involved in the surgery and underwent \na stage 1 repair. ___ findings in OR: 2 teeth in vocal cords, 3 \nteeth removed, right maxilla I+D'd, palate closed w/ flaps, jaw \nwas wired with screws which was later removed. The right tongue \nlaceration was cauterized and a ___ drain was placed in the \nneck. The patient returned to the operating room with ___ \nservice on ___ where she underwent mandible fixation, \ndebridement maxilla (stage II OMFS) Oral packing was removed \non ___. The patient developed epistaxis right nostril and it \nwas packed. A nasal trumpet was inserted to avoid fibrosing. \nThere was no further evidence of nasal bleeding. The patient \nwas transferred to the surgical floor on ___ \n \n ==========================================================\nHospital Floor Course:\nOn HD6 the patient was hemodynamically stable, maintaining \noxygen saturation on trach mask. Repeat CT scan of neck to \nassess for esophageal injury showed no changes. Neck JP drain \nfluid sent for amylase which was 182 down from previous 5698. On \nHD8 she was taken back to the operating room with Oral and \nmaxillofacial surgery for open reduction, internal fixation of \nright comminuted mandible fracture, removal of multiple foreign \nbodies from the right neck/mandible, right sinus surgery with \nexploration and debridement of nasopharynx, and exploration and \ndebridement of the right maxillary sinus. A second JP drain was \nplaced at the neck. She tolerated the procedure well. After \nrecovering in the post anesthesia care unit she was taken to the \nsurgical floor in stable condition. On POD9 the oral packing was \nremoved with no further bleeding. Panorex xrays were recommended \nby OMFS and will be obtained as an outpatient.\n\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating tube feed \nvia peg tube at goal rate, ambulating, voiding without \nassistance, and pain was being managed with oral medications. \nThe patient received discharge teaching and follow-up \ninstructions with understanding verbalized and agreement with \nthe discharge plan. Plastic surgery team will plan to surgically \nrepair right ear after patient is home and stable."}}
|
{'final_diagnoses': ['Penetrating gunshot wound to face and right and left neck:', 'C6 Transverse Process Fracture', 'Right neck hematoma', 'Extensive comminuted and displaced right maxillary and \nmandibular fractures', 'Esophageal Muscularis Injury', 'Mildly comminuted fracture of the left nasal bone\nand nasal septum', 'Multiple fractured teeth', 'Tongue laceration', 'Acute respiratory failure', 'Dysphagia'], 'procedures': ['Exploration of zone II of the right neck.', 'Esophagogastroduodenoscopy.', 'Suture repair of esophageal muscularis.', 'Direct laryngoscopy', 'irrigation and debridement of right maxillary defect', 'Extraction of teeth #4, 5, 6', 'Primary closure of palatal defect', 'Cauterization of right tongue laceration', 'Closed reduction internal fixation of comminuted right\nmandible fracture', 'Control of nasal bleeding', 'Insertion of ___ drain into right neck', 'Percutaneous tracheostomy.', 'Percutaneous endoscopic gastrostomy.', 'Open reduction, internal fixation of right comminuted\n mandible fracture via transcervical approach.', 'Removal of multiple foreign body from the right neck and\n right mandible.', 'Right functional endoscopic sinus surgery with\n exploration and debridement of the nasopharynx.', 'Right ___.', 'Exploration and debridement of the right maxillary\n sinus.'], 'visit_summary': "___ year old female with no known ___ transferred from an OSH for \nGSW to the face. Per EMS report, was at home with her boyfriend \nwhen the two engaged in an argument andhe shot a gun at the \npatient from above her head. On arrival to OSH, patient was \nawake and able to verbalize history. She was noted to have \nwounds at the left nasal bridge and swelling to the right \nmandibular fossa. Underwent CT imaging which\ndemonstrated a bullet in the thoracic inlet, marked neck \nswelling. She was intubated prior to transfer with etomidate \nand succinylcholine, first attempt, no complications. No lab \nresults at this time. The patient was paralyzed with\nvecuronium for transfer but noted to be moving all extremities \nspontaneously prior to intubation. She received Ancef and TDap.\n\nOn ___, the patient was taken to the OR for neck exploration. \nCT of the trachea showed no defects in esophagus/trachea. \nBecause of the facial injuries, the ___ service was consulted. \nThe patient was taken to the operating room on ___ for a trach \nand Peg, the ___ team was involved in the surgery and underwent \na stage 1 repair. ___ findings in OR: 2 teeth in vocal cords, 3 \nteeth removed, right maxilla I+D'd, palate closed w/ flaps, jaw \nwas wired with screws which was later removed. The right tongue \nlaceration was cauterized and a ___ drain was placed in the \nneck. The patient returned to the operating room with ___ \nservice on ___ where she underwent mandible fixation, \ndebridement maxilla (stage II OMFS) Oral packing was removed \non ___. The patient developed epistaxis right nostril and it \nwas packed. A nasal trumpet was inserted to avoid fibrosing. \nThere was no further evidence of nasal bleeding. The patient \nwas transferred to the surgical floor on ___ \n \n ==========================================================\nHospital Floor Course:\nOn HD6 the patient was hemodynamically stable, maintaining \noxygen saturation on trach mask. Repeat CT scan of neck to \nassess for esophageal injury showed no changes. Neck JP drain \nfluid sent for amylase which was 182 down from previous 5698. On \nHD8 she was taken back to the operating room with Oral and \nmaxillofacial surgery for open reduction, internal fixation of \nright comminuted mandible fracture, removal of multiple foreign \nbodies from the right neck/mandible, right sinus surgery with \nexploration and debridement of nasopharynx, and exploration and \ndebridement of the right maxillary sinus. A second JP drain was \nplaced at the neck. She tolerated the procedure well. After \nrecovering in the post anesthesia care unit she was taken to the \nsurgical floor in stable condition. On POD9 the oral packing was \nremoved with no further bleeding. Panorex xrays were recommended \nby OMFS and will be obtained as an outpatient.\n\nAt the time of discharge, the patient was doing well, afebrile \nand hemodynamically stable. The patient was tolerating tube feed \nvia peg tube at goal rate, ambulating, voiding without \nassistance, and pain was being managed with oral medications. \nThe patient received discharge teaching and follow-up \ninstructions with understanding verbalized and agreement with \nthe discharge plan. Plastic surgery team will plan to surgically \nrepair right ear after patient is home and stable.", 'medications_prescribed': ['Acetaminophen (Liquid) 1000 mg PO Q8H', 'Albuterol 0.083% Neb Soln 1 NEB IH Q6H:PRN chest congestion', 'Bisacodyl 10 mg PR QHS:PRN constipation', 'Chlorhexidine Gluconate 0.12% Oral Rinse 15 mL ORAL BID:PRN \noral hygiene', 'Docusate Sodium 100 mg PO BID', 'Heparin 5000 UNIT SC BID', 'Insulin SC \nSliding Scale\n\nFingerstick q6h\nInsulin SC Sliding Scale using REG Insulin', 'LORazepam 0.5-1 mg NG Q4H:PRN anxiety \nRX *lorazepam 2 mg/mL 0.25 - 0.5 mL by PEG every four (4) hours \nRefills:*0', 'Ondansetron 4 mg IV Q8H:PRN nasuea', 'OxycoDONE Liquid ___ mg PO Q3H:PRN Pain - Moderate \nhold for increased sedation, resp. rate <8 \nRX *oxycodone 5 mg/5 mL 5 mL by PEG every four (4) hours Disp \n#*420 Milliliter Refills:*0', 'Polyethylene Glycol 17 g PO DAILY:PRN conbstipation', 'Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line \nflush', 'Sodium Chloride 0.9% Flush ___ mL IV DAILY and PRN, line \nflush']}
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